<i>Clostridium difficile</i>in Long-Term–Care Facilities for the Elderly

Simor, Andrew E.; Bradley, Suzanne F.; Strausbaugh, Larry J.; Crossley, Kent; Nicolle, Lindsay E.

doi:10.1086/501997

Cited by 205 publications

(159 citation statements)

References 116 publications

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“…C. difficile is a major intestinal pathogen and particularly common among the elderly (Simor et al 2002). C. difficile was detected at low levels in 65% of the volunteers at the run-in.…”

Section: Discussionmentioning

confidence: 99%

Probiotic cheese containing Lactobacillus rhamnosus HN001 and Lactobacillus acidophilus NCFM® modifies subpopulations of fecal lactobacilli and Clostridium difficile in the elderly

Lahtinen

Forssten

Aakko

et al. 2011

AGE

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Aging is associated with alterations in the intestinal microbiota and with immunosenescence. Probiotics have the potential to modify a selected part of the intestinal microbiota as well as improve immune functions and may, therefore, be particularly beneficial to elderly consumers. In this randomized, controlled cross-over clinical trial, we assessed the effects of a probiotic cheese containing Lactobacillus rhamnosus HN001 and Lactobacillus acidophilus NCFM on the intestinal microbiota and fecal immune markers of 31 elderly volunteers and compared these effects with the administration of the same cheese without probiotics. The probiotic cheese was found to increase the number of L. rhamnosus and L. acidophilus NCFM in the feces, suggesting the survival of the strains during the gastrointestinal transit. Importantly, probiotic cheese administration was associated with a trend towards lower counts of Clostridium difficile in the elderly, as compared with the run-in period with the plain cheese. The effect was statistically significant in the subpopulation of the elderly who harbored C. difficile at the start of the study. The probiotic cheese was not found to significantly alter the levels of the major microbial groups, suggesting that the microbial changes conferred by the probiotic cheese were limited to specific bacterial groups. Despite that the administration of the probiotic cheese to the study population has earlier been shown to significantly improve the innate immunity of the elders, we did not observe measurable changes in the fecal immune IgA concentrations. No increase in fecal calprotectin and β-defensin concentrations suggests that the probiotic treatment did not affect intestinal inflammatory markers. In conclusion, the administration of probiotic cheese containing L. rhamnosus HN001 and L. acidophilus NCFM, was associated with specific changes in the intestinal microbiota, mainly affecting specific subpopulations of intestinal lactobacilli and C. difficile, but did not have significant effects on the major microbial groups or the fecal immune markers.

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“…C. difficile is a major intestinal pathogen and particularly common among the elderly (Simor et al 2002). C. difficile was detected at low levels in 65% of the volunteers at the run-in.…”

Section: Discussionmentioning

confidence: 99%

Probiotic cheese containing Lactobacillus rhamnosus HN001 and Lactobacillus acidophilus NCFM® modifies subpopulations of fecal lactobacilli and Clostridium difficile in the elderly

Lahtinen

Forssten

Aakko

et al. 2011

AGE

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“…Surveillance for CDI is limited by the use of nonculture-based methods to diagnose CDI, such as stool toxin assays, which have lower sensitivity than does C. difficile stool culture. [20][21][22][24][25][26][27] 2. Identifying patients with CDI Positive results of diarrheal stool tests for toxigenic C. difficile or its toxins are the most common methods used to identify patients with CDI.…”

Section: Purposementioning

confidence: 99%

“…Published guidelines for the management of CDI are few, and only some address CDI prevention. 22,[25][26][27] i. Most data published on CDI prevention are from before-after studies conducted in response to outbreaks.…”

Section: Purposementioning

confidence: 99%

Strategies to Prevent Clostridium difficile Infections in Acute Care Hospitals

Dubberke

Gerding

Classen

et al. 2008

Infect. Control Hosp. Epidemiol.

189

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Previously published guidelines are available that provide comprehensive recommendations for detecting and preventing healthcare-associated infections. The intent of this document is to highlight practical recommendations in a concise format designed to assist acute care hospitals in implementing and prioritizing their Clostridium difficile infection (CDI) prevention efforts. Refer to the Society for Healthcare Epidemiology of America/Infectious Diseases Society of America “Compendium of Strategies to Prevent Healthcare-Associated Infections” Executive Summary and Introduction and accompanying editorial for additional discussion.1. Increasing rates of CDIC. difficile now rivals methicillin-resistant Staphylococcus aureus (MRSA) as the most common organism to cause healthcare-associated infections in the United States.a. In the United States, the proportion of hospital discharges in which the patient received the International Classification of Diseases, Ninth Revision discharge diagnosis code for CDI more than doubled between 2000 and 2003, and CDI rates continued to increase in 2004 and 2005 (L. C. McDonald, MD, personal communication, July 2007). These increases have been seen in pediatric and adult populations, but elderly individuals have been disproportionately affected. CDI incidence has also increased in Canada and Europe.b. There have been numerous reports of an increase in CDI severity.c. Most reports of increases in the incidence and severity of CDI have been associated with the BI/NAP1/027 strain of C. difficile. This strain produces more toxins A and B in vitro than do many other strains of C. difficile, produces a third toxin (binary toxin), and is highly resistant to fluoroquinolones.

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“…Besides pseudomembranous colitis and toxic megacolon, complications, such as hypokalemia, gastrointestinal bleeding, and bowel perforation occur in up to 10% of patients with C. difficile-associated diarrhea (CDAD) [25]. However, residents of nursing homes with C. difficile are most often asymptomatic and will clear their feces by 2 months, although prolonged colonization for 3 months or longer has been observed [26]. An estimated 20% to 35% of patients with CDAD will experience at least one recurrent episode of CDAD.…”

Section: Clostridium Difficilementioning

confidence: 99%

“…During outbreaks of CDAD, up to 30% of nursing home residents have been found to harbor C. difficile [26].…”

Section: Clostridium Difficilementioning

confidence: 99%