Presence Of Clostridium Difficile Research Articles

Positive pathogens in stool could predict the clinical outcomes of sepsis-associated acute kidney injury in critical ill patient

In this study, we sought to evaluate the influence of positive pathogens in stool (PPS) on clinical outcomes in critical ill patients with Sepsis-associated acute kidney injury (S-AKI) from intensive care unit. Our sample consisted of 7338 patients, of whom 752 (10.25%) had PPS. We found that the presence of Clostridium difficile (C. difficile) and protists in stool samples was correlated with survival during hospitalization, as well as 30-day and 90-day survival. Interestingly, there was no significant difference in overall survival and 30-day in-hospital survival between the PPS group and the negative pathogens in stool (NPS) control group. However, the cumulative incidence of 90-day infection-related mortality was significantly higher in the PPS group (53 vs. 48%, P = 0.022), particularly in patients with C. difficile in their stool specimens. After adjusting for propensity scores, the results also have statistical significance. These findings suggest that PPS may affect the 90-days survival outcomes of S-AKI, particularly in patients with C. difficile and protists in their stool samples. Further research is warranted to further explore these associations.

Molecular detection of pathogenic bacteria in the colonic biopsies from patients with Ulcerative Colitis.

Ulcerative Colitis (UC) is an inflammatory bowel disease which is common in many areas of the world including Egypt. A lot of controversy regarding the pathogenesis of UC exist. The current study is an attempt to detect some pathogenic bacteria in UC patients. Endoscopic colonic biopsies obtained from 40 patients with ulcerative colitis and 20 controls were analyzed by means of real-time PCR technique for the presence of Clostridium difficile, Helicobacter Pylori (H. pylori) and pathogenic Escherichia Coli (E. coli) which are positive for KPC and/or OXA-48. All patients and control samples were negative for Clostridium difficile. Three of the 40 patient samples (7.5%) and none of the 20 controls were positive for H. pylori with no significant difference between the two groups. KPC-positive E. coli were detected in 11 of the 40 patients (27.5%) and in none of the controls with a significant difference between the two groups (P=0.01). All patients and control samples were negative for OXA-48 positive E. coli. Although this study does not support the claim that Clostridium difficile and/or H. pylori have a role in UC, it greatly suggests that pathogenic E. coli may be involved in one way or another in the course of UC.

Antibiotic-associated diarrhea in hospital: frequency and prophylaxis

The aim. To analyze the prevalence of antibiotic-associated diarrhea (AAD) caused by Clostridium difficile in a hospital setting.Materials and methods. 93 patients with 3 or more episodes of unformed stool (diarrhea) for two consecutive days or more, developed after the use of antibiotics, were monitored. All patients underwent rapid stool analysis for the presence of Clostridium difficile A and B toxins using the X/pert C. diff toxin A/B test.Results. Toxins A and/or B of Clostridium difficile were detected in 32 patients (34.4 %). The remaining patients (n = 61; 65.6 %) had idiopathic AAD. The most of the patients who were found to have Clostridium difficile toxins in the feces were in the infarction department, cardiology intensive care and trauma departments, i. e. they had severe diseases associated with reduced immunity and inactivity.Conclusions. The prevalence of AAD caused by Clostridium difficile in hospital settings is high. It is recommended to prescribe drugs for the correction of disorders of the gastrointestinal microflora from the first day of antibiotic therapy, since this will significantly reduce the prevalence of clinical manifestation of diarrhea associated with Clostridium difficile.

