A Large Outbreak of<i>Clostridium difficile</i>–Associated Disease with an Unexpected Proportion of Deaths and Colectomies at a Teaching Hospital Following Increased Fluoroquinolone Use

Muto, Carlene A.; Pokrywka, Marian; Shutt, Kathleen A.; Mendelsohn, Aaron B.; Nouri, Kathy; Posey, Kathy; Roberts, Terri L.; Croyle, Karen; Krystofiak, Sharon; Patel-Brown, Sujata; Pasculle, A. William; Paterson, David L.; Saul, Melissa; Harrison, Lee H.

doi:10.1086/502539

Cited by 584 publications

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“…As many risk factors for CDI are correlated, multivariate analysis provides independent risk estimates for variables that occur at the same time. Most multivariate models fi nd advanced age, antibiotic use, co-morbidities, and longer hospital stays are independently predictive of CDI ( 211,214,232 ). Although several studies have not shown an association with proton pump inhibitors (PPIs) and CDI, many other studies have found an association ( 235,236 ).…”

Section: Conflict Of Interestmentioning

confidence: 99%

“…Because there are few published data on the performance of one of the PCR tests, Simplexa -C. diffi cile Universal Direct Test (Quest Diagnostics, Madison, NJ), and the ribonuclease-mediated isothermal amplifi cation and chip-based detection method test (Great Basin Corporation, Salt Lake City, UT), it is not possible to comment on their performance at this time. Meta-analysis of three commercial PCR assays, GeneOhm Cdiff Assay BD Diagnostics GeneOhm, San Diego, CA; Xpert C. diffi cile Test Cepheid, Sunnyvale, CA; and ProGastro Cd Assay Gen-Probe, San Diego, CA indicate that they have similar sensitivities of and specifi cities of ~ 90 % and ~ 95 % , respectively, compared with TC ( 214 ). A recent large study comparing widely used commercially available tests showed that PCR for toxigenic C. diffi cile and GDH testing were the most sensitive tests for detection of C. diffi cile in stool specimens compared with a composite reference method of TC or a negative culture in patients with multiple positive tests and a clinical course consistent with CDI.…”

Section: Microbiological Testingmentioning

confidence: 99%

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Guidelines for Diagnosis, Treatment, and Prevention of Clostridium difficile Infections

Surawicz

Brandt

Binion

et al. 2013

American Journal of Gastroenterology

1,465

1,408

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Clostridium diffi cile infection (CDI) is a leading cause of hospital-associated gastrointestinal illness and places a high burden on our health-care system. Patients with CDI typically have extended lengths-of-stay in hospitals, and CDI is a frequent cause of large hospital outbreaks of disease. This guideline provides recommendations for the diagnosis and management of patients with CDI as well as for the prevention and control of outbreaks while supplementing previously published guidelines. New molecular diagnostic stool tests will likely replace current enzyme immunoassay tests. We suggest treatment of patients be stratifi ed depending on whether they have mild-to-moderate, severe, or complicated disease. Therapy with metronidazole remains the choice for mildto-moderate disease but may not be adequate for patients with severe or complicated disease. We propose a classifi cation of disease severity to guide therapy that is useful for clinicians. We review current treatment options for patients with recurrent CDI and recommendations for the control and prevention of outbreaks of CDI. Am J Gastroenterol 2013; 108:478-498; doi: 10.1038/ajg.2013 12. In patients in whom oral antibiotics cannot reach a segment of the colon, such as with Hartman's pouch, ileostomy, or colon diversion, vancomycin therapy delivered via enema should be added to treatments above until the patient improves. (Conditional recommendation, low-quality evidence)13. The use of anti-peristaltic agents to control diarrhea from confi rmed or suspected CDI should be limited or avoided, as they may obscure symptoms and precipitate complicated disease. Use of anti-peristaltic agents in the setting of CDI must always be accompanied by medical therapy for CDI. (Strong recommendation, low-quality evidence) Management of severe and complicated CDI14. Supportive care should be delivered to all patients and includes intravenous fl uid resuscitation, electrolyte replacement, and pharmacological venous thromboembolism prophylaxis. Furthermore, in the absence of ileus or signifi cant abdominal distention, oral or enteral feeding should be continued. 17. Vancomycin delivered orally (500 mg four times per day) and per rectum (500 mg in a volume of 500 ml four times a day) plus intravenous metronidazole (500 mg three times a day) is the treatment of choice for patients with complicated CDI with ileus or toxic colon and / or signifi cant abdominal distention. (Strong recommendation, low-quality evidence)18. Surgical consult should be obtained in all patients with complicated CDI. Surgical therapy should be considered in patients with any one of the following attributed to CDI: hypotension requiring vasopressor therapy; clinical signs of sepsis and organ dysfunction (renal and pulmonary); mental status changes; white blood cell count ≥ 50,000 cells / μ l, lactate ≥ 5 mmol / l; or failure to improve on medical therapy after 5 days. (Strong recommendation, moderate-quality evidence) Management of recurrent CDI (RCDI)19. The fi rst recurrence of CDI can be treated ...

