Posts filed under ‘Health Care-Associated Infections’

Proton pump inhibitors increase significantly the risk of Clostridium difficile infection in a low-endemicity, non-outbreak hospital setting.

Aliment Pharmacol Ther. 2009 Mar 15;29(6):626-34.

Dalton BR1, Lye-Maccannell T, Henderson EA, Maccannell DR, Louie TJ.

Author information

1Department of Pharmacy Services, Calgary Health Region, Calgary, AB, Canada. bruce.dalton@albertahealthservices.ca

Abstract

BACKGROUND:

Proton pump inhibitors (PPI) have been linked to higher risk of Clostridium difficile infection (CDI). The relevance of this association in hospitals with low disease activity, where an outbreak strain is nondominant, has been assessed in relatively few studies.

AIM:

To assess the association of PPI and CDI in a setting of low disease activity.

METHODS:

A retrospective cohort study was conducted at two hospitals. Patients admitted for > or = 7 days receiving antibiotics were included. Demographics, exposure to PPI, antibiotics and other drugs in relation to diagnosis of CDI were assessed by univariate and multivariate analyses.

RESULTS:

Of 14 719 patients, 149 (1%) first episode CDI were documented; PPI co-exposure increased CDI [1.44 cases/100 patients vs. 0.74 cases/100 non-exposed (OR: 1.96, 95% CI: 1.42-2.72)]. By logistic regression, PPI days (adjusted OR: 1.01 per day, 95% CI: 1.00-1.02), histamine-2 blockers, antidepressants, antibiotic days, exposure to medications, age, admission service and length of admission were significant predictors.

CONCLUSIONS:

A statistically significant increase in CDI was observed in antibiotic recipients who received PPI, but the absolute risk increase is modest. In settings of with low rates of CDI, the benefit of PPI therapy outweighs the risk of developing CDI. These data support programmes to decrease inappropriate use of PPI in hospitalized patients.

PDF

http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2036.2008.03924.x/pdf

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November 14, 2017 at 9:14 am

Control of an outbreak of infection with the hypervirulent Clostridium difficile BI strain in a university hospital using a comprehensive “bundle” approach.

Clin Infect Dis. 2007 Nov 15;45(10):1266-73.

Muto CA1, Blank MK, Marsh JW, Vergis EN, O’Leary MM, Shutt KA, Pasculle AW, Pokrywka M, Garcia JG, Posey K, Roberts TL, Potoski BA, Blank GE, Simmons RL, Veldkamp P, Harrison LH, Paterson DL.

Author information

1Division of Hospital Epidemiology and Infection Control, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA. mutoca@msx.upmc.edu

Abstract

Background

In June 2000, the hospital-acquired Clostridium difficile (CD) infection rate in our hospital (University of Pittsburgh Medical Center-Presbyterian, Pittsburgh, PA) increased to 10.4 infections per 1000 hospital discharges (HDs); the annual rate increased from 2.7 infections per 1000 HDs to 7.2 infections per 1000 HDs and was accompanied by an increase in the frequency of severe outcomes. Forty-seven (51%) of 92 HA CD isolates in 2001 were identified as the “epidemic BI strain.” A comprehensive CD infection control “bundle” was implemented to control the outbreak of CD infection.

METHODS:

The CD infection control bundle consisted of education, increased and early case finding, expanded infection-control measures, development of a CD infection management team, and antimicrobial management. Process measures, antimicrobial usage, and hospital-acquired CD infection rates were analyzed, and CD isolates were typed.

RESULTS:

The rates of compliance with hand hygiene and isolation were 75% and 68%, respectively. The CD management team evaluated a mean of 31 patients per month (11% were evaluated for moderate or severe disease). Use of antimicrobial therapy associated with increased CD infection risk decreased by 41% during the period 2003-2005 (P<.001). The aggregate rate of CD infection during the period 2001-2006 decreased to 4.8 infections per 1000 HDs (odds ratio, 2.2; 95% confidence interval, 1.4-3.1; P<.001) and by 2006, was 3.0 infections per 1000 HDs, a rate reduction of 71% (odds ratio, 3.5; 95% confidence interval, 2.3-5.4; P<.001). During the period 2000-2001, the proportion of severe CD cases peaked at 9.4% (37 of 393 CD infections were severe); the rate decreased to 3.1% in 2002 and further decreased to 1.0% in 2006–a 78% overall reduction (odds ratio, 20.3; 95% confidence interval, 2.8-148.2; P<.001). In 2005, 13% of CD isolates were type BI (20% were hospital acquired), which represented a significant reduction from 2001 (P<.001).