Clostridium difficile in bee products: assessing the spread of the bacterium

The vicinity of small apiaries to the farms makes honey and bee pollen prone to the contamination with clostridial spores. The possible presence of Clostridium difficile (C. difficile) spores in bee products may pose a risk especially to elderly who perceive them as natural remedies in health problems including functional bowel abnormalities. The aim of the study was to evaluate the prevalence of C. difficile spores in 120 samples of honey and 44 samples of bee pollen harvested in Northeastern Europe. All incubation procedures were performed in anaerobic conditions. The 10 g samples were subsequently pre-enriched in Cooked Meat Medium (CMM) and Brain Heart Infusion-supplement (BHIS) broths. Sporulated forms were seeded on supplemented C. difficile blood agar. Rapid immunoenzymatic tests targeted at glutamate dehydrogenase (GDH) detection and polymerase chain reaction (PCR) targeted at tpi gene detection were also performed. Based on microbiological culture 32 (20%) out of 164 samples were selected for culture on blood agar. The growth of ground-glass colonies was noted towards 13 (8%) samples. The presence of C. difficile was not confirmed by immunoenzymatic rapid tests towards any sample selected. Neither PCR assay targeted to tpi gene showed positive samples. This is the first report reviewing the possibility of native to Europe Apis mellifera (A. mellifera) bee products contamination with C. difficile. The samples of A. mellifera bee products produced in small apiaries in Northeastern Europe did not show the presence of C. difficile spores.

The role of a sequencing-based clinical intestinal screening test in patients at high-risk for Clostridium difficile and other pathogens: a case report

BackgroundHospitalization and antibiotic treatment can put patients at high risk for Clostridium difficile infection, where a disturbance of the gut microbiome allows for Clostridium difficile proliferation and associated symptoms, including mild, moderate, or severe diarrhea. Clostridium difficile infection is challenging to treat, often recurrent, and leads to almost 30,000 annual deaths in the USA alone. Here we present a case where SmartGut™, an at-home, self-administered sequencing-based clinical intestinal screening test, was used to identify the presence of Clostridium difficile in a patient with worsening diarrhea. Identification of this pathogen and subsequent treatment led to a significant improvement in symptoms.Case presentationThe patient is a 29-year-old white woman with a history of severe irritable bowel syndrome with diarrhea, hemorrhoidectomy, and anal sphincterotomy complicated by a perianal fistula and perirectal abscesses that required extended courses of broad-spectrum antibiotics. In June 2016, she developed intermittent Clostridium difficile infections, which required continued antibiotic use. Months later she used an at-home, self-administered, intestinal microbial test, the first of which was negative for the presence of Clostridium difficile, but it detected the relative abundance of microbes associated with irritable bowel syndrome outside the healthy reference ranges. In the subsequent 2 months after the negative Clostridium difficile result, her gastrointestinal symptoms worsened dramatically. A second microbiome test resulted in a positive Clostridium difficile finding and continued abnormal microbial parameters, which led the treating physician to refer her to a gastroenterologist. Additional testing confirmed the presence of Clostridium difficile with a toxin-positive strain. She received treatment immediately and her gastrointestinal symptoms improved significantly over the next week.ConclusionsThis case report suggests that more frequent DNA testing for Clostridium difficile infections may be indicated in patients that are at high-risk for Clostridium difficile infection, especially for patients with irritable bowel syndrome, and those who undergo gastrointestinal surgery and/or an extended antibiotic treatment. This report also shows that such testing could be effectively performed using at-home, self-administered sequencing-based clinical intestinal microbial screening tests. Further research is needed to investigate whether the observations reported here extrapolate to a larger cohort of patients.

Presence of Clostridium difficile in poultry and poultry meat in Egypt

C. difficile has been recognized as a potential zoonotic agent encouraging investigations of C. difficile prevalence and ribotypes in animals. Here we report the prevalence and diversity of Egyptian C. difficile in I) samples from healthy poultry (n = 50), II) samples from diseased poultry (n = 54), and III) poultry meat (n = 150). Thirteen isolates were obtained from seven healthy and five diseased animals, but no C. difficile was cultured from poultry meat. The isolated C. difficile strains belonged to 3 different PCR-ribotypes (039/2, 205 and 001/FLI01). The detection of strains related to RT 001 known for its ability to cause disease in humans makes poultry a potential reservoir for pathogenic C. difficile.

