Clostridium difficile is no longer just a nosocomial infection or an infection of adults

Pituch, Hanna

doi:10.1016/s0924-8579(09)70016-0

Cited by 72 publications

(44 citation statements)

References 27 publications

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“…Although CDI has been historically considered to be a healthcare-associated infection, recent reports have highlighted the prevalence 6 as well as increase in frequency, of the disease in the community. 6,82,83 A primary confounding factor in correctly identifying community-acquired CDI has been the lack of standardized criteria to define point-of-disease acquisition as well as prior antibiotic or risk factor exposure.…”

Section: In the Community And CDI Tropismmentioning

confidence: 99%

Clostridium difficileinfection

2010

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Section: In the Community And CDI Tropismmentioning

confidence: 99%

Clostridium difficileinfection

2010

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“…Most patients had not been hospitalized within the previous year, but more than half had used antibiotics within the previous six months 2 . The cause for this presence in the community has been explained by the previous hospitalization of patients and the use of antibiotics 22 , but this does still not explain the occurrence in our patients without these risk factors. It is possible that the presence in the community of asymptomatic carriers of C. difficile originating in hospitals has increased the community spread of this agent, especially in patients with underlying conditions.…”

mentioning

confidence: 55%

Pseudo-outbreak of Clostridium difficile associated diarrhea (CDAD) in a tertiary-care hospital

Dias

Yamashiro

Borrasca

et al. 2010

Rev. Inst. Med. trop. S. Paulo

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SUMMARYThe objective of this study was to describe a pseudo-outbreak of C. difficile in a hospital, following a change in the method used to detect the toxin.In February 2002, there were two cases of CDAD and in March 7 occurred, coinciding with a change of the test (from detection of toxin A to toxin A/B). An outbreak was suspected. Active surveillance and education of staff were started. A CDAD case was defined as a patient with acute onset of diarrhea (≥ three episodes of liquid stools) and a positive stool test. They were classified as hospital or community-acquired. Stool samples were also collected for C. difficile culture and isolates were typed using AP-PCR.From March 2002 through December 2003 there were 138 cases of CDAD: 70% were hospital-acquired and among the 30% with CDAD present on admission, most (81%) came directly from the community (50% had no history of hospitalization). Fiftytwo percent of hospital-acquired CDAD and 94% of cases on admission had already used antibiotics. The incidence of CDAD in hospitalized patients during surveillance was 3.3 per 1000 patient-admissions. The incidence of CDAD present on admission was 6.1/1000 patients. Sixteen isolates were typed and presented 13 different profiles.In conclusion, the CDAD increase in our study occurred due to change in diagnostic methods and not due to an outbreak, as suspected initially. The incidence in hospitalized patients was much lower than in reported outbreaks. There were 13 molecular types suggesting that an outbreak did not occur. CDAD was largely community-acquired.

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“…Las cepas de interés clínico son las productoras de toxinas: toxina A (TcdA) y/o B (TcdB). Ambas pertenecen al grupo de las grandes toxinas clostridiales (large clostridial toxins-LCTs) debido a sus altos pesos moleculares, 308 kDa para la toxina A y 269,6 kDa para la toxina B 9 . Ambas son mono-glucosil-transferasas que catalizan la glucosilación y la consecuente inactivación de Rho-GTPasas (Rho, Rac y Cdc42-pequeñas proteínas reguladoras del citoesqueleto de actina de las células eucariotas), llevando a la desorganización del citoesqueleto y a la muerte celular.…”

Section: Infectología Al Díaunclassified

“…Para desarrollar colonización o ICD uno debe primero estar expuesto al microorganismo. Aunque esta exposición puede ocurrir en la comunidad 9 , los centros sanitarios están asociados con mayor riesgo de adquirir C. difficile.…”

Section: Factores De Riesgounclassified

“…Aunque cada vez con mayor frecuencia existen casos generados en la comunidad, incluso sin exposición previa a antimicrobianos 9 , la mayor parte de las ICD se encuentran asociadas a la asistencia sanitaria (tanto en hospitales de agudos como de larga estancia) y muchas de estas infecciones pueden prevenirse mediante programas multifactoriales bien estructurados. Ninguna medida de forma individualizada es suficiente en la prevención y control de la ICD en los centros sanitarios.…”

Section: Prevenciónunclassified

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