Acquisition of Clostridium difficile-Associated Diarrhea in Hospitalized Patients Receiving Tube Feeding

Bliss, Donna Z; Johnson, Stuart; Savik, Kay; Clabots, Connie; Willard, Keith E.; Gerding, Dale N.

doi:10.7326/0003-4819-129-12-199812150-00004

Cited by 284 publications

(165 citation statements)

References 40 publications

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“…Where construct validity was determined, the following contrasting patient groups were compared because they were expected to have different incidences of diarrhea: patients with a positive C. difficile-toxin assay vs patients with a negative assay (Bliss et al, 1998); patients receiving antibiotics vs patients not receiving antibiotics (Bleichner et al, 1997); patients with severe hypoalbuminemia (r20 g/l) vs patients with moderate hypoalbuminemia (420 g/l) (Hwang et al, 1994); and patients on ITU vs patients not on ITU (Kelly et al, 1983).…”

Section: Validationmentioning

confidence: 99%

Assessment of fecal output in patients receiving enteral tube feeding: validation of a novel chart

2004

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Objective: To develop a practical, valid and reliable chart to assist in the accurate visual characterization of fecal output in patients receiving enteral tube feeding (ETF). Design: A chart incorporating verbal and pictorial descriptors of fecal output was developed. Validity and reliability were assessed by a questionnaire survey of health professionals and a clinical study of patients commencing ETF. Content validity was assessed from the results of the questionnaire, construct validity by contrasting groups analysis, concurrent validity by comparison of the chart with actual fecal weight and inter-rater reliability by independent characterization of the same fecal sample by two nurses. Setting: St George's Hospital, London, UK. Subjects: In all, 35 health professionals completed a questionnaire with respect to the chart. The chart was then used to monitor fecal output in 36 patients commencing ETF for a total of 171 patient-days, during which time nurses used the chart to characterize 269 fecal samples, of which 59 were subsequently weighed. Results: The results of the questionnaire suggested good content validity. The chart demonstrated statistically significant differences in fecal frequency, fecal consistency, fecal score and incidence of diarrhea for contrasting patient groups expected to have different fecal output (Po0.05). The inter-rater reliability was almost perfect for fecal consistency (95% agreement, k ¼ 0.91) and substantial for fecal weight (83%, k ¼ 0.75). In all, 83% of fecal samples were assigned to the correct weight category (k ¼ 0.75). Conclusion:The chart has good content, construct and concurrent validity and inter-rater reliability, and is suitable for both research and clinical use.

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Section: Validationmentioning

confidence: 99%

Assessment of fecal output in patients receiving enteral tube feeding: validation of a novel chart

2004

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“…1,[6][7][8][9][10][11][12][13][14][15]9). A pesar de los datos encontrados por estos investigadores, la muestra solo incluía 22 casos y 44 controles, y se plantearon reparos sobre la sensibilidad de la prueba diagnóstica utilizada para la detección de la toxina.…”

Section: Discussionunclassified

“…Contrario a lo hallado en la literatura científica (13,33), el uso de sondas de nutrición entérica se comportó como un factor protector en este estudio. Bliss, et al (13), encontraron que su uso, especialmente de sondas colocadas más allá del píloro, se relacionaba con un mayor riesgo de enfermedad asociada a C. difficile (20 % Vs. 8 %).…”

Section: Discussionunclassified

“…Bliss, et al (13), encontraron que su uso, especialmente de sondas colocadas más allá del píloro, se relacionaba con un mayor riesgo de enfermedad asociada a C. difficile (20 % Vs. 8 %). Algunas explicaciones de estos hallazgos serían el uso limitado de fórmulas elementales, las cuales se han relacionado con la infección por este germen debido a la alteración de la flora intestinal del colon (34,35), y el poco uso de sondas en el yeyuno para nutrición entérica, las cuales se han relacionado más con la infección por este microorganismo (13). Infortunadamente, no se pudieron recopilar datos sobre el tipo de sonda utilizada para la nutrición de los pacientes.…”

Section: Discussionunclassified

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Clinical and demographic profile and risk factors for Clostridium difficile infection

