Prevalence Of Clostridium Difficile Infection Research Articles

Clostridium Difficile Infection in Rectal Cancer Patients after Diverted Loop Ileostomy Closure.

Clostridium difficile infection is a cause of increased morbidity and mortality in hospitals, particularly in patients with cancer pathology. There are several factors favouring the development of Clostridium difficile infection among cancer patients, including age, exposure to antibiotic and proton pump inhibitors therapy, and chemotherapy. This study was conducted to observe the prevalence of Clostridium difficile infection after the reversal of ileostomy loop for rectal cancer surgery, which were initially operated either open or laparoscopic. A retrospective study was performed on patients who were operated in a single surgical team for rectal cancer who benefited of a diverted loop ileostomy over a 4-year period. Results: 23 patients were documented with Clostridium difficile infection out of a total of 63. All 23 patients underwent ileostomy closure later than 3 months after primary surgery, and postoperatively received antibiotic therapy associated with proton pump inhibitors in the first 24 hours. Conclusions: Closure of ileostomy later than 3 months after primary surgery, combined with chemotherapy, antibiotic therapy and proton pump inhibitors, increases the risk of developing Clostridium difficile infection.

Prevalence of Clostridium Difficile Infection (CDI) among Inflammatory Bowel Disease (IBD) Patients in Comparison to Non-IBD Patients in King Abdulaziz Medical City in Jeddah.

The prevalence of Clostridium difficile infection (CDI) as a common complication among inflammatory bowel disease (IBD) has been reported to increase worldwide and has been associated with a poor IBD outcome. In this study, our aim was to report on the prevalence of CDI among IBD vs. non-IBD patients in King Abdulaziz Medical City (KAMC). This retrospective descriptive study was carried out between 2016 and 2020. Data of 89 patients reported with CDI in KAMC were analyzed for demographics and correlations between various characteristics such as BMI, personal/family history of IBD, infection with CDI, diagnosis, method of diagnosis, and treatment modalities. Of the total 89 CDI patients, 59 (66.3%) were adults and 30 (33.7%) were pediatric, of which 36 (40.4%) were females and 53 (59.6%) were males. PCR was the main method of choice for the diagnosis of CDI (89.9%) followed by a positive-culture result (10.0%). Seventy-eight (87.6%) CDI patients were found to be immunocompromised, with two patients diagnosed with IBDs, one with UC, and one with CD. The recurrence rate was 38.4 (30 patients) among the immunocompromised group in comparison to 27.2 (3 patients) in the immunocompetent group (p=0.584). In this study, we found that adults were more prone to CDI infection, especially within hospital settings, and most of the CDI infections occurred in immunocompromised individuals, with cancer as the most common cause of it.

Antibiotic-Associated Clostridium difficile Diarrhoea in Tertiary Care Hospital – A Study from Western India

Antibiotic-associated Clostridium difficile (CD) diarrhoea is one of the common causes of healthcare-acquired infection. Cephalosporins, piperacillin-tazobactam and aminoglycosides are the common antibiotics which have the maximum chances of producing Clostridium difficile infection (CDI). Most Asian countries have easy accessibility to many of these antibiotics without prescription. Broad spectrum antibiotics have been indiscriminately used as empirical therapy over the last two decades which has resulted in an increased risk of C. difficile infection. In India, the prevalence of CDI is highly underestimated. This study aims to understand the prevalence, risk factors and comorbidities associated with CD diarrhoea in a tertiary care hospital from western India. 196 patients were included in the study who were diagnosed with antibiotic-associated diarrhoea (AAD) clinically. Stool samples collected were processed for anaerobic culture of C. difficile and immunochromatography test was done to detect C. difficile toxins A and B. The comorbidities associated as well as the use of antibiotics like cephalosporin or proton pump inhibitors were also noted for the patients with CDI. 32 samples yielded CD (16%), out of which toxin production was detected only in 16 isolates. The prevalence rate of CDI in our hospital was 5%. Most of the patients had history of chronic illnesses like diabetes mellitus, chronic kidney disease, ischemic heart disease, systemic hypertension, autoimmune diseases, or malignancy. Avoiding empirical therapy with antibiotics prone to cause AAD, Antimicrobial stewardship programme with proper infection control practices and epidemiological surveillance of CDI will help to reduce the burden of CDI in our country.

