Antibiotic Overuse is a Major Risk Factor for Clostridium difficile Infection in Surgical Patients

2017 ◽  
Vol 38 (10) ◽  
pp. 1254-1257 ◽  
Author(s):  
James T. Bernatz ◽  
Nasia Safdar ◽  
Scott Hetzel ◽  
Paul A. Anderson
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Clostridium Difficile ◽  
Clostridium Difficile Infection ◽  
Antibiotic Use ◽  
Morbidity And Mortality ◽  
Major Risk Factor ◽  
Surgical Patients ◽  
Antibiotic Overuse ◽  
The Past

Clostridium difficile infection (CDI) is associated with increased cost, morbidity, and mortality in postoperative patients. Variable rates of postoperative CDI are reported among 4 surgical specialties during the 30-month study period. Risk factors for CDI include antibiotic use, increased ASA score, and increased admissions in the past year.Infect Control Hosp Epidemiol 2017;38:1254–1257

scholarly journals The Analysis of Risk Factors and Clinical-Demographic Characteristics of Patients with Clostridium Dificille Infection as Well as The Outcome of Their Treatment

2016 ◽  
Vol 17 (2) ◽  
pp. 139-144
Author(s):  
Ivana Raković ◽  
Biljana Popovska Jovicic ◽  
Andriana Bukonjic ◽  
Sara Petrovic ◽  
Petar Canovic ◽  
...  
Keyword(s):  
Risk Factors ◽  
Clostridium Difficile ◽  
Clostridium Difficile Infection ◽  
Antibiotic Use ◽  
Demographic Characteristics ◽  
Medical Documentation ◽  
Hospital Treatment ◽  
Continuous Variables ◽  
Bacterial Strains ◽  
H2 Blockers

Abstract Pseudomembranous colitis is a frequent nosocomial infection associated with significant morbidity and mortality. Clostridium difficile infection incidence most frequently increases due to unreasonable antibiotic use and the appearance of new hypervirulent bacterial strains, which leads to prolonged hospitalization and an increase in the total cost of hospital treatment.This is a retrospective design study conducted at Clinical Centre Kragujevac from January to December 2014. The patient data were obtained from the protocol of the Virological Laboratory and from medical documentation. All statistical analyses were performed using the computer program SPSS. The descriptive statistical data are expressed as percentage values. Continuous variables are expressed as the arithmetic mean with the standard deviation.Clostridium difficile infection occurred more frequently with elderly patients (123 patients were over 65 years old). Out of 154 patients on antibiotic treatment, 110 patients were treated with a combination of two or more antibiotics from different pharmacological groups. The most represented antibiotics were from the cephalosporin (71.4%) and quinolone (46.3%) groups. A total of 85.8% of the patients used proton pump inhibitors and H2 blockers.Our results describe the clinical and demographic characteristics of patients with diagnosed Clostridium difficile infection. The most prevalent characteristics (age, antibiotic therapy, PPI and H2 blocker use), which other researchers have also mentioned as risk factors, were present in our study as well.

Risk Factors forClostridium difficileInfection in a Hepatology Ward

2007 ◽  
Vol 28 (2) ◽  
pp. 202-204 ◽  
Author(s):  
Dominique Vanjak ◽  
Guillaume Girault ◽  
Catherine Branger ◽  
Pierre Rufat ◽  
Dominique-Charles Valla ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Clostridium Difficile ◽  
Autoimmune Hepatitis ◽  
Attack Rate ◽  
Case Control Study ◽  
Antibiotic Use ◽  
Case Control ◽  
Strain Typing ◽  
Control Study

During 2001,Clostridium difficileinfection was observed in 23 patients hospitalized in a hepatology ward (attack rate, 0.9%). Since strain typing ruled out a clonal dissemination, we performed a case-control study. In addition to antibiotic use as a risk factor, theC. difficileinfection rate was higher among patients with autoimmune hepatitis (P< .01).

