Infections due to Clostridium Difficile

2021 ◽  
Author(s):  
Marcia B Goldberg ◽  
Molly Paras ◽  
K.C Coffey
Keyword(s):  
Clostridium Difficile ◽  
Disease Process ◽  
The United States ◽  
Healthcare Associated Infection ◽  
Therapeutic Guidelines ◽  
Common Causes ◽  
Control And Prevention ◽  
Current Infection ◽  
Healthcare Associated ◽  
Healthcare Epidemiology

Clostridium difficile is one of the most common causes of healthcare associated infection in the United States. Despite significant attention and resources, national rates increased dramatically between 2000-2011 and have only started to decline in the last five years.. The Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA) updated their clinical practice guidelines on the diagnosis and management of C. difficile disease in 2017. The recommended changes in therapeutic guidelines, recommendations for pediatric patient populations, and overview of available diagnostics are described herein. Additionally, this review discusses the changing epidemiology, examines the pathophysiology of the disease process, and outlines current infection control and prevention strategies.  This review has 6 figures and 9 tables. Key Words: Clostridium difficile, diarrhea, colitis, antibiotics, spores, nosocomial, hospital

scholarly journals Clinical Practice Guidelines for Clostridium difficile Infection in Adults and Children: 2017 Update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA)

2018 ◽  
Vol 66 (7) ◽  
pp. 987-994 ◽  
Author(s):  
L Clifford McDonald ◽  
Dale N Gerding ◽  
Stuart Johnson ◽  
Johan S Bakken ◽  
Karen C Carroll ◽  
...  
Keyword(s):  
United States ◽  
Clinical Practice ◽  
Clostridium Difficile ◽  
Infectious Diseases ◽  
Clostridium Difficile Infection ◽  
The United States ◽  
Healthcare Associated Infection ◽  
Adults And Children ◽  
Healthcare Associated ◽  
Healthcare Epidemiology

Abstract A panel of experts was convened by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA) to update the 2010 clinical practice guideline on Clostridium difficile infection (CDI) in adults. The update, which has incorporated recommendations for children (following the adult recommendations for epidemiology, diagnosis, and treatment), includes significant changes in the management of this infection and reflects the evolving controversy over best methods for diagnosis. Clostridium difficile remains the most important cause of healthcare-associated diarrhea and has become the most commonly identified cause of healthcare-associated infection in adults in the United States. Moreover, C. difficile has established itself as an important community pathogen. Although the prevalence of the epidemic and virulent ribotype 027 strain has declined markedly along with overall CDI rates in parts of Europe, it remains one of the most commonly identified strains in the United States where it causes a sizable minority of CDIs, especially healthcare-associated CDIs. This guideline updates recommendations regarding epidemiology, diagnosis, treatment, infection prevention, and environmental management.

scholarly journals Clinical Practice Guidelines for Clostridium difficile Infection in Adults and Children: 2017 Update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA)

2018 ◽  
Vol 66 (7) ◽  
pp. e1-e48 ◽  
Author(s):  
L Clifford McDonald ◽  
Dale N Gerding ◽  
Stuart Johnson ◽  
Johan S Bakken ◽  
Karen C Carroll ◽  
...  
Keyword(s):  
United States ◽  
Clinical Practice ◽  
Clostridium Difficile ◽  
Infectious Diseases ◽  
Clostridium Difficile Infection ◽  
The United States ◽  
Healthcare Associated Infection ◽  
Adults And Children ◽  
Healthcare Associated ◽  
Healthcare Epidemiology

Abstract A panel of experts was convened by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA) to update the 2010 clinical practice guideline on Clostridium difficile infection (CDI) in adults. The update, which has incorporated recommendations for children (following the adult recommendations for epidemiology, diagnosis, and treatment), includes significant changes in the management of this infection and reflects the evolving controversy over best methods for diagnosis. Clostridium difficile remains the most important cause of healthcare-associated diarrhea and has become the most commonly identified cause of healthcare-associated infection in adults in the United States. Moreover, C. difficile has established itself as an important community pathogen. Although the prevalence of the epidemic and virulent ribotype 027 strain has declined markedly along with overall CDI rates in parts of Europe, it remains one of the most commonly identified strains in the United States where it causes a sizable minority of CDIs, especially healthcare-associated CDIs. This guideline updates recommendations regarding epidemiology, diagnosis, treatment, infection prevention, and environmental management.