CONCLUSIONS:

The outbreak of CD infection with the BI strain in our hospital was controlled after implementing a CD infection control “bundle.” Early identification, coupled with appropriate control measures, reduces the rate of CD infection and the frequency of adverse events.

PDF

http://cid.oxfordjournals.org/content/45/10/1266.full.pdf+html

November 14, 2017 at 9:12 am

Long term effect of infection control practices and associated factors during a major Clostridium difficile outbreak in Costa Rica.

J Infect Dev Ctries. 2013 Dec 15;7(12):914-21.

Wong-McClure RA1, Ramírez-Salas E, Mora-Brenes N, Aguero-Sandí L, Morera-Sigler M, Badilla-Vargas X, Hernández-de Merzerville M, O’Shea M, Bryce E.

Author information

1Epidemiology Office and Surveillance, Caja Costarricense de Seguro Social, Genaro Valverde Building, Second Avenue, San José, Costa Rica. rwong@ccss.sa.cr.

Abstract

INTRODUCTION:

The C. difficile BI/NAP 1 hyper virulent strain has been responsible for the nosocomial outbreaks in several countries. The present study describes the infection control strategies utilized to achieve outbreak control as well as the factors associated with a C. difficile BI/NAP 1 hyper virulent strain outbreak in Costa Rica.

METHODOLOGY:

A descriptive analysis of the C. difficile outbreak was completed for the period of January 2007 to December 2010 in one affected hospital. An unmatched case-control study was subsequently performed to evaluate the association of exposure factors with C. difficile infection.

RESULTS:

The pattern of the outbreak was characterized by a sharp increase in the incidence rate during the initial weeks of the outbreak, which was followed by a reduction in the incidence curve as several infection control measures were implemented. The C. difficile BI/NAP1 infection was associated with the prescription of antibiotics, in particular levofloxacin (OR: 9.3; 95%CI: 2.1-40.2), meropenem (OR: 4.9, 95%CI: 1.0-22.9), cefotaxime (OR: 4.3, 95%CI: 2.4-7.7), as well as a medical history of diabetes mellitus (OR: 2.9, 95%CI: 1.5-5.8).

CONCLUSIONS:

The infection control strategies implemented proved to be effective in achieving outbreak control and in maintaining the baseline C. difficile incidence rate following it. The reported C. difficile outbreak was associated with the prescription of broad-spectrum antibiotics and a medical history of diabetes.

PDF

http://www.jidc.org/index.php/journal/article/view/24334937/956

November 14, 2017 at 9:11 am

Clostridium difficile infection in the community: are proton pump inhibitors to blame?

World J Gastroenterol. 2013 Oct 28;19(40):6710-3.

Freedberg DE1, Abrams JA.

Author information

1Daniel E Freedberg, Julian A Abrams, Division of Digestive and Liver Diseases, Columbia University Medical Center, New York, NY 10032, United States.

Abstract

Once a nosocomial disease, Clostridium difficile infection (CDI) now appears frequently in the community in the absence of exposure to antibiotics.

Prior studies have shown that patients with community-acquired CDI are younger, more likely to be female, and have fewer comorbidities compared to patients with hospital-associated CDI.

Because most studies of CDI are hospital-based, comparatively little is known about community-acquired CDI.

The recent study by Chitnis has received widespread attention because it used active surveillance to capture all cases of community-acquired CDI within a large population and assessed key risk factors.

The authors found that low-level healthcare exposure and proton pump inhibitor use were common among those with non-antibiotics associated, community-acquired CDI.

In this commentary, we discuss the changing epidemiology of community-acquired CDI and the evidence basis for the controversial association between proton pump inhibitors and community-acquired CDI.

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3812469/pdf/WJG-19-6710.pdf

November 14, 2017 at 9:10 am

Prevalence of Clostridium difficile colonization among healthcare workers.

BMC Infect Dis. 2013 Oct 4;13:459.

Friedman ND1, Pollard J, Stupart D, Knight DR, Khajehnoori M, Davey EK, Parry L, Riley TV.

Author information

1Department of Medicine and Infectious Diseases, Barwon Health, Geelong, Victoria, Australia. Deborahf@barwonhealth.org.au.

Abstract

BACKGROUND:

Clostridium difficile infection (CDI) has increased to epidemic proportions in recent years. The carriage of C. difficile among healthy adults and hospital inpatients has been established. We sought to determine whether C. difficile colonization exists among healthcare workers (HCWs) in our setting.

METHODS:

A point prevalence study of stool colonization with C. difficile among doctors, nurses and allied health staff at a large regional teaching hospital in Geelong, Victoria. All participants completed a short questionnaire and all stool specimens were tested by Techlab® C.diff Quik Check enzyme immunoassay followed by enrichment culture.