Clostridium difficile in beef cattle farms, farmers and their environment: Assessing the spread of the bacterium

In recent years, several studies have described the presence of Clostridium difficile in healthy and diarrhoeic farm and domestic animals. In pigs and cattle, the isolation of some PCR-ribotypes associated with human infection, especially PCR-ribotypes 014 and 078, has led us to hypothesize about the zoonotic transmission of C. difficile infections. If these animals are reservoirs of C. difficile, farmers in close contact with their animals are particularly at risk of acquiring and spreading the bacterium. This study investigates the presence of C. difficile in closely associated populations, beef cattle and farmers, as well as in the animal feed, manure and dust in five different farms in Belgium. C. difficile was isolated from calves and cattle with a prevalence varying between 5.5% and 11.3%. Furthermore, all of the isolates were toxigenic. An important age and breed effect was observed in the colonization of C. difficile. For age, there was a higher probability of colonization in calves of less than 6 months in age than in cattle over 11 months of age. For the type of breed a higher prevalence of the bacterium was detected in the Limousin breed than in the Belgian Bleu breed.By contrast, none of the human and animal feed samples tested positive for C. difficile. The results obtained indicate a persistent animal reservoir of C. difficile, but an indirect dissemination to humans, probably via the environment.

Automatic environmental disinfection with hydrogen peroxide and silver ions versus manual environmental disinfection with sodium hypochlorite: a multicentre randomized before-and-after trial

New technologies for automated disinfection have been developed, including the use of hydrogen peroxide atomized by specific equipment, with associated silver compounds. To compare the effectiveness of an automated disinfection system with hydrogen peroxide <8% and silver ion versus a manual method with 0.5% sodium hypochlorite solution when evaluating the reduction of microbial mesophilic contamination and Clostridium difficile presence; and to evaluate the time required for both of these processes. This was a randomized multicentre trial performed in different hospital wards that had been occupied previously by patients with Clostridium difficile infection. When patients were discharged their rooms were randomized to one of two decontamination arms. The surfaces where sampled using swabs, before and after disinfection. Swab samples were cultured for quantitative detection of microbial mesophilic contamination and qualitative detection of C.difficile. Before disinfection, 13% of surfaces decontaminated with hydrogen peroxide and silver ions and 20% of surfaces decontaminated with sodium hypochlorite showed presence of C.difficile spores. After disinfection, the samples containing C.difficile were 0% (P<0.001) in the group decontaminated with hydrogen peroxide and silver ions, and were 3% (P<0.001) in the group decontaminated with sodium hypochlorite. This difference was not statistically significant; nor was the difference in the reduction of the microbial mesophilic contamination. The differences between the groups were not statistically significant; however, the disinfection with hydrogen peroxide and silver ions is preferable due to less dependence on operators.

Antibiotic-associated diarrhea: Clinical characteristics and the presence of Clostridium difficile

Introduction and aimsEvidence in Colombia and Latin America has been insufficient for establishing the clinical characteristics of patients with antibiotic-associated diarrhea (AAD). The present study attempts to describe the clinical characteristics of patients with AAD and to determine the presence of Clostridium difficile, utilizing the polymerase chain reaction (PCR) technique. Materials and methodsForty-three patients with AAD, managed at the Hospital Universitario San Ignacio in Bogotá, Colombia, were evaluated. Prospective patient information was collected, with respect to demographic characteristics, profile of the antibiotic management received, clinical manifestations, risk factors, and paraclinical reports. In addition, the real-time PCR test for Clostridium difficile (Cepheid Xpert®) was performed. ResultsPatient mean age was 58 years (19.31 SD). The majority of the patients received 2 or more antibiotics (62.9%) and the beta-lactams were the most frequently used. Hospital stay ranged from 2 to 104 days with a median of 10 days. The most frequent clinical manifestations were abdominal pain and bloating, followed by fever and tachycardia. At the time of diagnosis, 23 patients had noninflammatory results in the stool sample analyses and 18 had kidney failure. The mean level of albumin was 2.4mg/dl (0.7 SD). The presence of Clostridium difficile was documented through PCR in 6 patients (13.95% of the cases). ConclusionsAAD patients were characterized by a high frequency of severe comorbidities and prolonged hospital stay. The presence of Clostridium difficile in only 13.9% of the cases suggests that other causes of diarrhea in the hospitalized patient should be considered.

