Clostridium difficile infection in elderly nursing home residents

Diaz, Cristina Rodriguez; Koulagenko, Nicolas Korsak; Taminiau, Bernard; Avesani, Véronique; Broeck, Johan Van; Delmée, Michel; Daube, Georges

doi:10.1016/j.anaerobe.2014.08.007

Cited by 24 publications

(17 citation statements)

References 32 publications

(44 reference statements)

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“…C. difficile is now a worldwide public health concern, as it is considered the major cause of antibiotic-associated infections in healthcare settings. Three previous reviews have addressed the recent epidemiology of CDI in hospitals, nursing homes and in the community as well as the principal outbreaks reported [2,42,43].…”

Section: Clostridium Difficile Discovery and Its Early History In Humansmentioning

confidence: 99%

“…Various automated RT-PCR systems are commercially available, intended as diagnostic tools for CDI. These systems include BD GeneOhm™ Cdiff (Becton Dickenson) 2 and Xpert ® C. difficile (Cepheid). 3 These commercial RTPCRs have been shown to be rapid (<4 h for a result), sensitive and specific.…”

Section: Laboratory Diagnosis Of CDImentioning

confidence: 99%

“…It is responsible for outbreaks of hospitalacquired infection, with symptoms including serious diarrhoea and, in several cases, pseudomembranous colitis and even death. Although the principal risk factors in patients are a history of antibiotic treatment, an age of over 65 years, and prolonged hospitalisation [1,2], in recent years, studies have described the bacterium spreading further into the community [3] and an increase in the incidence and severity of nosocomial C. difficile infection (CDI) in North America and Europe [4]. This rise has been attributed to the emergence of new hypervirulent strains, including PCRribotype 027 [5] and PCR-ribotype 078 [6], which has been associated with antimicrobial exposure.…”

Section: Introductionmentioning

confidence: 99%

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Clostridium difficile infection: Early history, diagnosis and molecular strain typing methods

Rodríguez

Broeck

Taminiau

et al. 2016

Microbial Pathogenesis

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a b s t r a c tRecognised as the leading cause of nosocomial antibiotic-associated diarrhoea, the incidence of Clostridium difficile infection (CDI) remains high despite efforts to improve prevention and reduce the spread of the bacterium in healthcare settings. In the last decade, many studies have focused on the epidemiology and rapid diagnosis of CDI. In addition, different typing methods have been developed for epidemiological studies. This review explores the history of C. difficile and the current scope of the infection. The variety of available laboratory tests for CDI diagnosis and strain typing methods are also examined.

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Section: Clostridium Difficile Discovery and Its Early History In Humansmentioning

confidence: 99%

Section: Laboratory Diagnosis Of CDImentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Clostridium difficile infection: Early history, diagnosis and molecular strain typing methods

Rodríguez

Broeck

Taminiau

et al. 2016

Microbial Pathogenesis

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“…While the C. difficile carriage rate in healthy adults is 1-3%, hospitalization is an important risk factor that increases the risk of colonization. After hospitalization, the frequency of asymptomatic colonization increases to 20-30%, especially in elderly patients (2)(3)(4).…”

mentioning

confidence: 99%

A Diagnostic Algorithm for the Detection of Clostridium difficile-Associated Diarrhea

Yoldaş¹,

Altındiş²,

Çufali³

et al. 2016

Balkan Med J

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Background: Clostridium difficile is a common cause of hospital-acquired diarrhea, which is usually associated with previous antibiotic use. The clinical manifestations of C. difficile infection (CDI) may range from mild diarrhea to fulminant colitis. Clostridium difficile should be considered in diarrhea cases with a history of antibiotic use within the last 8 weeks (community-associated CDI) or with a hospital stay of at least 3 days, regardless of the duration of antibiotic use (hospital-acquired CDI). Aims: This study investigated the frequency of CDI in diarrheic patients and evaluated the efficacy of the triple diagnostic algorithm that is proposed here for C. difficile detection. Study Design: Cross-sectional study. Methods: In this study, we compared three methods currently employed for C. difficile detection using 95 patient stool samples: an enzyme immunoassay (EIA) for toxin A/B (C. diff Toxin A+B; Diagnostic Automation Inc.; Calabasas, CA, USA), an EIA for glutamate dehydrogenase (GDH) (C. DIFF CHEK-60TM, TechLab Inc.; Blacksburg, VA, USA), and a polymerase chain reaction (PCR)-based assay (GeneXpert ® C. difficile; Cepheid, Sunnyvale, CA, USA) that detects C. difficile toxin genes and conventional methods as well. In this study, 50.5% of the patients were male, 50 patients were outpatients, 32 were from inpatient clinics and 13 patients were from the intensive care unit. Results:Of the 95 stool samples tested for GDH, 28 were positive. Six samples were positive by PCR, while nine samples were positive for toxin A/B. The hypervirulent strain NAP-1 and binary toxin was not detected. The rate of occurrence of toxigenic C. difficile was 5.1% in the samples. Cefaclor, ampicillin-sulbactam, ertapenem, and piperacillin-tazobactam were the most commonly used antibiotics by patients preceding the onset of diarrhea. Among the patients who were hospitalized in an intensive care unit for more than 7 days, 83.3% were positive for CDI by PCR screening. If the PCR test is accepted as the reference: C. difficile Toxin A/B ELISA sensitivity and specificity were 67% and 94%, respectively, and GDH sensitivity and specificity were 100% and 75%, respectively. Conclusion: Tests targeting C. difficile toxins are frequently applied for the purpose of diagnosing CDI in a clinical setting. However, changes in the temperature and reductant composition of the feces may affect toxin stability, potentially yielding false-negative test results. Therefore, employment of a GDH EIA, which has high sensitivity, as a screening test for the detection of toxigenic strains, may prevent false-negative results, and its adoption as part of a multistep diagnostic algorithm may increase accuracy in the diagnosis of CDIs.

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“…Toxigenic strains of C. difficile produce the toxin A and B exotoxins that mainly cause the symptoms of Infection C. difficile. In addition, some strains produce the binary toxin, whose role in the pathogenesis is not yet very clear [101][102][103]. The reference method for the detection of C. difficile is cytotoxicity of stool in cell culture, is recognized as the most sensitive method for detection of C. difficile, but its specificity is low, it does not distinguish between toxigenic and non-toxigenic isolates and requires 24 -48 h to obtain the first results [104].…”

Section: Difficile Toxinsmentioning

confidence: 99%