scholarly journals Multicenter Study of the Impact of Community-Onset Clostridium difficile Infection on Surveillance for C. difficile Infection

2009 ◽  
Vol 30 (6) ◽  
pp. 518-525 ◽  
Author(s):  
Erik R. Dubberke ◽  
Anne M. Butler ◽  
Bala Hota ◽  
Yosef M. Khan ◽  
Julie E. Mangino ◽  
...  
Keyword(s):  
Clostridium Difficile ◽  
Control Charts ◽  
Healthcare Facility ◽  
The United States ◽  
Outbreak Detection ◽  
Multicenter Cohort Study ◽  
Time Points ◽  
Stool Samples ◽  
The Impact ◽  
Community Onset

Objective.To evaluate the impact of cases of community-onset, healthcare facility (HCF)-associated Clostridium difficile infection (CDI) on the incidence and outbreak detection of CDI.Design.A retrospective multicenter cohort study.Setting.Five university-affiliated, acute care HCFs in the United States.Methods.We collected data (including results of C. difficile toxin assays of stool samples) on all of the adult patients admitted to the 5 hospitals during the period from July I, 2000, through June 30, 2006. CDI cases were classified as HCF-onset if they were diagnosed more than 48 hours after admission or as community-onset, HCF-associated if they were diagnosed within 48 hours after admission and if the patient had recently been discharged from the HCF. Four surveillance definitions were compared: cases of HCF-onset CDI only (hereafter referred to as HCF-onset CDI) and cases of HCF-onset and community-onset, HCF-associated CDI diagnosed within 30, 60, and 90 days after the last discharge from the study hospital (hereafter referred to as 30-day, 60-day, and 90-day CDI, respectively). Monthly CDI rates were compared. Control charts were used to identify potential CDI outbreaks.Results.The rate of 30-day CDI was significantly higher than the rate of HCF-onset CDI at 2 HCFs (P < .01 ). The rates of 30-day CDI were not statistically significantly different from the rates of 60-day or 90-day CDI at any HCF. The correlations between each HCF's monthly rates of HCF-onset CDI and 30-day CDI were almost perfect (ρ range, 0.94-0.99; P < .001). Overall, 12 time points had a CDI rate that was more than 3 standard deviations above the mean, including 11 time points identified using the definition for HCF-onset CDI and 9 time points identified using the definition for 30-day CDI, with discordant results at 4 time points (k = 0.794; P < .001).Conclusions.Tracking cases of both community-onset and HCF-onset, HCF-associated CDI captures significantly more CDI cases, but surveillance of HCF-onset, HCF-associated CDI alone is sufficient to detect an outbreak.

scholarly journals A Multicenter Study of Clostridium difficile Infection—Related Colectomy, 2000—2006

2012 ◽  
Vol 33 (5) ◽  
pp. 470-476 ◽  
Author(s):  
Amelia M. Kasper ◽  
Humaa A. Nyazee ◽  
Deborah S. Yokoe ◽  
Jeanmarie Mayer ◽  
Julie E. Mangino ◽  
...  
Keyword(s):  
Clostridium Difficile ◽  
Tertiary Care ◽  
Healthcare Facility ◽  
The United States ◽  
Healthcare Facilities ◽  
Tertiary Care Centers ◽  
Design And Methods ◽  
Study Hospital ◽  
Community Onset ◽  
Over Time

