Clostridium difficile infection epidemiology and management: Comparison of results of a prospective study with a retrospective one in a reference teaching and research hospital in Northern Italy

Domeniconi, G.; Serafino, S.; Amicis, Margherita Migone De; Formica, S.; Lanzoni, Monica; Maraschini, Anna; Sisto, Francesca; Consonni, Dario; Cappellini, Maria Domenica; Gavarini, Fabio; Castaldi, Silvana

doi:10.1016/j.ajic.2016.05.003

Cited by 7 publications

(6 citation statements)

References 10 publications

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“…Studies on the prevalence of C. difficile have been performed in many countries (Bauer et al, 2011;Kuwata et al, 2015a;Domeniconi et al, 2016). Although there have been some reports on the molecular epidemiology and antimicrobial susceptibility of C. difficile in China since 2006(Jin et al, 2010, the epidemic characteristics of this bacterium vary, which is probably associated with the geographic region.…”

Section: Introductionmentioning

confidence: 99%

Molecular epidemiology and antimicrobial susceptibility of Clostridium difficile isolated from the Chinese People’s Liberation Army General Hospital in China

Wang

Suo

Chen

et al. 2018

International Journal of Infectious Diseases

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Clostridium difficile is a Gram-positive, spore-forming obligate anaerobe responsible for antibiotic-associated diarrhoea. Its virulence is associated with the production of endotoxins A and B and endospores, which can cause symptoms, such as diarrhoea, toxic megacolon, and pseudomembranous colitis. Given the increasing elderly population and the well-recognized problem of over-prescribing of broad-spectrum antibiotics, it is critical to have an understanding of molecular epidemiology and antimicrobial susceptibility in China. This study analyzed the toxin types and multilocus sequence typing (MLST) results of 74 clinical isolates of C. difficile after the glutamate dehydrogenase (GDH) screening test and anaerobic culture. The minimum inhibitory concentrations (MICs) of four different antibiotics were determined for all of the isolates, and the bacterial resistance mechanisms were investigated. Sixty-five strains (75%) were toxigenic, including 54 tcdA-positive, tcdB-positive, and cdtA/cdtB-negative strains (ABCDT) and nine ABCDT strains. Eleven strains (14.9%) were non-toxigenic. All clinical isolates were classified into 26 MLST genotypes, with the predominant type being ST-54 (18.9%). All isolates were susceptible to vancomycin. The tetracycline, clindamycin, and levofloxacin resistance rates were 1.4%, 36.5%, and 20.3%, respectively. The expression of tet(M), erm(B), and mutations of gyrA and/or gyrB were observed in the tetracycline-, clindamycin-, and levofloxacin-resistant isolates, respectively.

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Section: Introductionmentioning

confidence: 99%

Molecular epidemiology and antimicrobial susceptibility of Clostridium difficile isolated from the Chinese People’s Liberation Army General Hospital in China

Wang

Suo

Chen

et al. 2018

International Journal of Infectious Diseases

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“…Epidemiological inspections were most often conducted in the workplaces of the respondents working in hospital treatment wards, very rarely in outpatient clinics. Numerous studies, as well as our own, confirm the strong correlation between the incidence of nosocomial infections and the number of professional trainings and controls, as well as the level of knowledge and frequency of properly performed medical procedures [ 5 , 18 , 37 ]. An Australian study by Grayson and Stewardson found that after 8 years of targeted training and intensive epidemiological checks implemented in 105 hospitals, the number of HAI had dropped by 15%.…”

Section: Discussionmentioning

confidence: 74%

“…It was found that the lower number of professional trainings for nurses translated not only into an increase in CDI by 36%, but also into a higher number of in-hospital mortality cases. It was also concluded that continuous hospital workers education could be more important than the possibility of isolating infected patients by putting them in single rooms [ 37 ]. That study demonstrated that the Hospital Infection Control Team correctly identified the relationship of intensified education and training in CDI cases and related mortality among patients when analyzing the CDI risk assessment.…”

Section: Discussionmentioning

confidence: 99%

Level of Knowledge of Medical Staff on the Basis of the Survey in Terms of Risk Management, Associated with Clostridioides difficile Infections