Review of Current Literature on the Economic Burden of Clostridium difficile Infection

2009 ◽  
Vol 30 (1) ◽  
pp. 57-66 ◽  
Author(s):  
Erik R. Dubberke ◽  
Albert I. Wertheimer
Keyword(s):  
Clostridium Difficile ◽  
Economic Burden ◽  
International Classification Of Diseases ◽  
The United States ◽  
Diagnosis Code ◽  
Number Of Patients ◽  
Classification Of Diseases ◽  
Control And Prevention ◽  
Healthcare Associated

Clostridium difficile is well recognized as the most common infectious cause of healthcare-associated diarrhea. Since 2000, this pathogen has demonstrated an increased propensity to cause more frequent and virulent illness that is often refractory to treatment. An analysis by the Centers for Disease Control and Prevention revealed that, in the United States, the number of patients discharged from hospitals who received the International Classification of Diseases, Ninth Revision discharge diagnosis code for C. difficile infection (CDI) more than doubled from 2000 to 2003. Unpublished data indicate that this trend has continued and that more than 250,000 US hospitalizations were associated with CDI in 2005. A previously uncommon hypervirulent strain of C. difficile is thought to contribute, in part, to the dramatic increase in the incidence and severity of the infection. Although the economic impact of the disease is believed to be profound and is expected to increase, data on the costs associated with CDI are scarce. To more completely assess its economic burden, we performed a review of available literature that reported costs associated with the infection.

scholarly journals Diagnostic stewardship and the 2017 update of the IDSA-SHEA Clinical Practice Guidelines for Clostridium difficile Infection

Diagnosis ◽  
2018 ◽  
Vol 5 (3) ◽  
pp. 119-125 ◽  
Author(s):  
Gregory R. Madden ◽  
Melinda D. Poulter ◽  
Costi D. Sifri
Keyword(s):  
Clinical Practice ◽  
Clostridium Difficile ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Diagnostic Errors ◽  
Laboratory Diagnosis ◽  
Healthcare Associated Infection ◽  
Diagnostic Strategies ◽  
Healthcare Associated ◽  
Healthcare Epidemiology

Abstract Diagnostic stewardship is an increasingly recognized means to reduce unnecessary tests and diagnostic errors. As a leading cause of healthcare-associated infection for which accurate laboratory diagnosis remains a challenge, Clostridium difficile offers an ideal opportunity to apply the principles of diagnostic stewardship. The recently updated 2017 Infectious Diseases Society of America (IDSA)-Society for Healthcare Epidemiology of America (SHEA) Clinical Practice Guidelines for C. difficile infection now recommend separate diagnostic strategies depending on whether an institution has adopted diagnostic stewardship in test decision making. IDSA-SHEA endorsement of diagnostic stewardship for C. difficile highlights the increasing role of diagnostic stewardship in hospitals. In this opinion piece, we introduce the concept of diagnostic stewardship by discussing the new IDSA-SHEA diagnostic recommendations for laboratory diagnosis of C. difficile. We outline recent examples of diagnostic stewardship, challenges to implementation, potential downsides and propose future areas of study.

scholarly journals Strategies to Prevent Clostridium difficile Infections in Acute Care Hospitals: 2014 Update

2014 ◽  
Vol 35 (S2) ◽  
pp. S48-S65 ◽  
Author(s):  
Erik R. Dubberke ◽  
Philip Carling ◽  
Ruth Carrico ◽  
Curtis J. Donskey ◽  
Vivian G. Loo ◽  
...  
Keyword(s):  
Clostridium Difficile ◽  
Acute Care ◽  
Acute Care Hospitals ◽  
Guidance Document ◽  
Healthcare Associated Infections ◽  
American Hospital ◽  
American Hospital Association ◽  
Healthcare Associated ◽  
Healthcare Epidemiology ◽  
Practical Recommendations

Previously published guidelines are available that provide comprehensive recommendations for detecting and preventing healthcare-associated infections (HAIs). The intent of this document is to highlight practical recommendations in a concise format designed to assist acute care hospitals in implementing and prioritizing their Clostridium difficile infection (CDI) prevention efforts. This document updates “Strategies to Prevent Clostridium difficile Infections in Acute Care Hospitals,” published in 2008. This expert guidance document is sponsored by the Society for Healthcare Epidemiology of America (SHEA) and is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America (IDSA), the American Hospital Association (AHA), the Association for Professionals in Infection Control and Epidemiology (APIC), and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise. The list of endorsing and supporting organizations is presented in the introduction to the 2014 updates.