The prevalence and clinical characteristics of Clostridium difficile infection in Saudi patients admitted with inflammatory bowel disease: A case-control study.

Inflammatory bowel disease (IBD) patients are at increased risk of Clostridium difficile infection (CDI), causing significant morbidity and mortality. This study examined CDI's prevalence, predisposing factors, and clinical outcomes in Saudi hospitalized IBD patients. : A retrospective case-control study was conducted at a tertiary medical city in Riyadh, Saudi Arabia. All Saudi adult patients with IBD, admitted over the preceding four years were identified from the hospital's database. Eligible patients were divided into those with CDI and those without CDI. Binary logistic regression was used to determine the predisposing factors for CDI among admitted IBD patients. During the study period, 95 patients were admitted with IBD. Crohn's disease (CD) was the predominant type (71.6%), whereas 28.4% of the patients were with ulcerative colitis (UC). Only 16 (16.8%) patients had positive CDI. CDI-positive patients tend to have hypertension and previous use of steroids. Patients with UC tend to have a higher risk of CDI than those with CD. Most patients recovered from the CDI (81.3%) with a median time to CDI clearance of 14 days. Three patients (18.8%) had recurrent CDI; among them, one died. The prevalence of CDI in Saudi IBD patients is similar to that reported elsewhere. UC, steroid treatment, and hypertension are risk factors for CDI in IBD patients. Recurrence of CDI in IBD patients is common and associated with a poor prognosis.

Comparative analysis and trends in liver transplant hospitalizations with Clostridium difficile infections: A 10-year national cross-sectional study.

Clostridium difficile infection (CDI) is the leading cause of antibiotic-associated diarrhea in the United States. We aimed to determine comparative trends in inpatient outcomes of liver transplant (LT) patients based on CDI during hospitalizations. The national inpatient sample database was used to conduct the present retrospective study regarding CDI among the LT hospitalizations from 2009 to 2019. Primary outcomes included 10-year comparative trends of the length of stay (LOS) and mean inpatient charges (MIC). Secondary outcomes included comparative mortality and LT rejection trends. There was a 14.05% decrease in CDI in LT hospitalizations over the study period (p=.05). The trend in LOS did not significantly vary (p=.9). MIC increased significantly over the last decade in LT hospitalizations with CDI (p<.001). LT hospitalizations of autoimmune etiology compared against non-autoimmune did not increase association with CDI, adjusted odds ratio (aOR) 0.97 (95% confidence interval [CI] 0.75-1.26, p=.87). CDI was associated with increased mortality in LT hospitalizations, aOR 1.84 (95% CI 1.52-2.24, p<.001). In-hospital mortality for LT hospitalizations with CDI decreased by 7.75% over the study period (p=.3). CDI increased transplant rejections, aOR 1.3 (95% CI 1.08-1.65, p<.001). There was a declining trend in transplant rejection for LT hospitalization with CDI from 5% to 3% over the study period (p=.0048). CDI prevalence does not increase based on autoimmune LT etiology. It increases mortality in LT hospitalizations; however, trend for mortality and transplant rejections has been declining over the last decade.

S1567 Celiac Disease Patients Have Higher Risk for Clostridium difficile Infections: A Population-Based Study