RESULTS:

Among 128 healthcare workers, 77% were female, of mean age 43 years, and the majority were nursing staff (73%). Nineteen HCWs (15%) reported diarrhoea, and 12 (9%) had taken antibiotics in the previous six weeks. Over 40% of participants reported having contact with a patient with known or suspected CDI in the 6 weeks before the stool was collected. C. difficile was not isolated from the stool of any participants.

CONCLUSION:

Although HCWs are at risk of asymptomatic carriage and could act as a reservoir for transmission in the hospital environment, with the use of a screening test and culture we were unable to identify C. difficile in the stool of our participants in a non-outbreak setting. This may reflect potential colonization resistance of the gut microbiota, or the success of infection prevention strategies at our institution.

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3850636/pdf/1471-2334-13-459.pdf

November 14, 2017 at 9:08 am

Clostridium difficile outbreak in Costa Rica – control actions and associated factors.

Rev Panam Salud Publica. 2012 Dec;32(6):413-8.

Wong-McClure RA1, Guevara-Rodríguez M, Abarca-Gómez L, Solano-Chinchilla A, Marchena-Picado M, O’Shea M, Badilla-Vargas X.

Author information

1Salud Colectiva, Subárea de Epidemiología, Caja Costarricense de Seguro Social, San José, Costa Rica. rwong@ccss.sa.cr

Abstract

OBJECTIVE:

To describe interventions implemented during a nosocomial outbreak of Clostridium difficile in a general hospital in Costa Rica from December 2009 to April 2010 in order to achieve outbreak control and the factors determined to be associated with C. difficile infection.

METHODS:

Laboratory-confirmed cases of C. difficile were analyzed to describe the outbreak pattern and intervention measures implemented. Cases were selected and recruited in a case-control study. Controls were selected from the same services and time period as the cases. Evaluated exposures included underlying medical conditions and treatments administered before the onset of symptoms.

RESULTS:

The mean ages in case and control groups were 62.3 and 55.3 years, respectively. Control measures included a hand-hygiene campaign, deep disinfection of hospital surfaces, strict isolation of cases, use of personal protection equipment, and restriction of antibiotic use. The adjusted attributable risks associated with the outbreak were diabetes [odds ratio (OR) 3.4, 95% confidence interval (CI) 1.5-7.7], chronic renal failure (OR 9.0, 95% CI 1.5-53.0), and prescribing ceftazidime (OR 33.3, 95% CI 2.9-385.5) and cefotaxime (OR 20.4, 95% CI 6.9-60.3).

CONCLUSIONS:

Timely implementation of control measures resulted in reduced infection transmission and successful control of the outbreak. Conditions associated with C. difficile infection were similar to those found in previously described outbreaks of this bacterium.

PDF

http://www.scielosp.org/pdf/rpsp/v32n6/a04v32n6.pdf

November 14, 2017 at 9:06 am

The effect of Clostridium difficile infection on length of hospital stay. A cohort study.

Enferm Infecc Microbiol Clin. 2013 Dec;31(10):660-4.

Article in Spanish

Monge D1, Millán I, González-Escalada A, Asensio A.

Author information

1Facultad de Medicina, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Madrid, España.

Abstract

INTRODUCTION:

Clostridium difficile is responsible for a spectrum of diseases known as “Clostridium difficile infection” (CDI). It is currently the leading cause of nosocomial diarrhea in developed countries. This infection has been associated with both increased hospital stay and mortality, and to a greater likelihood of readmission. In our country these undesirable effects have not yet been characterized. Our objective was to quantify the increase in hospital stay attributable to infection by C.difficile.

METHODS:

A retrospective cohort study matched by age, sex and admission date, was conducted in a tertiary care university hospital during an outbreak of nosocomial transmission of CDI.

RESULTS:

The cohort study included 38 infected, and 76 non-infected patients. Patients who developed CDI showed a higher proportion of malnutrition at admission (OR=10.3; 3.6 to 29.6), were exposed to a wider range of antibiotics (mean difference=1.5; 0.7-2.2), had a higher mortality (31.6% vs. 6.6% of controls, P<.001), and a longer hospital stay (median 31.5 days versus 5.5 days for controls, P<.001). After adjustment, infection by C.difficile was associated with an increase in hospital stay of 4 days (P<.001).

CONCLUSIONS:

C.difficile infection has important consequences on the length of hospital stay, and therefore on health costs.

PDF

http://apps.elsevier.es/watermark/ctl_servlet?_f=10&pident_articulo=90259000&pident_usuario=0&pcontactid=&pident_revista=28&ty=70&accion=L&origen=zonadelectura&web=zl.elsevier.es&lan=es&fichero=28v31n10a90259000pdf001.pdf

 

November 14, 2017 at 9:04 am

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