Incidence and Outcomes Associated WithClostridium difficileInfections

Abstract

IMPORTANCE An understanding of the incidence and outcomes of Clostridium difficile infection (CDI) in the United States can inform investments in prevention and treatment interventions. OBJECTIVE To quantify the incidence of CDI and its associated hospital length of stay (LOS) in the United States using a systematic literature review and meta-analysis. DATA SOURCES MEDLINE via Ovid, Cochrane Library Databases via Wiley, Cumulative Index of Nursing and Allied Health Complete via EBSCO Information Services, Scopus, and Web of Science were searched for studies published in the United States between 2000 and 2019 that evaluated CDI and its associated LOS. STUDY SELECTION Incidence data were collected only from multicenter studies that had at least 5 sites. The LOS studies were included only if they assessed postinfection LOS or used methods accounting for time to infection using a multistate model or compared propensity score-matched patients with CDI with control patients without CDI. Long-term-care facility studies were excluded. Of the 119 full-text articles, 86 studies (72.3%) met the selection criteria. DATA EXTRACTION AND SYNTHESIS Two independent reviewers performed the data abstraction and quality assessment. Incidence data were pooled only when the denominators used the same units (eg, patient-days). These data were pooled by summing the number of hospital-onset CDI incident cases and the denominators across studies. Random-effects models were used to obtain pooled mean differences. Heterogeneity was assessed using the I 2 value. Data analysis was performed in February 2019. MAIN OUTCOMES AND MEASURES Incidence of CDI and CDI-associated hospital LOS in the United States. RESULTS When the 13 studies that evaluated incidence data in patient-days due to hospital-onset CDI were pooled, the CDI incidence rate was 8.3 cases per 10 000 patient-days. Among propensity score-matched studies (16 of 20 studies), the CDI-associated mean difference in LOS (in days) between patients with and without CDI varied from 3.0 days (95% CI, 1.44-4.63 days) to 21.6 days (95% CI, 19.29-23.90 days). CONCLUSIONS AND RELEVANCE Pooled estimates from currently available literature suggest that CDI is associated with a large burden on the health care system. However, these estimates should be interpreted with caution because higher-quality studies should be completed to guide future evaluations of CDI prevention and treatment interventions.

Pre-Trained Deep Convolutional Neural Network for Clostridioides Difficile Bacteria Cytotoxicity Classification Based on Fluorescence Images

“…Similar trends are occurring in other countries [1,8]. Further studies assessing infection rates from 2010-2015 confirm that CDI remains a serious public healthcare burden costing US$5.4-6.3 billion per year [9,10].…”

“…The parameters that gave the most promising results are presented in Table 1. Training hyperparameters included: the optimizer type (SGD, RMSprop, Adagrad, Adadelta, Adam, AdaMax, Nadam), the batch size (32,64,128,256,512) and the number of epochs (5,10,15,20,30). In the table, we present the parameters that achieved the highest accuracy (Table 1).…”

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“…The incidence and severity of C. difficile infection (CDI) has increased over the past 20 years [ 2 ] such that it is now the leading cause of hospital-acquired infection worldwide [ 3 ]. In the US, CDI accounts for 15% of all nosocomial infections [ 4 ]. The annual economic cost of CDI in the US is estimated to be $5.4 billion with $4.7 billion of the costs incurred in healthcare settings [ 5 ].…”

Problems of <i>Clostridium difficile</i> infection (CDI) in Polish healthcare units

“…The binary toxin is encoded by the cdtA gene (the enzymic component) and the TcdB gene (the binding component). The extent to which this toxin contributes to the pathogenicity of CDI is now being researched [22][23][24][25][26][27][28][29][30][31][32][33].…”