Introduction: Clostridium difficile infection (CDI) is a common gastrointestinal pathology with the incidence in the United States to 20-30 per 100 000 population. Previous studies showed association of Celiac disease and CDI, however the prevalence of CDI in patients with celiac disease has not been described in literature. Our aim is to estimate the prevalence of CDI among celiac patients, and to assess whether celiac disease is an independent risk factor for CDI. Methods: A large multi-center database (Explorys Inc., Cleveland, OH, USA) of aggregated electronic health records of 26 different healthcare systems with a total of 360 hospitals and more than 70 million patients across the United States was utilized for this study. A cohort of patients with Celiac disease was identified. Later, a second sub-cohort of those who also had CDI was identified. We excluded all the patients age < 18, patients with inflammatory bowel diseases, immunosuppressed, HIV, Roux-en-Y bypass. Statistical Package for Social Sciences (SPSS version 25, IBM Corp) was used for statistical analysis, and for all analyses, a 2-sided P-value of < 0.05 was considered statistically significant. Multivariate analysis was performed to adjust for multiple factors including age, sex, race, smoking, use of proton pump inhibitors, diagnosis of celiac disease. Results: Among the 80,884,400 individuals screened in the database there were total of 143,180 with Celiac disease (0.17%). The baseline characteristics of patients with Celiac disease are represented in Table. Celiac disease was independently associated with a higher risk of developing CDI (OR= 2.592). Other factors associated with risk of CDI included age 18-65 (OR= 2.764), White race (OR =1.880), smoking (OR= 1.540), use of proton pump inhibitors (OR= 8.468) as in the Figure. Conclusion: Celiac disease seems to be an independent risk factor for CDI. Further studies are required to investigate specifics of pathophysiology, diagnosis and treatment of CDI in patient with celiac disease.Figure 1.: Multivariable analysis for risk factors in individuals with Clostridium Difficile Infection Table 1. - Baseline Catachrestic of Study Population. Celiac disease (%)N=143,180 No celiac disease (%)N=80,741,220 Age 18-65 9,7340 (67.9) 47,893,510 (59.3) >65 39,400 (27.5) 21,266,990 (26.2) Sex Male 1,640 (1.15) 189,850 (0.24) Race Caucasian 117,430 (82.0) 42,011,260 (52.0) Comorbidities Clostridium difficile 2,050 (1.43) 231,830 (0.29) Hypertension 45,710 (31.9) 14,183,650 (17.5) Type 2 Diabetes 20,050 (13.9) 5,651,930 (6.9) Hyperlipidemia 51,170 (35.7) 11,782,380 (14.5) Smoking 19,480 (13.6) 3,874,810 (52.0) Medications PPI 54,790 (38.27) 86,37,610 (10.70)

The prevalence, risk factors, and complications of Clostridium difficile infection in a tertiary care center, western region, Saudi Arabia

BackgroundClostridium difficile is an anaerobic gram-positive spore-forming bacillus that is most commonly associated with nosocomial diarrhea. This study aimed to analyze the prevalence and risk factors of Clostridium difficile infection (CDI) at a tertiary health care center, Western region, Saudi Arabia. We also aimed to examine the duration of exposure to each risk factor prior CDI development, and to categorize CDI as severe and non-severe depending on the white blood cell (WBC) count. Various complications of the infection were also analyzed. MethodsWe performed a retrospective chart review of all patients who had a positive nucleic acid amplification test (NAAT) for Clostridium difficile toxin genes between October 2018 and October 2020. ResultsThe prevalence of CDI among the included patients was 9.1% (237 of 2611 patients). The mean age (standard deviation) was 56.86 (21) years, and the infection was more prevalent among men (52.74%) than among women (47.26%). The most common risk factor associated with CDI was recent antibiotic use (74.68%), followed by recent acid suppressant use (67.50%), malignancy (46%), and previous gastrointestinal surgery (6.30%). The CDI recurrence rate was 13.90%. Piperacillin-tazobactam was the most frequently used broad-spectrum antibiotic, and was used in 38.8% of the patients, followed by meropenem. The most common malignancy type was lymphoma (22.94%, n = 25), followed by leukemia (n = 23). The most common type of surgery was subtotal colectomy (n = 6). Three patients underwent transverse colon resection, and two underwent ileocecal resection. Hypotension was the most frequently recorded complication (28.40%) in the study population. ConclusionThe prevalence rate of CDI among the study patients during the two-year study from October 2018 to October 2020 was 9.1%. Appropriate use of antibiotic and acid suppressants, and contact isolation measures can help in decreasing the number of CDI cases.

Trends in Clostridioides difficile prevalence, mortality, severity, and age composition during 2003–2014, the national inpatient sample database in the US

Background Clostridioides difficile (formerly known as Clostridium difficile) infection (CDI) is one of the most prevalent healthcare-associated infections in the United States (US). In the early 2000s, CDI emerged as a great threat with increasing prevalence, mortality, and severity, especially in advanced age. We investigated the US national trends in in-hospital CDI prevalence, mortality, severity, and age composition from 2003 to 2014. Methods We identified the patients with CDI using the national inpatient sample data from 2003 to 2014. We performed Poisson regression model and Kendall’s tau-b correlation test for our analyses. Results Adjusted overall CDI prevalence did not significantly change during 2003–2014. In-hospital mortality of overall CDI did not significantly change during 2003–2008, then significantly decreased during 2008–2014. Severity of overall CDI significantly increased during 2003–2008, then decreased during 2008–2014. The proportions of patients with age 65 years decreased in CDI prevalence, mortality, and severity during 2003–2014. Conclusions Compared to the earlier years 2003–2008, overall CDI outcome improved in the later years 2008–2014. Younger patients increasingly contributed to CDI prevalence, mortality, and severity during 2003–2014. More studies to understand underlying driving forces of changes in CDI trends are warranted to mitigate CDI.

