This guidance document provides thirty-six statements on strategies to prevent CDI in acute care settings, including 18 strong recommendations. No recommendation was provided for three questions.
In healthcare settings, future control efforts may need to focus on extending cleaning and disinfection procedures beyond the immediate surroundings of symptomatic carriers. Potential targets to prevent acquisition of C. difficile in the community include household settings, long-term care facilities and outpatient settings, while the role of livestock in entertaining transmission requires further investigation.
OBJECTIVE Distinguishing recurrent Clostridium difficile infection (CDI), defined as CDI caused by the same genotype, from reinfection with a different genotype, has important implications for surveillance and clinical trials investigating treatment effectiveness. We validated the proposed 8-week period for distinguishing "same genotype CDI" from "different genotype CDI," and we aimed to identify clinical variables with distinctiveness to propose an improved definition. METHODS From January 2004 to December 2013, a cohort of all inpatients with CDI at the University Hospital Basel, Switzerland, was established, and respective strains were collected. In patients with a second episode of CDI, both strains were compared using polymerase chain reaction (PCR) ribotyping. The standard definition of recurrence (within 8 weeks after initial diagnosis) was evaluated for its performance to predict CDI caused by the same genotype. RESULTS Among 750 patients with CDI, 130 (17.3%) were diagnosed with recurrence or reinfection. Strains from both episodes were available from 106 patients. Identical strains were identified in 36 patients with recurrence (36 of 47) and 27 patients with reinfection (27 of 59). Sensitivity, specificity, and negative and positive predictive values of the standard definition were 56%, 74%, 53%, and 76%, respectively. An extended period of 20 weeks resulted in the best match for both sensitivity and specificity (83% and 58%, respectively), while none of the clinical characteristics revealed independent distinctive power. CONCLUSIONS Our results challenge the utility of the 8-week cutoff for distinguishing recurrent CDI from reinfection. An extended period of 20 weeks may result in improved overall performance characteristics, but this finding requires external validation. Infect Control Hosp Epidemiol 2017;38:891-896.
BACKGROUND
The anaerobe Parvimonas micra is usually recovered as part of the normal flora or in polymicrobial infections of odontogenic or gastrointestinal origin. P. micra has rarely been described as the causative organism of pyogenic spondylodiscitis. Here we report multiple cases of spondylodiscitis caused by this organism and compare their clinical features with the published literature.
METHODS
We performed a retrospective review of all institutional cases with P. micra spondylodiscitis between 01 June 2012 and 31 May 2019. For comparison, the literature was searched for studies reporting vertebral infections with P. micra in adult patients.
RESULTS
Over 7 years, six cases were identified: one with a polymicrobial infection (with P. micra and Fusobacterium nucleatum) and five with P. micra as the only pathogen isolated. The six patients with P. micra infections were between 63 and 82 years old (median 72 years) and presented with persistent lower back pain. Common findings were infection of the lumbar spine region (in 6/6 cases) and recent dental inflammation (4/6 cases). 3/6 patients had previously undergone decompressive spinal surgery due to spinal stenosis (2 to 11 years before). In 4/6 cases the organism was detected in blood cultures drawn at admission. Treatment consisted of antibiotics for all patients and additional decompressive surgery due to abscess formation in half the cases. Outcomes were mostly favourable, but persistent pain was a common complaint after resolution of infection.
CONCLUSIONS
P. micra is a rare cause of spondylodiscitis. Nevertheless, recent dental procedures with subsequent back pain should lead to the consideration of possible anaerobic causes of spondylodiscitis. Heightened awareness of this pathogen and improvements in diagnostic methods might lead to higher detection rates.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.