Epidemiology of Clostridioides difficile infection in Canada: A six-year review to support vaccine decision-making

Xia, Yiqing; Tunis, Matthew; Frenette, Charles; Katz, Kevin; Amaratunga, Kanchana; Rose, S Rhodenizer; House, Althea; Quach, Caroline

doi:10.14745/ccdr.v45i78a04

Cited by 18 publications

(16 citation statements)

References 7 publications

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“…A study of a network of hospital laboratories in Poland aimed at determining the annual CDI incidence rate in 2011–2013 showed an average incidence of 6/10,000 pds (2011), 9/10,000 pds (2012), and 10/10,000 pds (2013) [ 31 ]. A multicentre Canadian study in 2011–2016 established that the incidence density ranged from 2 to 7/10,000 pds [ 32 ]. In the ECDC report for 2016, the incidence density in European countries is given as 2/10,000 pds; however, there is a large discrepancy between individual countries, from 2/10,000 pds in Austria to 13/10,000 pds in Estonia.…”

Section: Discussionmentioning

confidence: 99%

The Incidence of Healthcare-Associated Infections, Their Clinical Forms, and Microbiological Agents in Intensive Care Units in Southern Poland in a Multicentre Study from 2016 to 2019

Rafa

Wałaszek

et al. 2021

IJERPH

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Introduction. Healthcare-associated infections (HAIs) are a serious problem of modern medicine. Patients hospitalized in intensive care units (ICUs) develop HAI significantly more often than patients in other hospital units. Materials and Methods. Analysis involved HAIs from three ICUs in southern Poland. The study was conducted in 2016–2019 on the basis of methodology recommended by the Healthcare-Associated Infections Surveillance Network (HAI-Net) and European Centre for Disease Prevention and Control (ECDC). The objective was to analyse HAIs, their clinical forms, and microbiological agents. Results. The study included 3028 patients hospitalized for 26,558 person-days (pds) in ICU. A total of 540 HAIs were detected; incidence per 100 hospitalizations was 17.8%, incidence density per 1000 pds was 20.3. The mortality of patients with HAI was 16%, and in Clostridioides difficile infection (CDI), the mortality was 28%. The most common clinical form of HAI was bloodstream infection (BSI): 209 cases (incidence rate 6.9%), followed by pneumonia (PN): 131 (incidence rate 4.3%), and urinary tract infection (UTI): 110 cases (incidence rate 3.6%). The most frequently isolated bacteria were Klebsiella pneumoniae 16.4%, Acinetobacter baumannii 14.4%, Staphylococcus aureus 11.8%, and Escherichia coli 11.4%. Conclusions. A two-fold higher incidence rate of BSI was detected compared to the average incidence in European countries. BSI of unknown source (BSI-UNK) was predominant. K. pneumoniae and A. baumannii bacteria were the most often isolated microorganisms causing HAI. Infection control based on incidence rate for each type of infection is necessary in ICU to assess the epidemiological situation.

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Section: Discussionmentioning

confidence: 99%

The Incidence of Healthcare-Associated Infections, Their Clinical Forms, and Microbiological Agents in Intensive Care Units in Southern Poland in a Multicentre Study from 2016 to 2019

Rafa

Wałaszek

et al. 2021

IJERPH

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“…Hospital-acquired infection (HAI) was defined as CDI present >72 hours after admission, whereas non-HAI was defined as CDI present ≤72 hours after admission. 14 CDI severity was defined according to IDSA and SHEA guidelines. 13 A patient with white blood cell count ≥15×10 9 /L or a serum creatinine level >1.5 mg/dL was considered to have severe CDI.…”

Section: Study Populationmentioning

confidence: 99%

Initial vancomycin versus metronidazole for the treatment of first-episode non-severe Clostridioides difficile infection