Prevalence of Clostridium difficile Infection in the Hematopoietic Transplantation Setting: Update of Systematic Review and Meta-Analysis.

Hematopoietic stem cell transplant (HSCT) recipients are vulnerable to Clostridium difficile infection (CDI) due to risk factors such as immunosuppression, antimicrobial use, and frequent hospitalization. We systematically searched PubMed and Embase to screen relevant studies from April 2014 to November 2021. A meta-analysis was performed to identify the association between CDI and hematopoietic transplantation based on the standard mean difference and 95% confidence intervals (CIs). Among the 431 retrieved citations, we obtained 43 eligible articles, which included 15,911 HSCT patients at risk. The overall estimated prevalence of CDI was 13.2%. The prevalence of CDI among the 10,685 allogeneic transplantation patients (15.3%) was significantly higher than that among the 3,840 autologous HSCT recipients (9.2%). Different incidence rates of CDI diagnosis over the last 7 years were found worldwide, of which North America (14.1%) was significantly higher than Europe (10.7%) but not significantly different from the prevalence among Asia (11.6%). Notably, we found that the estimated prevalence of CDI diagnosed by polymerase chain reaction (PCR) (17.7%) was significantly higher than that diagnosed by enzyme immunoassay (11.5%), indicating a significant discrepancy in the incidence rate of CDI owing to differences in the sensibility and specificity of the detection methods. Recurrence of CDI was found in approximately 15% of the initial patients with CDI. Furthermore, 20.3% of CDI cases were severe. CDI was found to be a common complication among HSCT recipients, displaying an evident increase in the morbidity of infection.

Bacterial and Fungal Gut Dysbiosis and Clostridium difficile in COVID-19: A Review.

Background:Gastrointestinal symptoms are common in Coronavirus Disease 2019 (COVID-19), related to infection of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) of intestinal cells through the angiotensin converting enzyme 2 (ACE2) receptor in the brush border. Also, patients are treated with multiple antibiotics. Therefore, an increase in gut dysbiosis and in the prevalence of Clostridium difficile infection (CDI) is expected in patients with COVID-19.Methods:A PubMed search was conducted using the terms “gut microbiota,” “gut mycobiota,” “dysbiosis” AND “COVID-19”; “Clostridium difficile,” “Clostridioides difficile” AND “COVID-19”; “probiotics,” “bacteriotherapy AND COVID-19.” Only case series, observational and experimental studies were included.Results:A total of 384 papers were retrieved and 21 fulfilled selection criteria. Later, a new paper was identified, thus 22 papers were reviewed. Main findings: (1) gut bacterial dysbiosis has been found in fecal samples of COVID-19 patients, with enrichment of opportunistic organisms and decrease of beneficial commensals such as Faecalibacterium prausnitizii. Dysbiosis is related to inflammatory markers and illness severity. (2) There is evidence for abnormal gut barrier and bacterial translocation with a negative impact in the lungs. (3) Fungal dysbiosis correlating with pulmonary mycobiota, has also been found. (4) There is controversy in the CDI rates among COVID-19 patients versus controls and pandemic versus prepandemic era. (5) There is no available evidence yet to support bacteriotherapy in COVID-19. (6) Fecal microbiota transplantation (FMT) has been proposed for COVID-19, although there is no evidence to support it. Also, FMT can be safely used during the pandemic for CDI if strict screening protocols for donors and fecal product are implemented.Conclusions:In COVID-19 there is bacterial and fungal dysbiosis that correlates with systemic and pulmonary inflammation, and illness severity. Further investigations are warranted to determine the efficacy of bacteriotherapy and FMT for modulating gut dysbiosis in COVID-19.