Risk Factors for the Development of Clostridium difficile-Associated Diarrhea During a Hospital Outbreak

1991 ◽  
Vol 12 (6) ◽  
pp. 345-348 ◽  
Author(s):  
Alain Thibault ◽  
Mark A. Miller ◽  
Christina Gaese
Keyword(s):  
Risk Factors ◽  
Clostridium Difficile ◽  
Systemic Disease ◽  
Gastrointestinal Surgery ◽  
Significant Risk ◽  
Antibiotic Use ◽  
Surgical Patients ◽  
Convenience Sample ◽  
Significant Difference ◽  
Clostridium Difficile Associated Diarrhea

AbstractObjective:To evaluate the risk factors associated with a nosocomial outbreak of Clostridium difficile-associated diarrhea.Design:Case-control study with two control groups.Setting:University-affiliated urban hospital.Patients:A convenience sample of 26 patients was chosen out of a total of 78 hospitalized patients with C difficile-associated diarrhea, defined as the presence of diarrhea and a positive C difficile cytotoxin assay or stool culture. Twenty-six controls were matched for age, gender, ward, and date of admission; 18 additional controls were matched to surgical patients for date and ward of admission, as well as for the type of surgical procedure performed.Results:Significant risk factors for the development of C difficile-associated diarrhea were gastrointestinal surgery (exposure odds ratio [EOR] = 7.9, p= .004, 95% confidence interval [CI]= 1.9, 35), use of neomycin (EOR= 15.6, p=.012, 95% CI=1.7, 92), clindamycin (EOR=15.6, p=.005, 95% CI=1.7, 92), metronidazole (EOR=5.7,p=.02,95%CI= 1.4, 25), and excess antibiotic use (mean number of antibiotics = 4.2 versus 1.4, p<.00005). The presence of systemic disease and the use of antacids or immunosuppressive drugs were similar in cases and controls. In surgical patients, no specific antibiotic could be linked to C difficile-associated diarrhea because of uniform perioperative antibiotic use. There was a significant difference in the number of antibiotics administered to cases and controls (mean = 3.1 versus 1.9, p< .005).Conclusions:The results suggest that control of nosocomial C difficile-associated diarrhea may be attained by minimizing the administration of antibiotics, avoidance of high-risk antibiotics, and having a high index of suspicion of C difficile-associated diarrhea in patients who develop diarrhea after gastrointestinal surgery. Perioperative administration of metronidazole, when given with other antibiotics, failed to protect against the development of C difficile-associated diarrhea.

scholarly journals Clostridium Difficile and COVID-19: Novel Risk Factors for Acute Portal Vein Thrombosis

2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
Venkata Ram Pradeep Rokkam ◽  
Gurusaravanan Kutti Sridharan ◽  
Rathnamitreyee Vegunta ◽  
Radhakrishna Vegunta ◽  
Umesha Boregowda ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Abdominal Pain ◽  
Clostridium Difficile ◽  
Portal Vein ◽  
Portal Vein Thrombosis ◽  
Clostridium Difficile Infection ◽  
Thrombotic Risk ◽  
Vein Thrombosis ◽  
Venous Thromboembolic Events

The COVID-19 pandemic has created an unprecedented global health care crisis. COVID-19 patients are found to have increased thrombotic risk. Despite being on prophylactic anticoagulation, many develop serious arterial and venous thromboembolic events. Emerging reports indicate COVID-19 may be considered a novel risk factor for portal vein thrombosis. Although, intra-abdominal infections are identified as risk factors, clostridium difficile colitis has not been typically seen as a risk factor for PVT. We report a case of an elderly female with a recent diagnosis of COVID-19 and no prior history of cirrhosis or malignancy who presented with diarrhea due to clostridium difficile infection. She developed sudden onset severe abdominal pain during the course of hospitalization. Acute portal vein thrombosis was identified on CT imaging of the abdomen, and she improved well with therapeutic anticoagulation. Acute portal vein thrombosis usually results from a combination of local and systemic prothrombotic risk factors. The combination of local infection by clostridium difficile and COVID-19 coagulopathy led to development of portal vein thrombosis in our patient. To the best of our knowledge, this is the first case of portal vein thrombosis reported in a patient with clostridium difficile infection in the setting of COVID-19 coagulopathy. During the current pandemic, clinicians should strongly consider abdominal imaging in patients presenting with abdominal pain due to clostridium difficile infection in the setting of COVID-19 to rule out complications such as portal vein thrombosis. Early diagnosis and treatment of portal vein thrombosis prevent complications of portal hypertension and intestinal infarctions.