Translating Evidence into Practice Using a Systems Engineering Framework for Infection Prevention

2014 ◽  
Vol 35 (9) ◽  
pp. 1176-1182 ◽  
Author(s):  
Eric Yanke ◽  
Pascale Carayon ◽  
Nasia Safdar
Keyword(s):  
Systems Engineering ◽  
Infection Prevention ◽  
The United States ◽  
Multidrug Resistant ◽  
Recent Analysis ◽  
Emerging Pathogens ◽  
The Us ◽  
Significant Burden ◽  
Current Infection ◽  
Healthcare Associated

The current infection prevention era is defined by the rise of healthcare-associated infections (HAIs) and multidrug-resistant organisms (MDROs). Efforts to combat these and other emerging pathogens have resulted in rapid and ongoing evolution of the contemporary infection prevention environment. Currently, HAIs impose a significant burden on the US healthcare system. Recent analysis of National Healthcare Safety Network data from the early 2000s suggests that at least 1.7 million HAIs occur yearly in US hospitals, associated with at least 99,000 deaths. These numbers have likely increased over the past decade and suggest that HAIs are among the leading causes of death in the United States.

Clinical Practice Guidelines for Clostridium difficile Infection in Adults: 2010 Update by the Society for Healthcare Epidemiology of America (SHEA) and the Infectious Diseases Society of America (IDSA)

2010 ◽  
Vol 31 (05) ◽  
pp. 431-455 ◽  
Author(s):  
Stuart H. Cohen ◽  
Dale N. Gerding ◽  
Stuart Johnson ◽  
Ciaran P. Kelly ◽  
Vivian G. Loo ◽  
...  
Keyword(s):  
Environmental Management ◽  
Clinical Practice ◽  
Clostridium Difficile ◽  
Infection Control ◽  
Practice Guidelines ◽  
Virulent Strain ◽  
Severe Disease ◽  
Position Paper ◽  
Healthcare Associated ◽  
Healthcare Epidemiology

Since publication of the Society for Healthcare Epidemiology of America position paper onClostridium difficileinfection in 1995, significant changes have occurred in the epidemiology and treatment of this infection.C. difficileremains the most important cause of healthcare-associated diarrhea and is increasingly important as a community pathogen. A more virulent strain ofC. difficilehas been identified and has been responsible for more-severe cases of disease worldwide. Data reporting the decreased effectiveness of metronidazole in the treatment of severe disease have been published. Despite the increasing quantity of data available, areas of controversy still exist. This guideline updates recommendations regarding epidemiology, diagnosis, treatment, and infection control and environmental management.

scholarly journals Defining the black box: a narrative review of factors associated with adverse outcomes from severe Clostridioides difficile infection

2021 ◽  
Vol 14 ◽  
pp. 175628482110481
Author(s):  
Adam Ressler ◽  
Joyce Wang ◽  
Krishna Rao
Keyword(s):  
The United States ◽  
Adverse Outcomes ◽  
Chronic Illnesses ◽  
Narrative Review ◽  
Healthcare Associated Infection ◽  
Clostridioides Difficile ◽  
Clostridioides Difficile Infection ◽  
Patients At Risk ◽  
Hospital Deaths ◽  
Healthcare Associated

In the United States, Clostridioides difficile infection (CDI) is the leading cause of healthcare-associated infection, affecting nearly half a million people and resulting in more than 20,000 in-hospital deaths every year. It is therefore imperative to better characterize the intricate interplay between C. difficile microbial factors, host immunologic signatures, and clinical features that are associated with adverse outcomes of severe CDI. In this narrative review, we discuss the implications of C. difficile genetics and virulence factors in the molecular epidemiology of CDI, and the utility of early biomarkers in predicting the clinical trajectory of patients at risk of developing severe CDI. Furthermore, we identify associations between host immune factors and CDI outcomes in both animal models and human studies. Next, we highlight clinical factors including renal dysfunction, aging, blood biomarkers, level of care, and chronic illnesses that can affect severe CDI diagnosis and outcome. Finally, we present our perspectives on two specific treatments pertinent to patient outcomes: metronidazole administration and surgery. Together, this review explores the various venues of CDI research and highlights the importance of integrating microbial, host, and clinical data to help clinicians make optimal treatment decisions based on accurate prediction of disease progression.

scholarly journals Chlorhexidine-alcohol versus Povidone-Iodine-alcohol for surgical site antisepsis in caesarean section