Persistent Clostridium Difficile Diarrhea, Thinking Beyond Pseudomembranous Colitis: A Case Report

The prevalence of Clostridium difficile infection (CDI) is increasing along with the availability of diagnostic tests and is becoming a common nosocomial infection. CDI is the cause of nearly all occurrences of pseudomembranous colitis as well as 10-25% of antibiotic-related diarrhea. In patients presenting with persistent C. difficile diarrhea, the most common cause is the recurrence of pseudomembranous colitis but other differential diagnoses may need to be considered. In this case, we report a case of C. difficile diarrhea associated with life-threatening colitis and bowel ischemia.We report the case of a 60-year-old male with persistent C. difficile diarrhea complicated by bowel ischemia. He presented with one month of persistent diarrhea and vomiting that had been worsening over the past three days; these symptoms were precipitated with prolonged antibiotic use. The patient was not known to have any chronic diseases but was attending the oncology outpatient clinic for an undiagnosed colonic mass that needed further examination. The patient’s vitals showed tachycardia (116 bpm), and a palpable left lumbar mass was noted on examination. The patient’s laboratory tests revealed significantly high inflammatory markers and deranged renal functions, and x-ray images showed hemicolitis. The patient was admitted because of dehydration. Computed tomography (CT) of the abdomen was conducted which revealed bowel ischemia.A high index of suspicion for bowel ischemia should be held in C. difficile cases presenting with persistent symptoms. C. difficile infection is a very common healthcare-associated infection, its risk factors are older age, hospitalizations, and severe diseases. There is a need to increase the awareness of clinicians and prompt the diagnosis if suspicion of complicated C. difficile is present such as bowel ischemia.

707. Hospital-Onset Clostridioides difficile Infection Rates During COVID-19 Pandemic in the ICU Patients

BackgroundDue to COVID-19 gastrointestinal microbiome alterations, COVID-19 can be complicated by Clostridioides difficile infection (CDI). This retrospective cohort study aimed to evaluate the prevalence of Clostridium difficile infection in patients with COVID-19pneumoniaMethodsA retrospective cohort study was conducted on PCR Covid-19 positive patients admitted in the ICU from September,2020 to 30th April 2021. All patients in the cohort study were on mechanical ventilation, or at some point during their ICU admission required mechanical ventilation. Hospital-onset (HO-CDI), defined as a positive C. difficile test over 3 days after admission.ResultsOverall, during the study period, a total of 240 PCR Covid-19 patients were admitted to the ICU; of these, 11 (4.5%) were COVID-19 CDI positive. Nine were males (81%). The mean hospital stay for these COVID-19 patients was 12 days (range 1–59 days). HO-CDI median day of identification was 12 days. All patients received ≥2 antibiotics and dexamethasone at admission. Compared to historical controls, COVID-19 patients did not have a higher overall CDI positive rate. However, mortality among COVID-19 HO-CDI patients was increased 7/11 (63%).ConclusionWhether COVID-19 itself increases an individual’s risk for CDI remains unclear. Multiple contributing factors drive CDI incidence, severity, and recurrence. Although protective measures such as gowns and gloves during COVID-19 increased, CDI cases in the hospital setting should continue to emphasize the importance of antimicrobial stewardship. Disclosures All Authors: No reported disclosures

Clostridium difficile infection characteristics in a general surgery clinic.

Clostridium difficile (CD) is an anaerobic, gram-positive bacterium that can produce a spectrum of gastrointestinal diseases ranging from pseudomembranous colitis to diarrhea to toxic megacolon. The infection is even more difficult to manage as CD produces high-end spores, suggesting that this may be the cause of the dangerous recurrent disease as well as dissemination among healthy members in the community. Spores can be hosted in the digestive tract of both symptomatic and asymptomatic patients. The most relevant risk factor in the development of Clostridium difficile infection (CDI) seems to be the overuse of antimicrobials. Comorbidities are another risk factor that may predispose towards more serious CDI. Treatment options vary from oral antibiotics to extensive surgical interventions. The present study aimed to analyze the prevalence, severity, and management of CDIs in a general surgery department in an effort to determine the correlative elements between the infection and surgical pathology.