Antibiotic-associated diarrhea: Clinical characteristics and the presence of Clostridium difficile.

Evidence in Colombia and Latin America has been insufficient for establishing the clinical characteristics of patients with antibiotic-associated diarrhea (AAD). The present study attempts to describe the clinical characteristics of patients with AAD and to determine the presence of Clostridium difficile, utilizing the polymerase chain reaction (PCR) technique. Forty-three patients with AAD, managed at the Hospital Universitario San Ignacio in Bogotá, Colombia, were evaluated. Prospective patient information was collected, with respect to demographic characteristics, profile of the antibiotic management received, clinical manifestations, risk factors, and paraclinical reports. In addition, the real time PCR test for Clostridium difficile (Cepheid Xpert®, Sunnyvale, CA, United States) was performed. Patient mean age was 58 years (19.31 SD). The majority of the patients received 2 or more antibiotics (62.9%) and the beta-lactams were the most frequently used. Hospital stay ranged from 2 to 104 days with a median of 10 days. The most frequent clinical manifestations were abdominal pain and bloating, followed by fever and tachycardia. At the time of diagnosis, 23 patients had noninflammatory results in the stool sample analyses and 18 had kidney failure. The mean level of albumin was 2.4mg/dl (0.7 SD). The presence of Clostridium difficile was documented through PCR in 6 patients (13.95% of the cases). AAD patients were characterized by a high frequency of severe comorbidities and prolonged hospital stay. The presence of Clostridium difficile in only 13.9% of the cases suggests that other causes of diarrhea in the hospitalized patient should be considered.

PP019 Clostridium Difficile Infection Diagnosis: Hospital-based Health Technology Assessment

INTRODUCTION:Clostridium difficile infection is the leading cause of nosocomial diarrhea in developed countries and may progress to pseudomembranous colitis, sepsis and death. The risk factors are antibiotics use, advanced age and prolonged hospitalization. The diagnosis of Clostridium difficile infection is based on clinical history in combination with laboratory tests, which detect the Clostridium difficile presence or toxins. Clostridium difficile remains in spore form contaminating the environment and requiring measures to prevent hospital transmission. Tests with more accurate results to identify true carriers of Clostridium difficile allow the clinician to determine a safer treatment. This study evaluated accuracy and cost-effectiveness of the real-time polymerase chain reaction compared with the enzyme-linked immunosorbent assay from the perspective of a Brazilian public cardiology hospital.METHODS:A study diagram was constructed by type of test, linking the data of prevalence in hospital, accuracy and direct costs of tests. The costs were based on a hypothetical population comparing two strategies to identify the incremental expenditure between technologies. The analysis included comparisons for each test versus no test, and with each other. The prices were converted to the American currency taking into account the date of purchase of each product and respective price.RESULTS:For real-time polymerase chain reaction test versus no test, 214 patients would have tested to justify one empirical treatment suspension, at a cost of USD90,926.46. For enzyme-linked immunosorbent assay test, to prevent one unnecessary treatment, 375 patients would have to be tested at a cost of USD6,603.75. In the comparative analysis, only a single false-positive patient would have the treatment suspended after performing 375 real-time polymerase chain reaction tests at USD424.89 each one (USD159,333.75 in total). An incremental cost of USD152,730.00 may be necessary to benefit a single patient by discontinuing empirical treatment.CONCLUSIONS:The Real-time polymerase chain reaction test has restrictions as a test of choice for the diagnosis of Clostridium difficile infection, in services with low disease prevalence. It undergoes a significant change in its positive predictive value and does not offer a great impact in the clinical diagnosis.

Dysbiosis of fecal microbiota and high frequency of Citrobacter, Klebsiella spp., and Actinomycetes in patients with irritable bowel syndrome and gastroenteritis.

