Characteristics, Risk Factors, and Prevalence of Clostridioides difficile Among Hospitalized Patients in a Tertiary Care Hospital in Palestine

Abukhalil, Abdallah Damin; AbuKhdeir, Liana; Hamed, Malak; Al-Shami, Ni’meh; Naseef, Hani; Aiesh, Banan M.; Sabateen, Ali

doi:10.2147/idr.s333985

Cited by 3 publications

(9 citation statements)

References 34 publications

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“…In a recent study in Palestine, PPI use was associated with an increased risk of CDI among hospitalized patients. 25 Furthermore, the appropriateness of PPI therapy was noted as related to the patient gender and the number of comorbidities.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Proton Pump Inhibitors Prescribing Among Hospitalized Patients: A Cross-Sectional Study

Abukhalil¹,

Ali²,

Saad³

et al. 2023

IJGM

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Background Proton pump inhibitors (PPIs) are the most effective agents for managing acid-related disorders. However, inappropriate prescribing of PPIs is becoming an issue of concern. Objective This study aimed to assess the appropriate utilization of PPIs in terms of indication, dose, frequency, and route of administration during admission and discharge. Furthermore, direct costs associated with inappropriate PPI use were calculated. Methods A descriptive cross-sectional study was conducted at the internal medicine department of a tertiary hospital in Palestine from January 1, 2021, to June 30, 2021. The medical records of patients aged 18 years or older, hospitalized for 48 hours or more, and receiving oral or intravenous (IV) PPIs during their stay were collected and evaluated for the appropriateness of PPIs prescribed according to clinical guidelines. Results Of 262 patients, 80.2% had an appropriate indication for prophylaxis (67.6%) or treatment (12.6%). A total of 230 patients were prescribed IV pantoprazole.182 (79.1%) had an appropriate indication, whereas 122/182 (67%) received IV PPI instead of oral without an appropriate indication. Of the 32 patients who received 20 mg of oral omeprazole, 28 (87.5%) had an appropriate indication, dose, and route of administration, whereas 16/28 (57.1%) had an inappropriate frequency. At discharge, 32.5% of patients were discharged with unnecessary PPI prescriptions. The total direct cost of inappropriate PPI Indications and route of administration in 188 patients over six months was $1518. Conclusion This study showed that most patients received a PPI for an appropriate indication with the correct dose. However, a high prevalence of inappropriate IV pantoprazole administration was observed, resulting in the highest costs, demonstrating the importance of correctly ordering IV medications. Adherence to clinical guidelines, such as those of the American College of Gastroenterology (ACG), will improve the appropriateness of PPI prescribing, prevent complications, and reduce healthcare costs.

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Section: Discussionmentioning

confidence: 99%

Evaluation of Proton Pump Inhibitors Prescribing Among Hospitalized Patients: A Cross-Sectional Study

Abukhalil¹,

Ali²,

Saad³

et al. 2023

IJGM

Self Cite

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“…Thus, when considering antibiotic use, CDI's benefit and risk ratio must be weighed against one another. More importantly, isolating suspected or infected individuals in the inpatient setting are crucial [ 1 , 12 ].…”

Section: Discussionmentioning

confidence: 99%

“…Clostridium difficile ( C. difficile ) is an anaerobic, gram-positive, spore-forming bacillus and the most frequent cause of infectious diarrhea [ 1 ]. Due to antimicrobial disruption of the colon's natural microbiota, this bacterium may cause gastrointestinal tract infections.…”

Section: Introductionmentioning

confidence: 99%

“…Therefore, surface cleaning and proper personal hygiene among healthcare personnel are crucial to decrease the risk of CDI, and CDI patients must also be isolated to prevent transmission. The CDI probability is increased by several variables, including hospitalization, antibiotic exposure, and advancing age [ 1 , 9 ]. The United States recorded an 8% decrease in CDI between 2011 and 2014; numerous nations have implemented protocols and guidelines to reduce CDI in the acute-care setting through antibiotic stewardship, outbreak management, case detection and appropriate contact precautions, personal protective equipment, and environmental cleaning [ 5 , 10 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

“…In addition, after a few studies looked at the relationship between Helicobacter pylori treatment and CDI, using a proton pump inhibitor (PPI) in the two months before diagnosis increased the risk of CDI. Numerous further investigations were conducted after this relationship between PPI usage and CDI was discovered, although the results and interpretations have been contradictory [ 1 , 5 , 11 ]. In our study, we aim to present the characteristics of our patients with CDI and evaluate the factors associated with poor prognosis and outcomes.…”

