Clostridium difficile in western Romania: unfavourable outcome predictors in a hospital for infectious diseases

Laza, Ruxandra; Jurac, Ruxandra; Crişan, Alexandru; Lăzureanu, Voichiţa Elena; Licker, Monica; Popovici, Emilian Damian; Bădițoiu, Luminița

doi:10.1186/s12879-015-0895-y

Cited by 13 publications

(10 citation statements)

References 17 publications

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“…In our prospective study, CDI was considered to be the primary or a contributory cause in 15 (6.4%) deaths (up to D60), which appears a higher rate than reported for elsewhere in France (mortality at D30: 4% and at D60: 3.4%) and the Netherlands (3.3% at D30) [7,25,32]. However, this rate is similar to that reported elsewhere [33,34]. In Europe, 30-day mortality varied between 6.8% in Ireland to 42% in the UK.…”

Section: Discussionsupporting

confidence: 78%

Outcomes of Clostridium difficile-suspected diarrhea in a French university hospital

Khanafer¹,

Vanhems²,

Barbut

et al. 2018

Eur J Clin Microbiol Infect Dis

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Clostridium difficile infection (CDI) produces a variety of clinical presentations ranging from mild diarrhea to severe infection with fulminant colitis, septic shock, and death. CDI puts a heavy burden on healthcare systems due to increased morbidity and mortality, and higher costs. We evaluated the clinical impact of CDI in terms of complications and mortality in a French university hospital compared with patients with diarrhea unrelated to CDI. A 3-year prospective, observational, cohort study was conducted in a French university hospital. Inpatients aged 18 years or older with CDI-suspected diarrhea were eligible to participate in the study and were followed for up to 60 days after CDI testing. Among the 945 patients with diarrhea included, 233 had confirmed CDI. Overall, 106 patients (11.2%) developed at least one of the following complications: colectomy, colitis, ileitis/rectitis, ileus, intestinal perforation, megacolon, multiorgan failure, pancolitis, peritonitis, pseudomembranous colitis, renal failure, and sepsis/septic shock. The complication rate was significantly higher in patients with diarrhea related to C. difficile than in non-CDI patients (26.6% vs 6.2%, P < 0.001). At day 60, 137 (14.5%) patients had died, with 37 deaths among the CDI group (15.9%). Death was attributable to CDI in 15 patients (6.4%). Complications are more frequent among CDI cases than in patients with diarrhea not related to C. difficile. Assessment of CDI is necessary to ensure allocation of sufficient resources to CDI prevention.

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Section: Discussionsupporting

confidence: 78%

Outcomes of Clostridium difficile-suspected diarrhea in a French university hospital

Khanafer¹,

Vanhems²,

Barbut

et al. 2018

Eur J Clin Microbiol Infect Dis

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“…Implementation of these measures have indirectly limited the nosocomial spread of Clostridium difficile, as supported by our results that show a decrease in the incidence density of nosocomial CDI during the period with the maximum incidence of COVID-19. A prospective surveillance study of CDI, conducted by Laza et al in 2015, identified an incidence of CDI in Victor Babes Hospital, of 20.57/15.70 to 1000 discharged patients in 2013/2014 [24]. An increase in healthcare associated CDI-cases admitted in our hospital is also reported by Marinescu et al in 2019, after conducting a one-year observational study [25].…”

Section: Discussionsupporting

confidence: 56%

Clostridium Difficile and COVID-19: General Data, Ribotype, Clinical Form, Treatment-Our Experience from the Largest Infectious Diseases Hospital in Western Romania

et al. 2021

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Background and Objectives: In Coronavirus Disease 2019 (COVID-19), which is caused by the infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the clinical manifestations are primarily related to the pulmonary system. Under 10% of cases also develop gastrointestinal events such as diarrhea, nausea, vomiting and abdominal pain. Materials and Methods: We conducted an observational, retrospective study in the Infectious Diseases Clinic of ‘’Victor Babes’’ Hospital, Timis County, in order to assess the incidence, outcome and risk factors for Clostridium Difficile infection (CDI) in COVID-19 patients. Results: Out of 2065 COVID-19 cases, hospitalized between 1st September 2020 and 30th April 2021, 40 cases of CDI were identified with 32 cases of hospital-onset of CDI and eight cases of community-onset and healthcare-associated CDI. By randomization, polymerase chain reaction ribotyping of Clostridium Difficile was performed in six cases. All the randomized cases tested positive for ribotype 027. The percentage of cases recovered with complications at discharge was higher among COVID-19 patients and CDI (p = 0.001). The in-hospital stay, 36 days versus 28 days, was longer among COVID-19 patients and CDI (p = 0.01). The presence of previous hospitalization (p = 0.004) and administration of antibiotics during the hospital stay, increased the risk of CDI among COVID-19 patients. The mean adjusted CCI at admission was lower among controls (p = 0.01). In two cases, exitus was strictly CDI-related, with one case positive for 027 ribotype. Conclusions: CDI has complicated the outcome of COVID-19 patients, especially for those with comorbidities or previously exposed to the healthcare system. In the face of the COVID-19 pandemic and the widespread, extensive use of antibiotics, clinicians should remain vigilant for possible CDI and SARS-CoV-2 co-infection.

