A Predominantly Clonal Multi-Institutional Outbreak of<i>Clostridium difficile</i>–Associated Diarrhea with High Morbidity and Mortality

Loo, Vivian G.; Poirier, Lionel A.; Miller, Mark A.; Oughton, Matthew; Libman, Michael; Michaud, Sophie; Bourgault, Anne–Marie; Nguyen, Tuyen; Frenette, Charles; Kelly, Mirabelle; Vibien, Anne; Brassard, Paul; Fenn, Susan; Dewar, Ken; Hudson, Thomas J.; Horn, Richard; René, Pierre; Monczak, Yury; Dascal, André

doi:10.1056/nejmoa051639

Cited by 1,801 publications

(1,401 citation statements)

References 33 publications

Supporting

Mentioning

1,304

Contrasting

Unclassified

Order By: Relevance

“…The incidence of CDI has increased greatly in the last decade, due to the epidemic strain of the pathogen, NAP1/BI/027 [14,15]. Although CDI has been studied in the setting of allogeneic HPC transplant [10,11], changes in the epidemiology of the disease in the last few years suggest the need for reevaluation CDI in this group of patients to determine if there has been any shift in the clinical characteristics.…”

Section: Discussionmentioning

confidence: 99%

Peri‐transplant clostridium difficile infections in patients undergoing allogeneic hematopoietic progenitor cell transplant

et al. 2016

View full text Add to dashboard Cite

Clostridium difficile infections (CDI) remain the leading cause of infectious diarrhea among hospitalized patients in this country. Patients with hematologic malignancies, especially those who undergo hematopoietic progenitor cell transplants are particularly at risk for developing CDI. One hundred and forty seven consecutive allogeneic hematopoietic progenitor cell transplants were analyzed for peri-transplant Clostridium difficile infections (PT-CDI). Sixteen patients (11%) developed PT-CDI (Median time 5 7 days after transplant). The probability for developing PT-CDI during the peri-transplant period was 12.3%. History of CDI was strongly associated with the development of PT-CDI (P 5 0.008) (OR 5 5.48) (P 5 0.017). These patients also developed PT-CDI much earlier than in those without a history (median 1 day vs. 8 days, P 5 0.03). The probability for developing PT-CDI for those with a history was 39%. There was a trend toward significance (P 5 0.065) between matched related donor grafts and the development of PT-CDI (OR 5 0.245) (P 5 0.08). Age, sex, diagnosis, transplant preparative regimens, Graft-versus-host disease (GVHD) prophylaxis, grade 3/4 acute GVHD, or use of antimicrobials within 8 weeks of transplant were not associated with PT-CDI. Non-CDI-related deaths occurred in one patient in the PT-CDI group and nine in the group without PT-CDI. In the remaining 139 patients, the length of hospital stay for those with PT-CDI was significantly longer than those without (mean 27 days vs. 22 days; P 5 0.02).

show abstract

Section: Discussionmentioning

confidence: 99%

Peri‐transplant clostridium difficile infections in patients undergoing allogeneic hematopoietic progenitor cell transplant

et al. 2016

View full text Add to dashboard Cite

show abstract

“…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%

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

Surawicz

Brandt

Binion

et al. 2013

American Journal of Gastroenterology

1,451

1,394

View full text Add to dashboard Cite

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 ...

show abstract

“…In the early 2000s, an increase in the severity and incidence of CDI in North America was attributed to the emergence of a previously rare strain NAP1/BI/027 (Loo et al, 2005;McDonald et al, 2005).…”

Section: Emerging Strainsmentioning

confidence: 99%

“…isolates, this strain was fluoroquinolone-resistant, and its association with higher morbidity and mortality led to being labelled -hypervirulent‖ (Loo et al, 2005). Because the strain possessed a variant tcdC, the putative negative regulator of toxin production, that had a nonsense mutation as well as distinctive 18bp deletion (Loo et al, 2005), it was initially assumed that increased toxin production was responsible for the apparent increase in virulence.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

Clostridium difficile infection: Evolution, phylogeny and molecular epidemiology

Elliott

Androga

Knight

et al. 2017

Infection, Genetics and Evolution

View full text Add to dashboard Cite

Over the recent decades, Clostridium difficile infection (CDI) has emerged as a global public health threat. Despite growing attention, C. difficile remains a poorly understood pathogen, however, the exquisite sensitivity offered by next generation sequencing (NGS) technology has enabled analysis of the genome of C. difficile, giving us access to massive genomic data on factors such as virulence, evolution, and genetic relatedness within C. difficile groups. NGS has also demonstrated excellence in investigations of outbreaks and disease transmission, in both small and large-scale applications. This review summarizes the molecular epidemiology, evolution, and phylogeny of C. difficile, one of the most important pathogens worldwide in the current antibiotic resistance era.

show abstract

A Predominantly Clonal Multi-Institutional Outbreak ofClostridium difficile–Associated Diarrhea with High Morbidity and Mortality

Abstract: A strain of C. difficile that was resistant to fluoroquinolones and had binary toxin and a partial deletion of the tcdC gene was responsible for this outbreak of C. difficile-associated diarrhea. Exposure to fluoroquinolones or cephalosporins was a risk factor.

Cited by 1,801 publications

References 33 publications

Peri‐transplant clostridium difficile infections in patients undergoing allogeneic hematopoietic progenitor cell transplant

Peri‐transplant clostridium difficile infections in patients undergoing allogeneic hematopoietic progenitor cell transplant

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

Clostridium difficile infection: Evolution, phylogeny and molecular epidemiology

Contact Info

Product

Resources

About