Kiersnowska

Lemiech-Mirowska

Semczuk

et al. 2021

IJERPH

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Infections caused by the toxigenic strains of Clostridioides difficile in the hospital environment pose a serious public health problem. The progressive increase in hospital infections in Poland indicates that risk management is a tool that is not used in an effective way and significantly differs from the goals set by the Leading Authorities, the Ministry of Health and its subordinate units. Systematic education of medical personnel constitutes the basic element of rational risk management aimed at reducing the number of infections as it allows for the transfer of knowledge, development of appropriate organizational procedures, and improves internal communication. This paper presents the results of a survey conducted in hospital facilities throughout Poland. The study dealt with what medical personnel know about channels of transmission and prevention of Clostridioides difficile infections in the hospital setting, professional training and risk management in terms of reducing the number of infections. The survey reveals that Clostridioides difficile continues to be a serious problem in the inpatient care system. Procedures and management strategies implemented by hospitals in order to limit the spread of the pathogen are predominantly focused on short-term action, which does not lead to a real improvement in terms of hospitalized patients’ safety. The infection risk management system was assessed at a fairly low level. The obtained research results confirmed the research hypotheses that had been formulated.

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“…Several genomic investigations contradicted the possibility of ward-based contact for many cases, having shown that CD strains isolated from different patients hospitalized in common wards belonged to different types [ 7 ]. Based on epidemiological linkages, health-care workers are considered the infective links for bacterial transmission among patients [ 25 , 26 ]. A very low risk of CDI among household contacts and the absence of outbreaks in the related families contradict the responsibility of health-care workers in diffusion of the disease [ 27 ].…”

Section: Discussionmentioning

confidence: 99%

Epidemiology of Clostridium Difficile Infection in a Large Hospital in Northern Italy: Questioning the Ward-Based Transmission

Piatti¹,

Bruzzone²,

Fontana³

et al. 2017

TOMICROJ

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Background: Clostridium Difficile infection (CDI) is considered a ward-based nosocomial infection, due to contagion among patients. Molecular studies recently questioned ward-based contact for disease spread.Objective:To investigate whether it is plausible that CDI spread in San Martino Hospital of Genoa was due to a ward-based contact and patient-to-patient diffusion.Methods:We conducted a retrospective cohort study of CDI cases from April 2010 to March 2015. We referred to Hospital data set and Admission Service. Multilevel modelling approach and ecological analysis were used to assess C. difficile infection risk according to wards and time of occurrence. Six representative CD strains were ribotyped to assess a possible equivalence.Results:The assessment of 514 CDI cases showed that the risk of disease and rate of incidence in wards were independent, while frequency of cases and number of wards involved exhibited a positive relationship, excluding the typical epidemic pattern of contagious diffusion, i.e., many cases in few wards. The extra-binomial variability due to ward clustering was not significant, indicating homogeneity in the probability of CDI occurrence across all wards. Three hundred sixty-eight patients changed ward, without showing connection between the frequency of cases in new wards and incidence among new subjects. Trigonometric components described a significant contribution of seasonality, with excess of CDI cases during the winter months. Molecular analysis showed different ribotypes of CD strains from the same ward.Conclusion:From our results it seems unlikely that in our institution CDI occurrence is due to ward-based contact and inter-human contagion of the organism.

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Clostridium difficile infection epidemiology and management: Comparison of results of a prospective study with a retrospective one in a reference teaching and research hospital in Northern Italy

Cited by 7 publications

References 10 publications

Molecular epidemiology and antimicrobial susceptibility of Clostridium difficile isolated from the Chinese People’s Liberation Army General Hospital in China

Molecular epidemiology and antimicrobial susceptibility of Clostridium difficile isolated from the Chinese People’s Liberation Army General Hospital in China

Level of Knowledge of Medical Staff on the Basis of the Survey in Terms of Risk Management, Associated with Clostridioides difficile Infections

Epidemiology of Clostridium Difficile Infection in a Large Hospital in Northern Italy: Questioning the Ward-Based Transmission

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