Carvajal¹,

Pacheco²,

Jaimes³

2017

biomedica

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Contribución de los autores:Todos los autores participaron en igual medida en todos los aspectos del estudio y la redacción del manuscrito. Introducción. La enfermedad asociada a Clostridium difficile es la principal causa de diarrea infecciosa adquirida en el hospital; su creciente incidencia, las menores tasas de respuesta al tratamiento inicial y la mayor tasa de recaídas han incrementado la carga de la enfermedad. Objetivo. Determinar las características clínicas de los pacientes hospitalizados con enfermedad asociada a C. difficile. Materiales y métodos. Se hizo un estudio de casos anidado en una cohorte. Se revisaron las historias clínicas de pacientes con diarrea iniciada durante su hospitalización a quienes se les había practicado la prueba de detección de la toxina A-B de C. difficile, entre febrero de 2010 y febrero de 2012. Se definió como caso al paciente hospitalizado con diarrea y prueba de Enzyme Linked Fluorescent Assay (ELFA) positiva para la toxina y, como control, a aquel con resultado negativo para la toxina. Se recolectaron los datos demográficos y clínicos, así como la información sobre los factores asociados, la estancia hospitalaria, el tratamiento y las complicaciones. Perfil clínico y demográfico y factores de riesgo frente a la infección por Clostridium difficileResultados. Durante el periodo de seguimiento se recolectaron datos de 123 pacientes, de los cuales 30 fueron positivos para la toxina. La edad media en la población de estudio fue de 49 años y el 60 % correspondía a hombres. Los síntomas predominantes fueron el dolor abdominal (35 %) y la fiebre (34 %). Las principales complicaciones fueron la alteración electrolítica y la sepsis grave asociada con disfunción renal. La mortalidad total fue de 13 % y los factores independientes asociados con la aparición de la infección fueron el uso de inhibidores de la bomba de protones y la cirugía gastrointestinal previa. Conclusiones. El uso de inhibidores de la bomba de protonesy la cirugía gastrointestinal previa fueron factores asociados con la infección por C. difficile. Clinical and demographic profile and risk factors for Clostridium difficile infectionIntroduction: Clostridium difficile infection is the leading cause of nosocomial infectious diarrhea. The increasing incidence added to a lower rate of response to the initial treatment and higher rates of relapse has generated a higher burden of the disease. Objective: To determine the clinical characteristics of hospitalized patients with C. difficile infection. Materials and methods:We made a nested case-cohort study. We reviewed medical records of the patients with nosocomial diarrhea for whom an assay for toxin A-B of C. difficile had been requested from February, 2010, to February, 2012. We defined case as a patient with diarrhea and a positive assay for the toxin, and control as those patients with a negative assay for the toxin. We collected data on demographic and clinical characteristics, risk factors, hospital length of stay, treatment, and complications. Results: We collec...

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“…Diarrhoea occurs commonly due to multiple factors, including prolonged antibiotic use, concomitant medications (H 2 antagonists, antacids, chemotherapy and laxatives), altered bacterial flora, formula osmolality, method or rate of infusion, lactose intolerance and bacterial contamination of formulas and delivery systems [24][25][26]. Antibiotics can do so by altering bacterial flora in ways that result in the overgrowth of Clostridium difficile, other bacteria and Candida [27]. Metabolic complications include fluid and electrolyte disorders, hyperglycemia, vitamin and trace element deficiencies and re-feeding syndrome [28,29].…”

Section: Introductionmentioning

confidence: 99%

Study of Feeding Jejunostomy as an Add on Procedure in Upper Gastrointestinal Surgeries

Shenoy

Adapala

2013

Indian J Surg

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Jejunostomy is usually indicated as an additional procedure during major surgery of upper digestive tract to administer enteral nutrition in post-operative period. Complications associated with it can be mechanical, infectious, gastrointestinal or metabolic. The aim of the study was to evaluate safety of post-operative feeding jejunostomy in different types of major upper gastrointestinal surgeries. It was a prospective study conducted during the period between August 2009 and September 2011. Post-operative cases of major upper gastrointestinal surgeries who receive jejunostomy feeds were included in the study. Sampling was done by convenient method with sample size of 50 cases. Post-operatively, patients were monitored according to standard orders of enteral nutrition. Total calorie and protein intake through feeding jejunostomy was calculated regularly, and complications were assessed in terms of frequency, type, duration, management, and final outcome in different types of upper gastro intestinal surgeries. Analysis was done using chi square test with the help of statistical package SPSS vers.13. P < 0.05 was considered as significant. Complications observed were gastrointestinal −8 (16 %), mechanical −6 (12 %), infectious −4 (8 %) and metabolic −4 (8 %). Duration of complications ranged from 1 to 7 days (mean, 4 days). All types of complications observed during study were less severe and could be managed by simple measurements. Haemoglobin, serum albumin and weight of the patient at the time of discharge were improved for all patients when compared to pre-operative values. All patients received target calories and proteins through feeding jejunostomy. Considering benefits of enteral feeding via jejunostomy tube with minor and acceptable complications, we conclude that feeding jejunostomy is a preferred route of nutritional administration in those who undergo major upper gastro intestinal surgeries.

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Acquisition of Clostridium difficile-Associated Diarrhea in Hospitalized Patients Receiving Tube Feeding

Cited by 284 publications

References 40 publications

Assessment of fecal output in patients receiving enteral tube feeding: validation of a novel chart

Assessment of fecal output in patients receiving enteral tube feeding: validation of a novel chart

Clinical and demographic profile and risk factors for Clostridium difficile infection

Study of Feeding Jejunostomy as an Add on Procedure in Upper Gastrointestinal Surgeries

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