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“…In the hospital in the study, the specific association between the β-lactams with β-lactamase inhibitors prescription and the significant decrease of ceftriaxone consumption can be partly explained by the availability (beginning in 2012) of laboratory diagnoses of Clostridium difficile enterocolitis by Enzyme-Linked Fluorescent Assay (with the detection of toxins A and B in fresh stool samples). We noted an increased awareness for C. difficile associated diseases (CDAD), not only in the ICU included in the present study, but also at the hospital level (IIIrd generation cephalosporins being the most frequently recorded in treatment protocols of CDAD patients) [ 25 ]. The increase for other classes of antibiotics was particularly marked in the context of intensified administration of Colistin, an indirect indication of increased incidence of carbapenem-resistant strains.…”

Section: Discussionmentioning

confidence: 99%

Intensive care antibiotic consumption and resistance patterns: a cross-correlation analysis

Bădițoiu

Axente

Lungeanu

et al. 2017

Ann Clin Microbiol Antimicrob

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BackgroundOver recent decades, a dramatic increase in infections caused by multidrug-resistant pathogens has been observed worldwide. The aim of the present study was to investigate the relationship between local resistance bacterial patterns and antibiotic consumption in an intensive care unit in a Romanian university hospital.MethodsA prospective study was conducted between 1st January 2012 and 31st December 2013. Data covering the consumption of antibacterial drugs and the incidence density for the main resistance phenotypes was collected on a monthly basis, and this data was aggregated quarterly. The relationship between the antibiotic consumption and resistance was investigated using cross-correlation, and four regression models were constructed, using the SPSS version 20.0 (IBM, Chicago, IL) and the R version 3.2.3 packages.ResultsDuring the period studied, the incidence of combined-resistant and carbapenem-resistant P. aeruginosa strains increased significantly [(gradient = 0.78, R2 = 0.707, p = 0.009) (gradient = 0.74, R2 = 0.666, p = 0.013) respectively], mirroring the increase in consumption of β-lactam antibiotics with β-lactamase inhibitors (piperacillin/tazobactam) and carbapenems (meropenem) [(gradient = 10.91, R2 = 0.698, p = 0.010) and (gradient = 14.63, R2 = 0.753, p = 0.005) respectively]. The highest cross-correlation coefficients for zero time lags were found between combined-resistant vs. penicillins consumption and carbapenem-resistant P. aeruginosa strains vs. carbapenems consumption (0.876 and 0.928, respectively). The best model describing the relation between combined-resistant P. aeruginosa strains and penicillins consumption during a given quarter incorporates both the consumption and the incidence of combined-resistant strains in the hospital department during the previous quarter (multiple R2 = 0.953, p = 0.017). The best model for explaining the carbapenem resistance of P. aeruginosa strains based on meropenem consumption during a given quarter proved to be the adjusted model which takes into consideration both previous consumption and incidence density of strains during the previous quarter (Multiple R2 = 0.921, p = 0.037).ConclusionsThe cross-correlation coefficients and the fitted regression models provide additional evidence that resistance during the a given quarter depends not only on the consumption of antibacterial chemotherapeutic drugs in both that quarter and the previous one, but also on the incidence of resistant strains circulating during the previous quarter.Electronic supplementary materialThe online version of this article (10.1186/s12941-017-0251-8) contains supplementary material, which is available to authorized users.

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Clostridium difficile in western Romania: unfavourable outcome predictors in a hospital for infectious diseases

Cited by 13 publications

References 17 publications

Outcomes of Clostridium difficile-suspected diarrhea in a French university hospital

Outcomes of Clostridium difficile-suspected diarrhea in a French university hospital

Clostridium Difficile and COVID-19: General Data, Ribotype, Clinical Form, Treatment-Our Experience from the Largest Infectious Diseases Hospital in Western Romania

Intensive care antibiotic consumption and resistance patterns: a cross-correlation analysis

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