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Section: Conflict Of Interestmentioning

confidence: 99%

Section: Microbiological Testingmentioning

confidence: 99%

Guidelines for Diagnosis, Treatment, and Prevention of Clostridium difficile Infections

Surawicz

Brandt

Binion

et al. 2013

American Journal of Gastroenterology

1,465

1,408

View full text Add to dashboard Cite

show abstract

“…En 2001, Fernández-Caniggia, et al, (24) reportaron la edad avanzada, las comorbilidades, la hospitalización, el tratamiento antimicrobiano y la inmunosupresión reciente, como factores asociados a la infección por C. difficile en una serie de 245 pacientes en Argentina (25). En México, en un estudio de 113 casos y 226 controles, CamachoOrtiz, et al, encontraron que la edad de más de 65 años, el uso de inhibidores de la bomba de protones, la hospitalización durante las 12 semanas previas al diagnóstico, la hospitalización prolongada, la estancia en la unidad de cuidados intensivos y el uso previo de antibióticos, eran factores de riesgo para la infección por C. difficile (26).…”

Section: Discussionunclassified

Characteristics of Clostridium difficile infection in a high complexity hospital and report of the circulation of the NAP1/027 hypervirulent strain in Colombia

Gualtero¹,

Abril²,

Camelo³

et al. 2017

biomedica

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Introducción. Clostridium difficile es el principal responsable de la diarrea asociada al uso de antibióticos. En Colombia y en Latinoamérica, el conocimiento sobre el comportamiento epidemiológico de la infección por C. difficile todavía es limitado.Objetivo. Describir las características de una serie de pacientes con infección por C. difficile.Materiales y métodos. Se hizo un estudio descriptivo de una serie de casos de pacientes con infección por C. difficile atendidos en la Fundación Clínica Shaio, entre enero de 2012 y noviembre de 2015.Resultados. Se estudiaron 36 pacientes con una edad promedio de 65 años. Se determinaron los siguientes factores relacionados con la infección por C. difficile: uso previo de antimicrobianos (94,4 %), hospitalización en los últimos tres meses (66,7 %) y uso de inhibidores de la bomba de protones (50 %). Las comorbilidades más comunes fueron la enfermedad renal crónica (41,7 %) y la diabetes mellitus (30,6 %). Los síntomas más frecuentes fueron más de tres deposiciones diarreicas (97,1 %) y dolor abdominal (42,9 %). En cuanto a la gravedad de los casos, 44,4 % se clasificó como leve a moderado, 38,9 % como grave, y 11,1 % como complicado o grave. El método de diagnóstico más utilizado (63,8% de los pacientes) fue la identificación de la toxina mediante reacción en cadena de la polimerasa (PCR). La mortalidad global durante la hospitalización fue de 8 %. Se identificaron cuatro cepas del serotipo NAP1/027 y nueve muestras fueron positivas para la toxina binaria.Conclusión. La infección por C. difficile debe sospecharse en pacientes con deposiciones diarreicas y factores asociados tradicionalmente a esta enfermedad. Se reportó la circulación de cepas hipervirulentas del serotipo NAP1/027 en Colombia, lo cual debe enfrentarse con la vigilancia epidemiológica y el diagnóstico temprano

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“…424,425 Although alcohol-based handrubs may not be effective against C. difficile, it has not been shown that they trigger the rise of C. difficile-associated disease. [426][427][428][429] C. difficile-associated disease rates began to rise in the USA long before the wide use of alcohol-based handrubs. 430,431 One outbreak with the epidemic strain REA-group B1 ( ribotype 027) was successfully managed while introducing alcohol-based handrub for all patients other than those with C. difficile-associated disease.…”

Section: Activity Of Antiseptic Agents Against Sporeforming Bacteriamentioning

confidence: 99%

Hand Hygiene

Longtin¹,

Sax²,

Allegranzi³

et al. 2011

N Engl J Med

107

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A Large Outbreak ofClostridium difficile–Associated Disease with an Unexpected Proportion of Deaths and Colectomies at a Teaching Hospital Following Increased Fluoroquinolone Use

Abstract: Exposure to levofloxacin was an independent risk factor for C. difficile-associated diarrhea and appeared to contribute substantially to the outbreak. Restricted use of levofloxacin and the other implicated antibiotics may be required to control the outbreak

Cited by 584 publications

References 48 publications

Guidelines for Diagnosis, Treatment, and Prevention of Clostridium difficile Infections

Guidelines for Diagnosis, Treatment, and Prevention of Clostridium difficile Infections

Characteristics of Clostridium difficile infection in a high complexity hospital and report of the circulation of the NAP1/027 hypervirulent strain in Colombia

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