Transcriptome-based identification of the beneficial role of blackcurrant, strawberry and yellow onion to attenuate the cytopathic effects of Clostridium difficile toxins

BACKGROUND: Clostridium difficile Infection (CDI) can lead to diarrhea and fulminant colitis. C. difficile infects the host using toxins. Recent studies report prevalence of CDI in the small intestine. Berries are known to contain antioxidants and phenolic compounds that might mitigate bacterial infection. OBJECTIVE: We explored the impact of C. difficile toxins on the small intestine using an in vitro approach and used systems biology techniques together with data integration to identify food compounds that can reduce their cytopathic impact. METHODS: Differentiated Caco-2 cells were exposed to C. difficile toxins and the transcriptomic changes were studied. To identify foods with potential beneficial counteracting effects, the transcriptomic profiles were integrated with transcriptomics data from Caco-2 cells exposed to various food compounds and analyzed using multivariate analysis. RESULTS: Beneficial food candidates, selected by multivariate analysis, such as blackcurrant, strawberry and yellow onion were further examined for their potential to counteract the effect of the toxin-induced disruption of cell integrity and toxin translocation. Our results confirmed effects of food compounds, on the cytopathic effects of toxins in the small intestine. CONCLUSION: Blackcurrant, strawberry and yellow onion can counteract C. difficile toxins induced effects.

P217 Clostridium Difficile Infection as a cause of severe outcomes in patients with Inflammatory Bowel Disease

Abstract Background The prevalence of Clostridium difficile infection (CDI) in patients with inflammatory bowel disease (IBD) is higher than in general population. CDI may produce a negative effect on the clinical course of IBD. The aim of the study was to define the frequency of CDI in patients with IBD and to study risk factors that predict severe outcomes associated with CDI in IBD patients. Methods 1278 medical records were analyzed in a retrospective study of patients with IBD, of which 808 patients met the inclusion criteria. Patients were divided into 2 groups based on the presence of a preliminary diagnosis of CDI. Our primary outcome was time to total colectomy or death with follow-up censored at 180 days after CDI. Statistical analysis was carried out using Pearson Chi-square and two-sample t-test. Results The frequency of CDI in patients with IBD was 17.6%. The mean age of occurrence of CDI in patients with IBD was 37.8±12.9. The first group included 143 patients CDI+IBD, and the second group - 665 patients IBD without CDI. In the first group C-reactive protein, erythrocyte sedimentation rate and fecal calprotectin levels were significantly higher and albumin level was lower than in the second group (р&amp;lt;0.05). The average albumin level in the first group was 20.8±1.83 mg/l, in the second group – 38.7±2.36 mg/l (р&amp;lt;0.05). Only 25.3% of all patients with CDI had a history of antibiotic use, and 30.4% had previously used steroids. Long-term immunosuppressive therapy in patients with IBD has an impact on the development of CDI: among patients with CDI 48.7% long-term received azathioprine/6-mercaptopurine, in patients without IBD – 18.3% (p&amp;lt;0.001). Only 19% of patients with CDI had control of the disease with salicylate therapy, while 62% of patients without CDI achieved remission by taking salicylates (p&amp;lt;0.05). Of these, 7 patients (4.9%) met our primary outcome (1 death, 6 colectomy) at a median of 21 days. On multivariate analysis, serum albumin&amp;lt;22 mg/L (HR 7.93, 95% CI 1.006–62.57), was independent predictors of our primary outcome. Conclusion The frequency of CDI in patients with IBD was 17.6%. The study shows that patients with IBD are more sensitive to the development of CDI at a young age, while not having such traditional risk factors as recent hospitalization or antibiotic use. Patients with IBD with CDI in history often noted the ineffectiveness of therapy with salicylates; often require the assignment of biological therapy. IBD patients with CDI have a lower average albumin, and a higher activity of the inflammatory process (p&amp;lt;0.05). Serum albumin&amp;lt;22 mg/L was independent predictors of severe outcomes in hospitalized IBD patients with CDI.