Objective.To assess Clostridium difficile infection (CDI)-related colectomy rates by CDI surveillance definitions and over time at multiple healthcare facilities.Setting.Five university-affiliated acute care hospitals in the United States.Design and Methods.Cases of CDI and patients who underwent colectomy from July 2000 through June 2006 were identified from 5 US tertiary care centers. Monthly CDI-related colectomy rates were calculated as the number of CDI-related colectomies per 1,000 CDI cases, and cases were categorized according to recommended surveillance definitions. Logistic regression was performed to evaluate risk factors for CDI-related colectomy.Results.In total, 8,569 cases of CDI were identified, and 75 patients underwent CDI-related colectomy. The overall colectomy rate was 8.7 per 1,000 CDI cases. The CDI-related colectomy rate ranged from 0 to 23 per 1,000 CDI episodes across hospitals. The colectomy rate for healthcare-facility-onset CDI was 4.3 per 1,000 CDI cases, and that for community-onset CDI was 16.5 per 1,000 CDI cases (P < .05). There were significantly more CDI-related colectomies at hospitals B and C (P < .05).Conclusions.The overall CDI-related colectomy rate was low, and there was no significant change in the CDI-related colectomy rate over time. Onset of disease outside the study hospital was an independent risk factor for colectomy.

scholarly journals Multicenter Study of Clostridium difficile Infection Rates from 2000 to 2006

2010 ◽  
Vol 31 (10) ◽  
pp. 1030-1037 ◽  
Author(s):  
Erik R. Dubberke ◽  
Anne M. Butler ◽  
Deborah S. Yokoe ◽  
Jeanmarie Mayer ◽  
Bala Hota ◽  
...  
Keyword(s):  
Clostridium Difficile ◽  
Hospital Admission ◽  
Healthcare Facility ◽  
The United States ◽  
Incidence Rates ◽  
Regional Problem ◽  
Toxin Assay ◽  
Definition Of ◽  
Study Hospital ◽  
Community Onset

Objective.To compare incidence rates of Clostridium difficile infection (CDI) during a 6-year period among 5 geographically diverse academic medical centers across the United States by use of recommended standardized surveillance definitions of CDI that incorporate recent information on healthcare facility (HCF) exposure.Methods.Data on C. difficile toxin assay results and dates of hospital admission and discharge were collected from electronic databases. Chart review was performed for patients with a positive C. difficile toxin assay result who were identified within 48 hours after hospital admission to determine whether they had any HCF exposure during the 90 days prior to their hospital admission. CDI cases, defined as any inpatient with a stool toxin assay positive for C. difficile, were categorized into 5 surveillance definitions based on recent HCF exposure. Annual CDI rates were calculated and evaluated by use of the χ2 test for trend and the χ2 summary test.Results.During the study period, there were significant increases in the overall incidence rates of HCF-onset, HCF-associated CDI (from 7.0 to 8.5 cases per 10,000 patient-days; P < .001); community-onset, HCF-associated CDI attributed to a study hospital (from 1.1 to 1.3 cases per 10,000 patient-days; P = .003); and community-onset, HCF-associated CDI not attributed to a study hospital (from 0.8 to 1.5 cases per 1,000 admissions overall; P < .001). For each surveillance definition of CDI, there were significant differences in the total incidence rate between HCFs.Conclusions.The increasing incidence rates of CDI over time and across healthcare institutions and the correlation of CDI incidence in different surveillance categories suggest that CDI may be a regional problem and not isolated to a single HCF within a community.

scholarly journals Community-Associated Clostridium difficile Infection among Veterans with Spinal Cord Injury and Disorder

2014 ◽  
Vol 35 (5) ◽  
pp. 577-580 ◽  
Author(s):  
Salva N. Balbale ◽  
Stuart Johnson ◽  
Stephen P. Burns ◽  
Stephen M. Kralovic ◽  
Barry Goldstein ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Clostridium Difficile ◽  
Spinal Cord Injuries ◽  
Healthcare Facility ◽  
Antibiotic Exposure ◽  
Cord Injury ◽  
Lower Likelihood ◽  
The Impact ◽  
Community Onset

The impact of community-associated Clostridium difficile infection (CA-CDI) on patients with spinal cord injuries and disorders (SCI/Ds) is not fully understood. We examined CA-CDI cases among veterans with SCI/D, comparing them with community-onset, healthcare facility-associated (CO-HCFA) cases. Generally, patients with CA-CDI had less comorbidity, less severe CDI, and lower likelihood of antibiotic exposure.