scholarly journals 2425. Correlating Use of High-Risk Antimicrobials and the Incidence of Hospital-Onset Clostridium difficile Infection: Targeting Prescribing Trends for Antimicrobial Stewardship

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S838-S838
Author(s):  
Elizabeth Thottacherry ◽  
Philip L Whitfield ◽  
Taylor D Steuber ◽  
Chao Li ◽  
Adam J Sawyer ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
High Risk ◽  
Clostridium Difficile ◽  
Clostridium Difficile Infection ◽  
Univariate Analysis ◽  
Antibiotic Use ◽  
Financial Strain ◽  
Modifiable Risk Factors ◽  
Prescribing Trends

Abstract Background Hospital-onset Clostridium difficile infection (HO-CDI) has a significant morbidity and mortality risk. It also poses increasing financial strain on the healthcare system. Certain antibiotics have been associated with increased HO-CDI incidence and novel strategies are needed to determine what modifiable risk factors exist. Choices of antibiotic have changed overtime time to overcome potential side effects, leading to a possibility that changed prescribing trends could be linked to significant differences in the rate of HO-CDI. Methods This study took place at a 971-bed community hospital from January 2016 to January 2018. Monthly utilization (grams) of 11 antimicrobials considered high risk of HO-CDI was collected, along with monthly HO-CDI rate. Antimicrobials included cephalosporins, carbapenems, fluoroquinolones and clindamycin. Correlational (Pearson’s) and logistic regression analyses were completed to identify association with HO-CDI. A P-value of < 0.05 was considered statistically significant. Results 215 cases of HO-CDI were identified during the study period with 30 being classified as severe. The average HO-CDI rate was 4.3 cases/1000 patient-days. There were no significant correlations identified for any antimicrobials and HO-CDI rate (p> 0.05 for all interactions). Pearson’s correlation coefficients were not significant for any antimicrobial. The multivariable logistic regression model including all antimicrobials, indicated that only ceftazidime had a statistically significant positive effect on the HO-CDI rate. Bearing in mind that only a small number of ceftazidime was prescribed, additional univariate analysis was performed indicating that there was no significant linear association between the HO-CDI rate and ceftazidime utilization (P = 0.3527). Conclusion Our study shows that there is no significant correlation between specific antimicrobial use and HO-CDI rates, even though there has been a general increase in HO-CDI rates. Additional analysis involving control groups of antibiotic use in patients without HO-CDI as well as incidence of HO-CDI in patients without antibiotic use at all is required to further assess possible modifiable risk factors in the inpatient population. Disclosures All authors: No reported disclosures.

scholarly journals Risk factors for healthcare-associated Clostridium difficile infection in pediatric hematopoietic stem cell transplant recipients

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S401-S401
Author(s):  
Richard H Drew ◽  
Clara Ni ◽  
Matthew Kelly ◽  
Dustin Wilson ◽  
Christina Sarubbi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Stem Cell ◽  
Clostridium Difficile ◽  
Hematopoietic Stem Cell ◽  
Clostridium Difficile Infection ◽  
Pediatric Patients ◽  
Antibiotic Use ◽  
Cell Transplant ◽  
Hematopoietic Stem ◽  
Healthcare Associated

