Epidemiology of Clostridium difficile: a hospital-based descriptive study in Argentina and Mexico

Abstract

A prospective study was conducted in four tertiary hospitals in Argentina and Mexico in order to describe the occurrence of Clostridium difficile infection (CDI) in these settings. The objective was to evaluate the incidence of CDI in at-risk populations in Argentina (one center) and Mexico (three centers) and to further explore potential study sites for vaccine development in this region. A prospective, descriptive, CDI surveillance study was conducted among hospitalized patients aged ≥40 years who had received ≥48h of antibiotic treatment. Stool samples were collected from those with diarrhea within 30 days after starting antibiotics and analyzed for toxins A and B by ELISA, and positive samples were further tested by toxinogenic culture and restriction endonuclease analysis type assay. Overall, 466 patients were enrolled (193 in Argentina and 273 in Mexico) of whom 414 completed the follow-up. Of these, 15/414 (3.6%) experienced CDI episodes occurring on average 18.1 days after admission to hospital and 15.9 days after the end of antibiotics treatment. The incidence rate of CDI was 3.1 (95% CI 1.7-5.2) per 1000 patient-days during hospitalization, and 1.1 (95% CI 0.6-1.8) per 1000 patient-days during the 30-day follow-up period. This study highlighted the need for further evaluation of the burden of CDI in both countries, including the cases occurring after discharge from hospital.

Impaired Quality of Life, Work, and Activities Among Adults with Clostridium difficile Infection: A Multinational Survey

“…In addition to healthcare-acquired CDI, community-acquired CDI is increasingly a concern as rates increase [ 5 – 7 ]. Though lower in incidence than in the USA, CDI remains a large and growing concern in both Europe and Asia; however, published estimates may undercount the actual burden given the lack of testing, underdiagnoses, and potentially missed community-acquired cases [ 8 – 12 ].…”

Enfermedad asociada a Clostridium difficile (EACD) en el Hospital Escuela Universitario y el IHSS. Enero a mayo 2016

“…De hecho, el uso de antimicrobianos al menos con 14 días de antelación y hasta 3 meses es uno de los factores comunes en el 100% de los pacientes sintomáticos (Cohen, Gerding, and Johnson 2010). Aunque en teoría cualquier antibiótico puede ser relacionado con la enfermedad, medicamentos como la clindamicina y las cefalosporinas identificadas en proporción de uso de 33 y 60% respectivamente explican en parte las tasas de prevalencia para las EACD en los hospitales en estudio al igual que lo reportado por otros investigadores (Amy et al 2015;Lopardo et al 2015).…”

“…En conclusión, C. difficile es una bacteria que se encuentra INTRODUCCIÓN C. difficile es una bacteria Gram positiva anaerobia, productora de esporas responsable de un porcentaje importante de diarrea asociada al uso de antibióticos de amplio espectro en el ámbito hospitalario. Fue identificado en 1935 como Bacillus difficilis en la flora fecal de niños sanos y reconocido como causa de la colitis asociada a antibióticos (Lopardo et al 2015;Price, Larson, and Crow 1979).…”

Assessing the Burden of Clostridium difficile Infection in Low- and Middle-Income Countries

“…The 017 strain was shown to have a particularly high prevalence in a study in Argentina, in which the percentage of CDI cases attributable to this strain was above 75% from 2002 to 2006 in an urban tertiary hospital (31). In the 2015 study of CDI in 4 tertiary hospitals in Argentina and Mexico by Lopardo et al (22), the predominant strain type recovered was also ribotype 017.…”

“…A 2017 study in three hospitals in Colombia utilizing detection of toxins A/B (by EIA) in stools from patients with diarrhea estimated the CDI prevalence rate at 9.7% (21). In contrast, a 2015 descriptive CDI surveillance study in 4 tertiary hospitals in Argentina and Mexico used ELISA for toxins A and B to test stools from hospitalized patients aged Ն40 years who developed diarrhea within 30 days after receiving in-hospital antibiotics and found that 41% of patients with diarrhea tested positive for toxinogenic C. difficile (22). Similarly García et al (23), working in a Peruvian tertiary care setting and utilizing an EIA for toxins A/B, showed that CDI was the cause of 35.2% of cases of nosocomial diarrhea.…”