Evolving oncology provider perspectives on care delivery during the COVID-19 pandemic.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18609-e18609
Author(s):  
Divya Ahuja Parikh ◽  
Meera Vimala Ragavan ◽  
Sandy Srinivas ◽  
Sarah Garrigues ◽  
Eben Lloyd Rosenthal ◽  
...  
Keyword(s):  
Cancer Care ◽  
Care Delivery ◽  
The United States ◽  
Advanced Practice ◽  
Curative Surgery ◽  
Time Points ◽  
Patients With Cancer ◽  
Provider Perspectives ◽  
Significant Difference ◽  
The Impact

e18609 Background: The COVID-19 pandemic prompted rapid changes in cancer care delivery. We sought to examine oncology provider perspectives on clinical decisions and care delivery during the pandemic and to compare provider views early versus late in the pandemic. Methods: We invited oncology providers, including attendings, trainees and advanced practice providers, to complete a cross-sectional online survey using a variety of outreach methods including social media (Twitter), email contacts, word of mouth and provider list-serves. We surveyed providers at two time points during the pandemic when the number of COVID-19 cases was rising in the United States, early (March 2020) and late (January 2021). The survey responses were analyzed using descriptive statistics and Chi-squared tests to evaluate differences in early versus late provider responses. Results: A total of 132 providers completed the survey and most were white (n = 73/132, 55%) and younger than 49 years (n = 88/132, 67%). Respondents were attendings in medical, surgical or radiation oncology (n = 61/132, 46%), advanced practice providers (n = 48/132, 36%) and oncology fellows (n = 16/132, 12%) who predominantly practiced in an academic medical center (n = 120/132, 91%). The majority of providers agreed patients with cancer are at higher risk than other patients to be affected by COVID-19 (n = 121/132, 92%). However, there was a significant difference in the proportion of early versus late providers who thought delays in cancer care were needed. Early in the pandemic, providers were more likely to recommend delays in curative surgery or radiation for early-stage cancer (p < 0.001), delays in adjuvant chemotherapy after curative surgery (p = 0.002), or delays in surveillance imaging for metastatic cancer (p < 0.001). The majority of providers early in the pandemic responded that “reducing risk of a complication from a COVID-19 infection to patients with cancer” was the primary reason for recommending delays in care (n = 52/76, 68%). Late in the pandemic, however, providers were more likely to agree that “any practice change would have a negative impact on patient outcomes” (p = 0.003). At both time points, the majority of providers agreed with the need for other care delivery changes, including screening patients for infectious symptoms (n = 128/132, 98%) and the use of telemedicine (n = 114/132, 86%) during the pandemic. Conclusions: We found significant differences in provider perspectives of delays in cancer care early versus late in the pandemic which reflects the swiftly evolving oncology practice during the COVID-19 pandemic. Future studies are needed to determine the impact of changes in treatment and care delivery on outcomes for patients with cancer.

Recommendations for Surveillance of Clostridium difficile–Associated Disease

2007 ◽  
Vol 28 (2) ◽  
pp. 140-145 ◽  
Author(s):  
L. Clifford McDonald ◽  
Bruno Coignard ◽  
Erik Dubberke ◽  
Xiaoyan Song ◽  
Teresa Horan ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Clostridium Difficile ◽  
Pseudomembranous Colitis ◽  
Ad Hoc ◽  
Toxic Megacolon ◽  
Healthcare Facility ◽  
Case Patient ◽  
Healthcare Settings ◽  
Community Onset ◽  
Laboratory Assay