Do the types and routes of proton pump inhibitor treatments affect clostridium difficile in ICU patients? A retrospective cohort study

ABSTRACT Background: : Proton pump inhibitors (PPI) are associated with Clostridium difficile infection (CDI). Impact of the route of administration is unknown. Research Design and Methods: Patients in Multiparameter Intelligent Monitoring in Intensive Care II database (MIMIC-II) from 2001 to 2008, >18 years old, admitted to medical, surgical, or cardiac ICUs were included. PPI exposures were omeprazole, esomeprazole, lansoprazole, and pantoprazole. PPI administration routes were oral or intravenous. Patients who received histamine receptor antagonists (H2RA) were the control arm. CDI was identified using ICD-9 diagnostic code 008.45. Multiple logistic regression analysis was performed to calculate odds ratios (OR). Results: The study included 16,820 patients (57% male) with a mean age of 63 (SD±17) years and hospitalization duration of 10.2 days (SD±11). Pantoprazole was the most common PPI (94%). CDI occurred in 2.4% and more in patients receiving PPIs than H2RAs (3.0% vs. 0.8%, p < 0.001). CDI prevalence increased with intravenous (95%CI = 1.69–3.39, OR 2.4) and oral (95%CI = 1.59–3.27, OR 2.3) PPI use compared to H2RAs. CDI prevalence was not associated with PPI route in the multivariable model (OR 1.07, 95%CI 0.86–1.34). Conclusions: Both intravenous and oral PPI use in the ICU were independently associated with CDI.

Diarrhea associated with Clostridium difficile in the oncology clinic

Purpose of the study. To conduct typing of toxigenic strains of Clostridium difficile, obtained from oncological patients who are in hospital.Material and Methods. The study included 130 patients with Clostridium difficile – associated diarrhea. First, the presence of toxins A+B+ in the feces was determined by enzyme immunoassay on an automatic miniVidas analyzer from BioMieux SA (France). For screening using real-time PCR, 26 toxigenic Clostridium difficile were selected. For the study used the system GeneXpert company «Cepheid» (Sweden).Results. Of the 1287 patients with diarrhea who were treated in an oncologic hospital, 130 (10,1%) tested positive for toxin A+B+ Clostridium difficile. For the study using real-time PCR, 26 samples were taken. The average age of patients is 57 years. 10 (38,5%) toxigenic strains were identified as hypervirulent ribotype. 7/10 strains were isolated for 3 consecutive month. The average age of patients with hypervirulent strains was 45 years. Patients participating in the study, in most cases were from the surgical departments – 61,5%, from the therapeutic – 34,7%.Conclusion. The study showed that the prevalence of Clostridium difficile infection in our clinic is lower than in other countries. Although hypervirulent strains accounted for 1/3 of all typed Clostridium difficile, special attention should be paid to them. Delayed diagnosis, delay in the onset of specific therapy in cancer patients can lead to a deterioration in the quality of life and in some cases be fatal. PCR diagnostics can determine the hypervirulent ribotype and carry out epidemiological measures aimed at preventing local outbreaks in the hospital.

Anastomotic Leak is Increased With Clostridium difficile Infection After Colectomy: Machine Learning-Augmented Propensity Score Modified Analysis of 46 735 Patients.

Clostridium difficile infection (CDI) is now the most common cause of healthcare-associated infections, with increasing prevalence, severity, and mortality of nosocomial and community-acquired CDI which makes up approximately one third of all CDI. There are also increased rates of asymptomatic colonization particularly in high-risk patients. C difficile is a known collagenase-producing bacteria which may contribute to anastomotic leak (AL). Machine learning-augmented multivariable regression and propensity score (PS)-modified analysis was performed in this nationally representative case-control study of CDI and anastomotic leak, mortality, and length of stay for colectomy patients using the ACS-NSQIP database. Among 46735 colectomy patients meeting study criteria, mean age was 61.7years (SD 14.38), 52.2% were woman, 72.5% were Caucasian, 1.5% developed CDI, 3.1% developed anastomotic leak, and 1.6% died. In machine learning (backward propagation neural network)-augmented multivariable regression, CDI significantly increases anastomotic leak (OR 2.39, 95% CI 1.70-3.36; P < .001), which is similar to the neural network results. Having CDI increased the independent likelihood of anastomotic leak by 3.8% to 6.8% overall, and in dose-dependent fashion with increasing ASA class to 4.3%, 5.7%, 7.6%, and 10.0%, respectively, for ASA class I to IV. In doubly robust augmented inverse probability weighted PS analysis, CDI significantly increases the likelihood of AL by 4.58% (95% CI 2.10-7.06; P < .001). This is the first known nationally representative study on CDI and AL, mortality, and length of stay among colectomy patients. Using advanced machine learning and PS analysis, we provide evidence that suggests CDI increases AL in a dose-dependent manner with increasing ASA Class.