Section: Introductionmentioning

confidence: 99%

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Clostridium difficile Infection: Risk and Poor Prognostic Factors at a Tertiary Hospital in the Eastern Region of Saudi Arabia

Miqdad,

Kosaraju,

Mohamad

et al. 2023

Cureus

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Background: Clostridium difficile ( C. difficile ) is a common cause of hospital-acquired diarrhea. It is associated with significantly higher mortality and morbidity in addition to the cost-effectiveness burden on the healthcare system. The primary risk factors for C. difficile infection (CDI) are past C. difficile exposure, proton pump inhibitors, and antibiotic usage. These risk factors are also associated with poor prognosis. Objective: This study was performed in Dr. Sulaiman Al Habib Tertiary Hospital in the Eastern Region of Saudi Arabia. The aim was to evaluate the risk and prognostic factors of CDI and their association with the outcomes of hospital stay, such as complications, length of stay (LOS), and treatment duration. Patients and methods: This is a retrospective cohort study for all patients who tested for C. difficile in the medical department. The target population was all adult patients ≥16 years with positive stool toxins for C. difficile between April 2019 and July 2022. The main outcome measures are risk and poor prognostic factors for CDI. Results: C. difficle infection patients were included in the study; 12 (52.2%) were female, and 11 (47.8%) were male. The mean age of the patients was 58.3 (SD: 21.5) years; 13 (56.5%) patients were below 65 years, and 10 were above 65 years. Only four patients were without comorbidities, and 19 (82.6%) patients had various comorbidities. Importantly, hypertension was the most common comorbidity in 47.8% of the patients. Furthermore, advanced age significantly impacted the hospital LOS as the mean age among patients who stayed at the hospital less than four days and those who stayed ≥4 days was 49.08 (19.7) and 68.36 (19.5), respectively ( P = .028). Conclusion: Advanced age was the most frequent poor prognostic factor among our inpatient participants with positive CDI. It was significantly associated with longer hospital LOS, more complications, and longer treatment duration.

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Antibiotic-Associated Clostridium difficile Diarrhoea in Tertiary Care Hospital – A Study from Western India

Bhatawadekar¹,

Yadav²,

Babu³

et al. 2023

J. Pure Appl. Microbiol.

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Antibiotic-associated Clostridium difficile (CD) diarrhoea is one of the common causes of healthcare-acquired infection. Cephalosporins, piperacillin-tazobactam and aminoglycosides are the common antibiotics which have the maximum chances of producing Clostridium difficile infection (CDI). Most Asian countries have easy accessibility to many of these antibiotics without prescription. Broad spectrum antibiotics have been indiscriminately used as empirical therapy over the last two decades which has resulted in an increased risk of C. difficile infection. In India, the prevalence of CDI is highly underestimated. This study aims to understand the prevalence, risk factors and comorbidities associated with CD diarrhoea in a tertiary care hospital from western India. 196 patients were included in the study who were diagnosed with antibiotic-associated diarrhoea (AAD) clinically. Stool samples collected were processed for anaerobic culture of C. difficile and immunochromatography test was done to detect C. difficile toxins A and B. The comorbidities associated as well as the use of antibiotics like cephalosporin or proton pump inhibitors were also noted for the patients with CDI. 32 samples yielded CD (16%), out of which toxin production was detected only in 16 isolates. The prevalence rate of CDI in our hospital was 5%. Most of the patients had history of chronic illnesses like diabetes mellitus, chronic kidney disease, ischemic heart disease, systemic hypertension, autoimmune diseases, or malignancy. Avoiding empirical therapy with antibiotics prone to cause AAD, Antimicrobial stewardship programme with proper infection control practices and epidemiological surveillance of CDI will help to reduce the burden of CDI in our country.

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Characteristics, Risk Factors, and Prevalence of Clostridioides difficile Among Hospitalized Patients in a Tertiary Care Hospital in Palestine

Cited by 3 publications

References 34 publications

Evaluation of Proton Pump Inhibitors Prescribing Among Hospitalized Patients: A Cross-Sectional Study

Evaluation of Proton Pump Inhibitors Prescribing Among Hospitalized Patients: A Cross-Sectional Study

Clostridium difficile Infection: Risk and Poor Prognostic Factors at a Tertiary Hospital in the Eastern Region of Saudi Arabia

Antibiotic-Associated Clostridium difficile Diarrhoea in Tertiary Care Hospital – A Study from Western India

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