Background.The epidemiology of Clostridium difficile-associated disease (CDAD) is changing, with evidence of increased incidence and severity. However, the understanding of the magnitude of and reasons for this change is currently hampered by the lack of standardized surveillance methods.Objective and Methods.An ad hoc C. difficile surveillance working group was formed to develop interim surveillance definitions and recommendations based on existing literature and expert opinion that can help to improve CDAD surveillance and prevention efforts.Definitions and Recommendations.A CDAD case patient was defined as a patient with symptoms of diarrhea or toxic megacolon combined with a positive result of a laboratory assay and/or endoscopic or histopathologic evidence of pseudomembranous colitis. Recurrent CDAD was defined as repeated episodes within 8 weeks of each other. Severe CDAD was defined by CDAD-associated admission to an intensive care unit, colectomy, or death within 30 days after onset. Case patients were categorized by the setting in which C. difficile was likely acquired, to account for recent evidence that suggests that healthcare facility-associated CDAD may have its onset in the community up to 4 weeks after discharge. Tracking of healthcare facility–onset, healthcare facility–associated CDAD is the minimum surveillance required for healthcare settings; tracking of community–onset, healthcare facility–associated CDAD should be performed only in conjunction with tracking of healthcare facility–onset, healthcare facility–associated CDAD. Community–associated CDAD was defined by symptom onset more than 12 weeks after the last discharge from a healthcare facility. Rates of both healthcare facility–onset, healthcare facility–associated CDAD and community–onset, healthcare facility–associated CDAD should be expressed as case patients per 10,000 patient–days; rates of community-associated CDAD should be expressed as case patients per 100,000 person-years.

scholarly journals 2351. Rate and Consequences of Missed Clostridioides (Clostridium) difficile Infection Diagnosis from Non-disclosure of Clostridioides difficile Multiplex PCR Results. Two-Hospital Experience

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S809-S809
Author(s):  
Ioannis Zacharioudakis ◽  
Fainareti Zervou ◽  
Michael Phillips ◽  
Maria E Aguero-Rosenfeld
Keyword(s):  
New York ◽  
Clostridium Difficile ◽  
The United States ◽  
Adverse Outcomes ◽  
Adult Patients ◽  
Unknown Etiology ◽  
Clostridioides Difficile ◽  
Appropriate Therapy ◽  
Traditional Risk Factors ◽  
Community Onset

Abstract Background It is common practice among microbiology laboratories in the United States to blind the BioFire FilmArray GI Panel results for Clostridioides (Clostridium) difficile (C. difficile) in fear of over-diagnosis of C. difficile infection (CDI). Methods We conducted a retrospective cohort study in 2 tertiary academic centers in New York to examine the rate of missed CDI diagnosis and the associated adverse outcomes from blinding the BioFire FilmArray GI Panel results for C. difficile. Of note, in one of the two included hospitals the list of daily positives is reviewed by an Infectious Diseases attending to determine whether cases have been tested for CDI and if not if they meet criteria for CDI. Adult patients with FilmArray GI Panel positive for C. difficile on admission to the hospital who lacked dedicated testing for C. difficile were included in the analysis and were stratified as possible, probable and definite cases of missed CDI diagnosis. Results Among the 144 adult patients with a FilmArray GI Panel test positive for C. difficile within 48 hours of hospital admission, 18 did not have a concurrent dedicated C. difficile testing. Eight patients were categorized as possible cases of missed CDI diagnosis, 5 as probable and 4 as definite, for a total of 17 cases of at least possibly missed CDI diagnosis. One case was considered to represent C. difficile colonization rather than infection for a rate of 6.9% of CDI over-diagnosis based on the FilmArray GI Panel results. Missed CDI diagnoses were associated with a delay in initiation of appropriate therapy, admission to the intensive care unit, hospital re-admission, colorectal surgery and death/discharge to hospice. Five out of 17 cases of missed CDI diagnosis (29.4%) lacked traditional risk factors for CDI. Conclusion In conclusion, the practice of concealing FilmArray GI Panel results for C. difficile may lead to a higher rate of missed CDI diagnosis than over-diagnosis and might need to be re-considered at least in patients with community-onset colitis of unknown etiology on presentation to the hospital. Disclosures All authors: No reported disclosures.

scholarly journals Estimated Burden of Community-Onset Respiratory Syncytial Virus–Associated Hospitalizations Among Children Aged <2 Years in the United States, 2014–15