This study was aimed to characterize putative differences of fecal microbiota between irritable bowel syndrome (IBS) and gastroenteritis patients and healthy controls. New evidence proposed that gut microbiota has a deep effect on the balance between health and disease. The presence of Clostridium difficile, Campylobacter spp., Enterobacteriacea and Staphylococci were detected in the samples using selective and specific culture media. Microscopic examination of the samples was done to detect Actinomycetes, yeasts, Bifidobacteria, Fusobacterium spp., as well as white blood cells, red blood cells, mucus and epithelial cells. Results of this study showed relatively higher frequency of Citrobacter spp., Lactobacilli, and Actinomycetes in the IBS patients. Elevated levels of WBC, RBC secretion, and increased amounts of Klebsiella, Escherichia coli and Citrobacter spp. were characterized in the patients with gastroenteritis compared with the control group. Depletion of gram positive cocci and gram negative bacilli also suggested dysbiosis of intestinal microbiota in these patients.

Clostridium difficile presence in Spanish and Belgian hospitals

Clostridium difficile is recognised worldwide as the main cause of infectious bacterial antibiotic-associated diarrhoea in hospitals and other healthcare settings. The aim of this study was to first survey C. difficile prevalence during the summer of 2014 at the Central University Hospital of Asturias (Spain). By typing the isolates obtained, it was then possible to compare the ribotype distribution at the Spanish hospital with results from the St Luc University Hospital in Belgium over the same period. The prevalence of positive cases reported in Spain and Belgium was 12.3% and 9.3% respectively. The main PCR-ribotypes previously described in Europe were found in both hospitals, including 078, 014, 012, 020 and 002. In the Spanish hospital, most of the C. difficile-positive samples were referred from oncology, acute care and general medicine services. In the Belgian hospital the majority of positive samples were referred from the paediatric service. However, a high percentage of isolates from this service were non-toxigenic. This study finds that the presence and detection of C. difficile in paediatric and oncology services requires further investigation.

Old Age and Aerobic Microorganisms of Patients Affected by Clostridium difficile Infection are Associated Primarily with the Intestinal Presence of Clostridium difficile

Clostridium difficile infection in human occurs when the organism is present and germinating in the bowel. Old age of patients’ and particular microorganisms in stools are identified as risk factors for the disease onset. We aimed to investigate if risk factors for C. difficile infections in a large Italian hospital were connected to C. difficile intestinal presence or to germination. Toxin B positivity was linked with age over 65 years (P=0.03), medical hospitalization (P=0.015) and growth of Enterobacteriaceae (P=0.029) and Enterococcus (P=0.05) from the same stools. The presence of tcdB was even more strictly linked with old age (P=0.005), medicine hospitalization (P=0.012) and growth of Enterobacteriaceae (P=0.003) and Enterococcus (P=0.04). Our results indicated that the presence of C. difficile in stools, irrespective of being spore or vegetative form, is reliably associated with old age of subjects and fecal presence of viable Enterobacteriaceae and Enterococcus.

Clostridium difficile in retail chicken meat parts and liver in the Eastern Region of Turkey

In recent studies, the presence of Clostridium difficile has been shown in foods and animals that may be a source of infection in susceptible humans. In the present study, it was aimed to investigate the prevalence of toxigenic Clostridium difficile spores and vegetative cells in chicken meat parts and liver. For this purpose, 310 samples (75 leg quarters, 75 breast, 60 wings, 60 drumsticks and 40 chicken livers) were collected from two cities in eastern region of Turkey for 6 months and analyzed for the presence of C. difficile. C. difficile was isolated from 25 (8.06 %) of 310 samples. The prevalence of C. difficile was 12, 8, 6.6, 5 and 7.5 % for the leg quarter, breast, wing, drumstick and liver, respectively. The results showed that the prevalence of C. difficile in chicken samples was higher in winter months (December, January and February). Multiplex PCR results showed that 5 of 25 C. difficile isolates had toxin B (tcdB) gene, and 8 isolates had toxin A (tcdA) gene. None of the isolates was having binary toxin (cdtA or cdtB) genes. The findings of the present study show that toxigenic C. difficile spores can be found in both chicken meat parts and in livers although their numbers is low.