Abstract Background Limited published literature exists to identify unique risk factors for Clostridium difficile infection (CDI) in pediatric hematopoietic stem cell transplantation (HSCT) recipients. Our objective was to describe the epidemiology of CDI in pediatric patients undergoing HSCT and to identify potential risk factors for CDI. Methods This IRB-waived, single-center retrospective review included Duke University Hospital (DUH) patients 12 months of age or older admitted to pediatrics between March 1, 2012 and August 23, 2016 undergoing initial HSCT during the index hospitalization. The primary endpoint (PCR-confirmed CDI within 100 days post-transplantation) was characterized using descriptive statistics. Transplant type, prior CDI history, days of total parenteral nutrition (TPN), and antibiotic use intensity scores were compared between occurrence groups using Pearson’s chi-square, Wilcoxon rank-sum or Student’s t tests as appropriate. Results 207 subjects (most Caucasian [55%] and male [61%]) were included, and 15 (7.2%) died. CDI occurred in 24 (12%) within a median (interquartile range) of 35 (9, 47) days since HSCT, and most (92%) were hospital-onset. All cases were healthcare-associated and mild-moderate in severity. None of the patients experienced CDI-related complications. CDI-positive and CDI-negative patients were similar with regards to demographics. Higher median (adjusted) days of TPN (80.6 vs. 29, P &lt; 0.0001) and antibiotic use intensity scores (382.8 vs. 191.0, P &lt; 0.0001), respectively, were associated with CDI. No significant differences between these groups were observed with regard to transplant type (P = 0.28) and prior CDI history (P = 0.10). Conclusion CDI occurred in 12% of pediatric patients within 100 days of undergoing initial HSCT. Onset of this mild-moderate, uncomplicated disease occurred within a median of 35 days and commonly during hospitalization. Patients with CDI were more likely to have increased use of TPN and a higher antibiotic use intensity score. Disclosures All authors: No reported disclosures.

Evaluation of Hospital Room Assignment and Acquisition of Clostridium difficile Infection

2011 ◽  
Vol 32 (3) ◽  
pp. 201-206 ◽  
Author(s):  
Megan K. Shaughnessy ◽  
Renee L. Micielli ◽  
Daryl D. DePestel ◽  
Jennifer Arndt ◽  
Cathy L. Strachan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Clostridium Difficile ◽  
Tertiary Care ◽  
Significant Risk ◽  
Extended Period ◽  
Significant Risk Factor ◽  
Antibiotic Use ◽  
Care Hospital ◽  
Icu Discharge

Background and Objective.Clostridium difficile spores persist in hospital environments for an extended period. We evaluated whether admission to a room previously occupied by a patient with C. difficile infection (CDI) increased the risk of acquiring CDI.Design.Retrospective cohort study.Setting.Medical intensive care unit (ICU) at a tertiary care hospital.Methods.Patients admitted from January 1, 2005, through June 30, 2006, were evaluated for a diagnosis of CDI 48 hours after ICU admission and within 30 days after ICU discharge. Medical, ICU, and pharmacy records were reviewed for other CDI risk factors. Admitted patients who did develop CDI were compared with admitted patients who did not.Results.Among 1,844 patients admitted to the ICU, 134 CDI cases were identified. After exclusions, 1,770 admitted patients remained for analysis. Of the patients who acquired CDI after admission to the ICU, 4.6% had a prior occupant without CDI, whereas 11.0% had a prior occupant with CDI (P = .002). The effect of room on CDI acquisition remained a significant risk factor (P = .008) when Kaplan-Meier curves were used. The prior occupant's CDI status remained significant (P = .01; hazard ratio, 2.35) when controlling for the current patient's age, Acute Physiology and Chronic Health Evaluation III score, exposure to proton pump inhibitors, and antibiotic use.Conclusions.A prior room occupant with CDI is a significant risk factor for CDI acquisition, independent of established CDI risk factors. These findings have implications for room placement and hospital design.

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