2019 ◽  
Vol 8 (4) ◽  
pp. 1359
Author(s):  
Vishnu Priya Kesani ◽  
Sruthi Talasila ◽  
Sheela S. R.
Keyword(s):  
Caesarean Section ◽  
Surgical Site Infection ◽  
Povidone Iodine ◽  
Care Center ◽  
Tertiary Care ◽  
Site Infection ◽  
Healthcare Associated Infection ◽  
Skin Antisepsis ◽  
Control And Prevention ◽  
Healthcare Associated

Background: Caesarean section is one of the most common procedures performed. Recent studies found that surgical-site infection (SSI) was the most common healthcare-associated infection. Authors hypothesized that optimization of preoperative skin antisepsis may decrease postoperative infections. The objective was to establish the efficacy of chlorhexidine-based antiseptic protocol versus povidone-iodine protocol in reducing SSI for patients undergoing caesarean deliveries.Methods: This is a randomized prospective study conducted from April 2017 to September 2017 at a tertiary care center in India. Women who underwent caesarean sections were allocated into either group. Enrolled patients were randomly assigned to have the surgical site painted with chlorhexidine-alcohol preparation or painted with a solution of 10% povidone-iodine and then with surgical spirit. The outcomes were any SSI occurring within a week or during the 30 day follow up period of the surgery including any of: superficial or deep surgical site infection, or endometritis, according to Centers for Disease Control and Prevention definitions.Results: A total of 560 subjects (273 in the chlorhexidine group and 287 in the iodine group) qualified for the study. The number of surgical-site infection was significantly lower in the chlorhexidine group than in the iodine group (6.95% vs. 14.28%; P=0.005). Chlorhexidine–alcohol was significantly more protective than iodine-alcohol against both superficial incisional infections (5.49% vs. 10.10%, P=0.03) and deep incisional infections (1.46% vs. 4.18%, P=0.04).Conclusions: This study highlighted that Chlorhexidine-alcohol provided superior skin antisepsis in comparison to povidone iodine-alcohol.

scholarly journals Building an Interactive Geospatial Visualization Application for National Healthcare-Associated Infection Surveillance (Preprint)

2020 ◽  
Author(s):  
Shuai Zheng ◽  
Jonathan R. Edwards ◽  
Margaret A. Dudeck ◽  
Prachi Patel ◽  
Lauren Wattenmaker ◽  
...  
Keyword(s):  
Quality Measurement ◽  
Healthcare Facility ◽  
The United States ◽  
Surveillance Program ◽  
Development Effort ◽  
Healthcare Associated Infection ◽  
Healthcare Facilities ◽  
National Healthcare ◽  
State And Local ◽  
Healthcare Associated

BACKGROUND The Centers for Disease Control and Prevention’s (CDC’s) National Healthcare Safety Network (NHSN) is the most widely used healthcare-associated infection (HAI) and antimicrobial use and resistance (AUR) surveillance program in the United States. Over 37,000 healthcare facilities participate in the program and submit a large volume of HAI and AUR surveillance data. These data are used by the facilities themselves, CDC, and other agencies and organizations for a variety of purposes, including infection prevention, antimicrobial stewardship, and clinical quality measurement. Among the summary metrics made available by NHSN are standardized infection ratios (SIRs), which are used to identify HAI prevention needs and measure progress at the national, regional, state and local levels. OBJECTIVE To extend the use of geospatial methods and tools to NHSN data, and in turn to promote and inspire new uses of the rendered data for analysis and prevention purposes, we developed a web-enabled system that enables integrated visualization of HAI metrics and supporting data. METHODS We leveraged geocoding and visualization technologies that are readily available and in current use to develop a web-enabled system designed to support visualization and interpretation of data submitted to NHSN from geographically dispersed sites. The server-client model-based system enables users to access the application via a web-browser. RESULTS We integrated multiple datasets into a single page dashboard designed to enable users to navigate across different HAI event types, choose specific healthcare facility or geographic locations for data displays, and scale across time units within identified time periods. We launched the system for internal CDC use in January 2019. CONCLUSIONS CDC NHSN statisticians, data analysts, and subject matter experts identified opportunities to extend the use of geospatial methods and tools to NHSN data and provided the impetus to develop NHSNViz. The development effort proceeded iteratively, with the developer adding or enhancing functionality and including additional data sets in a series of prototype versions, each of which incorporated user feedback. The initial production version of NHSNViz provides a new geospatial analytic resource built in accordance with CDC user requirements and extensible to additional users and uses in subsequent versions.

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