Epidemiological study of Clostridium difficile infection in critical patients admitted to the Intensive Care Unit

Data on the epidemiology of infections caused by Clostridium difficile (CDI) in critically ill patients are scarce and center on studies with a limited time framework and/or epidemic outbreaks. ObjectiveTo describe the characteristics and risk factors of critically ill patients admitted to the ICU with CDI, as well as the treatments used for the control of such infections. Materials and methodsA retrospective study was made of patients included in the ENVIN-ICU registry with CDI in 2012. Patients were followed up to 72h after discharge from the ICU. A case report form was used to record the following data: demographic variables, risk factors related to CDI, treatment and outcome. Infections were classified as community-acquired, nosocomial out-ICU and nosocomial in-ICU, according to the day on which Clostridium difficile isolates were obtained. Infection rates as episodes per 10,000 days of ICU stay are presented. The global in-ICU and hospital mortality rates were calculated. ResultsSixty-eight episodes of CDI in 33 out of a total of 173 ICUs participating in the registry were recorded (19.1%) (2.1 episodes per 10,000 days of ICU stay). Forty-five patients were men (66.2%), with a mean (SD) age of 63.4 (16.4) years, a mean APACHE II score on ICU admission of 19.9 (7.4), and an underlying medical condition in 44 (64.7%). Sixty-two patients (91.2%) presented more than 3 liquid depositions/day, 40 (58.8%) in association with severe sepsis or septic shock. Community-acquired infection occurred in 13 patients (19.1%), nosocomial out-ICU infection in 13 (19.1%), and in-ICU infection in 42 (61.8%). Risk factors included age>64 years in 39 cases (57.4%), previous hospital admission (3 months) in 32 (45.6%), use of antimicrobials (previous 7 days) in 57 (83.8%), enteral nutrition in 23 (33.8%), and the use of H2 inhibitors in 39 (57.4%). Initial combined treatment was administered to 18 patients (26.5%). Metronidazole was used in 60 (88.2%) and vancomycin in 31 (45.6%). The in-ICU mortality rate was 25.0% (n=17), with a hospital mortality 27.9% (n=19). ConclusionsThe rate of ICD in ICU patients is low, the infection affects severely ill patients, and is associated with high mortality. The presence of CDI is a marker of poor prognosis.

Survival of Clostridium difficile spores at low temperatures

Clostridium difficile's presence has been reported in meat products stored typically at low temperatures. This study evaluated the viability in phosphate buffer saline (PBS) of spores from epidemic C. difficile strain R20291 (4.6 log CFU/ml) and M120 (7.8 log CFU/ml). Viability was assessed during 4 months at −80 °C, −20 °C, 4 °C (refrigeration), and 23 °C (room temperature), and after 10 freeze (−20 °C)/thaw (+23 °C) cycles. Although spore viability decreased, significant viability was still observed after 4 months at −20 °C, i.e., 3.5 and 3.9 log CFU/ml and −80 °C, i.e., 6.0 and 6.1 log CFU/ml for strains R20291 and M120, respectively. The same trend was observed for M120 at 4 °C and 23 °C, while for R20291 the viability change was non-significant at 4 °C but increased significantly at 23 °C (p > 0.05). After 10 freeze-thaw cycles, viability of both strains decreased but a significant fraction remained viable (4.3 and 6.3 log CFU/ml for strain R20291 and M120, respectively). Strikingly, both strains showed higher viability in a meat model than in PBS. A small but significant decrease (p < 0.05) from 6.7 to 6.3 log CFU/ml in M120 viability was observed after 2-month storage in the meat model while the decrease from an initial 3.4 log CFU/ml observed for R20291 was non-significant (p = 0.12). In summary, C. difficile spores can survive low-temperature conditions for up to 4 months.