Zhang

Beckett

Abouanaser

et al. 2021

ASHE

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Objective: Clostridioides difficile infection (CDI) is the leading cause of infectious nosocomial diarrhea. Although initial fidaxomicin or vancomycin treatment is recommended by most major guidelines to treat severe CDI, there exists varied recommendations for first-episode non-severe CDI. Given the discrepancy in current treatment guidelines, we sought to evaluate the use of initial vancomycin versus metronidazole for first-episode non-severe CDI. Methods: We conducted a retrospective cohort study of all adult inpatients with first-episode CDI at our institution from January 2013 to May 2018. The initial vancomycin versus initial metronidazole cohorts were examined using a multivariate logistic regression model. Results: The study cohort of 737 patients had a median age of 72.3 years, and 357 of these patients (48.4%) had hospital-acquired infection. Among 326 patients with non-severe CDI, recurrence, new incident infection, and 30-day mortality rates were 16.2%, 10.9%, and 5.3%, respectively, when treated with initial metronidazole, compared to 20.0%, 1.4%, and 10.0%, respectively, when treated with initial vancomycin. In an adjusted multivariable analysis, the use of initial vancomycin for the treatment of non-severe CDI was associated with a reduction in new incident infection (adjusted odds ratio [ORadj], 0.11; 95% confidence interval [CI], 0.02–0.86; P = .035), compared to initial metronidazole. Conclusions: Initial vancomycin was associated with a reduced rate of new incident infection in the treatment of adult inpatients with first-episode non-severe CDI. These findings support the use of initial vancomycin for all inpatients with CDI, when fidaxomicin is unavailable.

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“…Time to treatment and time to recurrence were measured from the start of the initial CDI diagnosis. Hospital-acquired infection (HAI) was defined as CDI present >72 hours after admission or infection present on admission, whereas non-HAI was defined as CDI present ≤72 hours after admission [13].…”

Section: Methodsmentioning

confidence: 99%

Initial vancomycin versus metronidazole for the treatment of first-episode non-severe Clostridioides difficile infection

Zhang

Beckett

Abouanaser

et al. 2020

Preprint

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BackgroundClostridium difficile infection (CDI) is an important cause of nosocomial diarrhea. Given the discrepancy in current treatment guidelines for mild CDI, we sought to evaluate the use of first-line vancomycin for the treatment of non-severe infection.MethodsWe conducted a retrospective cohort study of all adult inpatients with first episode CDI at our institution from January 2013 to May 2018. CDI was defined as a positive C. difficile loop-mediated isothermal amplification assay, in conjunction with ≥3 type 5–7 stools on the Bristol stool scale. To evaluate the impact of first-line vancomycin treatment on adverse clinical outcomes in patients with first episode non-severe CDI, the initial vancomycin vs. initial metronidazole cohorts were first examined in an unadjusted logistic regression analysis for any combination of relapse, recurrence, and all-cause 30-day mortality, followed by an adjusted multivariable analysis.ResultsA total of 737 cases were included. Patients had a median age of 72.3 years (Q1: 61.2, Q3: 83.3) and 628 (85.2%) were classified as non-severe CDI. Among patients with non-severe CDI (n = 628), relapse, recurrence, and mortality rates were 17.4%, 7.0%, and 11.4%, respectively, when treated with initial metronidazole, compared to 18.6%, 3.1%, and 7.8%, respectively, when treated with initial vancomycin. In an adjusted multivariable analysis, the use of first-line vancomycin for the treatment of non-severe CDI was associated with a reduction in recurrence or 30-day mortality (ORadj: 0.51; 95%CI: 0.28–0.94; P=0.03).ConclusionsInitial vancomycin was associated with reduced recurrence or all-cause 30-day mortality in the treatment of adult inpatients with first episode non-severe CDI. Our findings support the use of initial vancomycin for all C. difficile inpatients, irrespective of disease severity, as recommended by Infectious Diseases Society of America guidelines.

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Epidemiology of Clostridioides difficile infection in Canada: A six-year review to support vaccine decision-making

Cited by 18 publications

References 7 publications

The Incidence of Healthcare-Associated Infections, Their Clinical Forms, and Microbiological Agents in Intensive Care Units in Southern Poland in a Multicentre Study from 2016 to 2019

The Incidence of Healthcare-Associated Infections, Their Clinical Forms, and Microbiological Agents in Intensive Care Units in Southern Poland in a Multicentre Study from 2016 to 2019

Initial vancomycin versus metronidazole for the treatment of first-episode non-severe Clostridioides difficile infection

Initial vancomycin versus metronidazole for the treatment of first-episode non-severe Clostridioides difficile infection

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