2019 ◽  
Vol 9 (5) ◽  
pp. 587-595 ◽  
Author(s):  
Carmen S Arriola ◽  
Lindsay Kim ◽  
Gayle Langley ◽  
Evan J Anderson ◽  
Kyle Openo ◽  
...  
Keyword(s):  
Respiratory Syncytial Virus ◽  
Census Data ◽  
The United States ◽  
Surveillance Network ◽  
Detection Probabilities ◽  
Syncytial Virus ◽  
Us Children ◽  
Us Census ◽  
The Impact ◽  
Community Onset

Abstract Background Respiratory syncytial virus (RSV) is a major cause of hospitalizations in young children. We estimated the burden of community-onset RSV-associated hospitalizations among US children aged &lt;2 years by extrapolating rates of RSV-confirmed hospitalizations in 4 surveillance states and using probabilistic multipliers to adjust for ascertainment biases. Methods From October 2014 through April 2015, clinician-ordered RSV tests identified laboratory-confirmed RSV hospitalizations among children aged &lt;2 years at 4 influenza hospitalization surveillance network sites. Surveillance populations were used to estimate age-specific rates of RSV-associated hospitalization, after adjusting for detection probabilities. We extrapolated these rates using US census data. Results We identified 1554 RSV-associated hospitalizations in children aged &lt;2 years. Of these, 27% were admitted to an intensive care unit, 6% needed mechanical ventilation, and 5 died. Most cases (1047/1554; 67%) had no underlying condition. Adjusted age-specific RSV hospitalization rates per 100 000 population were 1970 (95% confidence interval [CI],1787 to 2177), 897 (95% CI, 761 to 1073), 531 (95% CI, 459 to 624), and 358 (95% CI, 317 to 405) for ages 0–2, 3–5, 6–11, and 12–23 months, respectively. Extrapolating to the US population, an estimated 49 509–59 867 community-onset RSV-associated hospitalizations among children aged &lt;2 years occurred during the 2014–2015 season. Conclusions Our findings highlight the importance of RSV as a cause of hospitalization, especially among children aged &lt;2 months. Our approach to estimating RSV-related hospitalizations could be used to provide a US baseline for assessing the impact of future interventions.

Assessment of Clostridium difficile–Associated Disease Surveillance Definitions, North Carolina, 2005

2008 ◽  
Vol 29 (3) ◽  
pp. 197-202 ◽  
Author(s):  
Preeta K. Kutty ◽  
Stephen R. Benoit ◽  
Christopher W. Woods ◽  
Arlene C. Sena ◽  
Susanna Naggie ◽  
...  
Keyword(s):  
North Carolina ◽  
Clostridium Difficile ◽  
Disease Surveillance ◽  
Retrospective Cohort ◽  
Healthcare Facility ◽  
Catchment Areas ◽  
Toxin Assay ◽  
Definition Of ◽  
Community Onset ◽  
Modest Correlation