Estudio epidemiológico de infección por Clostridium difficile en pacientes críticos ingresados en una Unidad de Cuidados Intensivos

Data on the epidemiology of infections caused by Clostridium difficile (CDI) in critically ill patients are scarce and center on studies with a limited time framework and/or epidemic outbreaks. ObjectiveTo describe the characteristics and risk factors of critically ill patients admitted to the ICU with CDI, as well as the treatments used for the control of such infections. Material and methodsA retrospective study was made of patients included in the ENVIN-ICU registry with CDI in 2012. Patients were followed up to 72h after discharge from the ICU. A case report form was used to record the following data: demographic variables, risk factors related to CDI, treatment and outcome. Infections were classified as community-acquired, nosocomial out-ICU and nosocomial in-ICU, according to the day on which Clostridium difficile isolates were obtained. Infection rates as episodes per 10,000 days of ICU stay are presented. The global in-ICU and hospital mortality rates were calculated. ResultsSixty-eight episodes of CDI in 33 out of a total of 173 ICUs participating in the registry were recorded (19.1%) (2.1 episodes per 10,000 days of ICU stay). Forty-five patients were men (66.2%), with a mean (SD) age of 63.4 (16.4) years, a mean APACHE II score on ICU admission of 19.9 (7.4), and an underlying medical condition in 44 (64.7%). Sixty-two patients (91.2%) presented more than 3 liquid depositions/day, 40 (58.8%) in association with severe sepsis or septic shock. Community-acquired infection occurred in 13 patients (19.1%), nosocomial out-ICU infection in 13 (19.1%), and in-ICU infection in 42 (61.8%). Risk factors included age>64 years in 39 cases (57.4%), previous hospital admission (3 months) in 32 (45.6%), use of antimicrobials (previous 7 days) in 57 (83.8%), enteral nutrition in 23 (33.8%), and the use of H2 inhibitors in 39 (57.4%). Initial combined treatment was administered to 18 patients (26.5%). Metronidazole was used in 60 (88.2%) and vancomycin in 31 (45.6%). The in-ICU mortality rate was 25.0% (n=17), with a hospital mortality 27.9% (n=19). ConclusionsThe rate of ICD in ICU patients is low, the infection affects severely ill patients, and is associated with high mortality. The presence of CDI is a marker of poor prognosis.

P113 The lived experience of attending a formal inflammatory bowel disease patient education programme. A phenomenological study

reactive protein-CRP etc.) factors, FC and fecal MMP-9. IBD patients in remission were selected as a control group. Results: 90 IBD patients with relapse were enrolled in our study (male/female: 44/46, mean age: 36.68 years; CD/UC: 38/51). 49 subjects in clinical remission were enrolled in the control group. The mean values of CRP, leukocytes, FC and MMP9 were 23.52mg/l, 10.05 G/l, 1292.46 mg/g and 11.77 ng/ml in the relapsed group and 6.54mg/l, 7.06 G/l, 216.11 mg/g, 3.46 ng/ml in the control group. The clinical activity indices showed mild and moderate disease activity: the mean value of CDAI was 227.9, and pMayo score was 5.2 points. 56.6% of patients had positive microbiological results. Clostridium difficile A and B toxin positivity was verified in 91% of the cases. Statistical analysis showed significant difference between FC and MMP-9 values in patients with relapse and remission, but not in Clostridium difficile positive and negative cases. Our results revealed an association between previous antibiotic use and Clostridium difficile positivity (p = 0.03). Conclusions: We suggest that the presence of Clostridium difficile is very frequent in flare-ups of IBD and it has an important role in the relapse, therefore the stool analysis is recommended in every relapse to optimize therapy. FC and MMP-9 has no diagnostic power to differentiate between infection-induced and natural relapse.

Contamination of ready-to-eat raw vegetables with Clostridium difficile in France.

The presence of Clostridium difficile in food like shellfish, vegetables and meat has been reported in several publications during the past few years. The objective of this study was to assess the prevalence of ready-to-eat raw vegetables contaminated with C. difficile in France. One hundred and four ready-to-eat salads and vegetables were studied. Toxigenic C. difficile strains were isolated in three samples (2.9 %): two ready-to-eat salads (one heart of lettuce and one lamb's lettuce salad) and one portion of pea sprouts. The strains belonged to three different PCR ribotypes: 001, 014/020/077 and 015. The detection thresholds for vegetative cells and spores cells varied between 1 and 3 c.f.u. in 20 g salad and between 6 and 15 c.f.u. in 20 g salad, respectively, for the method employed.