S1218 A Population-Based Study: Prevalence of Clostridioides difficile Colitis in Pediatric Population With Known Sickle Cell Disease

INTRODUCTION: Studies have shown that frequency of asymptomatic carriage of Clostridiodes difficile is higher among infants and children than adults. However, they are not likely to develop symptoms of infection unless they have other gastrointestinal disorders like inflammatory bowel disease. Pediatric patients with sickle cell disease (SCD) may be at higher risk of Clostridium difficile infection (CDI) due to multiple hospitalizations, antibiotic exposure and transfusions. To our knowledge, no large studies have evaluated the risk of CDI in pediatric population with known sickle cell disease. Our objective is to study the epidemiology of CDI associated with sickle cell disease in pediatric population. METHODS: We performed a retrospective population-based study using IBM EXPLORYS, a HIPPA-enabled web platform which includes over 65 million patient data, pooled from multiple healthcare systems that use electronic health records. Pediatric population <19 years with SCD which includes Hemoglobin SS, Hemoglobin SC and Sickle Beta-thalassemia and those without SCD were identified in the database and the prevalence of CDI in both the cohorts was evaluated. The prevalence was calculated per 100,000 population. Patient characteristics, comorbidities, transfusions, antibiotic exposure etc. were compared between the two cohorts. Chi-square with Yate’s correction was used for the comparison of different groups. Data were analyzed with R statistical software (RStudio, Inc. Boston, MA). RESULTS: A total of 11,917,280 pediatric patients were identified among which 29,440 (0.25%) had SCD diagnosis. The prevalence of CDI among the SCD pediatric patients was significantly higher than those without SCD (136 versus 44, P < 0.0001). The proportion of SCD patients with CDI who received red blood cell transfusions and immunosuppressant medication was significantly higher than those without SCD. Differences in other characteristics like gender and race were also noted. None of the SCD patients with CDI had IBD. There was no difference in the antibiotic exposure (Table 1). CONCLUSION: Pediatric SCD patients who are asymptomatic carriers may be at risk of HA-CDI due increased hospitalizations and transfusion need. Further prospective studies are needed to evaluate the risk of CDI in pediatric SCD population.Table 1.: Characteristics of Pediatric with Healthcare-Associated Clostridioides difficile Infection with and without Sickle cell disease

S0254 Factors Influencing Clostridium difficile Infection Amongst African Americans in a Community Hospital

INTRODUCTION: Clostridium difficile infection (CDI) poses a significant health concern amongst hospitalized patients in the United States. Underlying comorbidity significantly increases the burden of this infection especially in vulnerable populations. However, we have shown that the severity and infection rates are lower in African Americans treated at our community hospital. Unnecessary isolation protocols increase length of stay and overall cost of healthcare. The aim of this study is to determine factors that could predict CDI amongst African Americans at Harlem Hospital in an effort to avoid unnecessary isolation of patients. METHODS: Information was collected from hospital charts of patients who were isolated for clostridium infection between January 2016 and December 2018. A total of 251 patients were isolated for suspected infection during this time. Baseline socio-demographic information, immune compromising comorbidities, days on antibiotic therapy, and length of hospital stay were extracted from clinical records. Descriptive, bivariate and multivariate logistic analysis was done. RESULTS: 251 patients were isolated for CDI of which 48% were females and 52% male. 56 patients (22%) were confirmed positive and the median age was 61 with an IQR [20–92]. Average length of hospital stay varies from one to 80 days with the average length of antibiotic use being 14 days [range 1–44]. There was no significant difference between the length of antibiotic therapy in those with CDI compared with those without. The average length of hospital stay for those with CDI was 33 days and for those without the infection was 34. Older patients were more significantly affected with CDI (P < 0.05). CDI increases by age 3% [OR (1.01–1.05)], Male 28% [OR (0.67–2.41)], days on antibiotics 1% [OR (0.99–1.02)], immune compromising status 48% [OR (0.79–2.810)]. CONCLUSION: A large percentage of our hospital patients with diarrheal illness suspected of having CDI in fact test negative for the disease. Strict adherence to Centers for Disease Control and Prevention (CDC) guidelines may likely decrease unnecessary isolation protocols. The prevalence of CDI was influenced by the age of the patient as the risk increases with age. This might be attributed to a weaker immune response as shown.