Objective.To determine the timing of community-onset Clostridium difficile–associated disease (CDAD) relative to the patient's last healthcare facility discharge, the association of postdischarge cases with healthcare facility–onset cases, and the influence of postdischarge cases on overall rates and interhospital comparison of rates of CDAD.Design.Retrospective cohort study for the period January 1, 2005, through December 31, 2005.Setting.Catchment areas of 6 acute care hospitals in North Carolina.Methods.We reviewed medical and laboratory records to determine the date of symptom onset, the dates of hospitalization, and stool C. difficile toxin assay results for patients with CDAD who had diarrhea and positive toxin–assay results. Cases were classified as healthcare facility–onset if they were diagnosed more than 48 hours after admission. Cases were defined as community-onset if they were diagnosed in the community or within 48 hours after admission, and were also classified on the basis of the time since the last discharge: if within 4 weeks, community-onset, healthcare facility–associated (CO-HCFA); if 4-12 weeks, indeterminate exposure; and if more than 12 weeks, community-associated. Pearson's correlation coefficient was used to assess the association between monthly rates of healthcare facility–onset, healthcare facility–associated (HO-HCFA) cases and CO-HCFA cases. We performed interhospital rate comparisons using HO-HCFA cases only and using both HO-HCFA and CO-HCFA cases.Results.Of 1046 CDAD cases, 442 (42%) were HO-HCFA cases and 604 (58%) were community-onset cases. Of the 604 community-onset cases, 94 (15%) were CO-HCFA, 40 (7%) were of indeterminate exposure, and 208 (34%) community-associated. A modest correlation was found between monthly rates of HO-HCFA cases and CO-HCFA cases across the 6 hospitals (r = 0.63, P<.001). Interhospital rankings changed for 6 of 11 months if CO-HCFA cases were included.Conclusions.A substantial proportion of community-onset cases of CDAD occur less than 4 weeks after discharge from a healthcare facility, and inclusion of CO-HCFA cases influences interhospital comparisons. Our findings support the use of a proposed definition of healthcare facility–associated CDAD that includes cases that occur within 4 weeks after discharge.

scholarly journals 764. Will the Addition of Probiotics to Patients Receiving Intravenous Antimicrobial Therapy Reduce the Incidence of Healthcare Facility-Onset Clostridium difficile Infection?

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S479-S479
Author(s):  
Punit Shah ◽  
Jessica Kay ◽  
Adanma Akogun ◽  
Silvia Wise ◽  
Sarfraz Aly ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Clostridium Difficile ◽  
Clostridium Difficile Infection ◽  
Primary Outcome ◽  
Standard Of Care ◽  
Healthcare Facility ◽  
Polymerase Chain Reaction Test ◽  
Multiple Logistic Regression ◽  
Icu Admission ◽  
The Impact

Abstract Background Exposure to antimicrobials is a known risk factor for Clostridium difficile infection (CDI). Antimicrobials cause collateral damage by disrupting the natural intestinal microbiota allowing for C.difficile to thrive and production of C.difficile toxins. Probiotics could modulate the onset and course of CDI. However, the data on probiotics for the prevention of CDI is conflicting. Methods We conducted an IRB approved retrospective cohort study at a 340-bed community hospital. All hospitalized patients from August 1, 2017 through July 31, 2020 were evaluated for enrollment. Patients were included if they received at least one dose of intravenous (IV) antibiotic and had a length of stay of at least 3 days. Patients were excluded if they were younger than 18 years, or if they had a positive C.difficile polymerase chain reaction test before antibiotics were started. The primary outcome was the incidence of healthcare facility-onset Clostridium difficile infection (HO-CDI). Descriptive statistics were used to analyze demographics data, and the primary outcome of HO-CDI was analyzed using Fisher’s exact test and multiple logistic regression. Results A total of 20,257 patients received IV antibiotics during the study time frame. Of these, 2,659 patients received probiotics. Primary outcome of HO-CDI occurred in 46 patients in the IV antibiotics alone cohort (0.26%) and 5 patients in the probiotics plus IV antibiotics cohort (0.19%). The difference in HO-CDI between these two groups was not statistically significant, p=0.677. A multiple logistic regression was performed to see the impact of proton pump inhibitor use, age, ICU admission, Charlson Comorbidity Index, probiotic use and CDI in the past 12 months on the primary outcome. C.difficile infection in prior 12 months [OR 3.37, 95%CI 1.04-10.97] and ICU admission [OR 1.81, 95%CI 1.02-3.19] were associated with higher CDI. The addition of probiotics to patients on IV antibiotics did not exhibit a protective effect [OR 0.72, 95% CI 0.28-1.81]. Conclusion The addition of probiotics to standard of care was not beneficial in the prevention of HO-CDI. We endorse robust antibiotic stewardship practices as part of the standard of care bundle that institutions should employ to decrease the incidence of HO-CDI. Disclosures All Authors: No reported disclosures

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