Is Clostridium Difficile Endemic in Chronic-Care Facilities?

Bender, Bradley S.; Laughon, Barbara E.; Gaydos, Charlotte A.; Forman, Michael; Bennett, Richard G.; Greenough, William B.; Sears, Stephen D.; Bartlett, John G.

doi:10.1016/s0140-6736(86)92559-6

Cited by 173 publications

(72 citation statements)

References 23 publications

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“…In a chronic care facility for the elderly, approximately 30 % of patients were found to harbour C. difficile. Of the patients studied, 28 % were toxinpositive and 33 % were culture-positive (Bender et al, 1986). This compares well with the 27 % of culture-positive and 14 % of toxin-positive patients in the RVH.…”

Section: Discussionsupporting

confidence: 75%

“…These findings compare with a study which isolated C. difficile from 15 % of environmental surfaces in a chronic care ward for the elderly (Bender et al, 1986) and an investigation by Al Saif & Brazier (1996) which isolated C. difficile from 20 % of inanimate objects from various hospital environments.…”

Section: Discussionsupporting

confidence: 54%

“…In healthy adults, the rate of asymptomatic colonization is thought to be less than 5 % (Ambrose et al, 1985;Aronsson et al, 1985;Phillips & Rogers, 1981). However, several studies have shown that rates in hospitalized elderly patients may be much higher (Bender et al, 1986;Brazier et al, 1999).…”

Section: Introductionmentioning

confidence: 99%

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Clostridium difficile in a geriatric unit: a prospective epidemiological study employing a novel S-layer typing method

McCoubrey

Starr

Martin

et al. 2003

Journal of Medical Microbiology

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Clostridium difficile is the major identifiable cause of antibiotic-associated diarrhoea in the UK. The aim of this study was to employ traditional culture, toxin detection and a novel typing method to determine the level of C. difficile colonization and disease in a population of elderly patients and to investigate the association between strains in the patients and their environment. Three hundred and ninety patients between 62 and 101 years of age admitted to a geriatric unit in the Royal Victoria Hospital (RVH), Edinburgh, were investigated for the presence of C. difficile. C. difficile was cultured from 100 (26 %) patients using pre-reduced cycloserine-cefoxitin egg yolk agar, and toxin(s) was detected in the faeces of 34 of these patients using the Techlab ELISA test kit for the detection of C. difficile toxins A and/or B. Toxin(s) was detected in a further 18 patients from whom no C. difficile was detected in culture. Of the patients in whom C. difficile was detected, 49 % had diarrhoea, with the highest proportion of patients with diarrhoea being both culture-and toxin-positive for C. difficile. Environmental sampling of the patient environment yielded C. difficile from 14 % of samples. The organism was most frequently isolated from floors, sluice-rooms and toilet areas. The variation in the molecular mass of the C. difficile S-layer proteins was exploited as the basis of a novel typing method for C. difficile. Isolates from patients in the RVH were given a four-digit 'S-type' number based on their S-layer protein profile. A total of seven S-types were identified, with one type, toxigenic S-type 5236, accounting for 73 % of all clinical isolates and 91 % of environmental isolates.

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Section: Discussionsupporting

confidence: 75%

Section: Discussionsupporting

confidence: 54%

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Clostridium difficile in a geriatric unit: a prospective epidemiological study employing a novel S-layer typing method

McCoubrey

Starr

Martin

et al. 2003

Journal of Medical Microbiology

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“…Our selective case definition decreased the probability of false positives. According to Gerding et al (32), 10% or more of inpatients may be colonized with C difficile; however, only a minority of these patients develop CDAD even when the cytotoxin is found (33)(34)(35).…”

Section: Discussionmentioning

confidence: 99%

N‐CDAD in Canada: Results of the Canadian Nosocomial Infection Surveillance Program 1997 N‐CDAD Prevalence Surveillance Project

Hyland

Ofner-Agostini²,

Miller

et al. 2001

Canadian Journal of Infectious Diseases and Medical Microbiolog

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BACKGROUND:A 1996 preproject survey among Canadian Hospital Epidemiology Committee (CHEC) sites revealed variations in the prevention, detection, management and surveillance ofClostridium difficile-associated diarrhea (CDAD). Facilities wanted to establish national rates of nosocomially acquired CDAD (N-CDAD) to understand the impact of control or prevention measures, and the burden of N-CDAD on health care resources. The CHEC, in collaboration with the Laboratory Centre for Disease Control (Health Canada) and under the Canadian Nosocomial Infection Surveillance Program, undertook a prevalence surveillance project among selected hospitals throughout Canada.OBJECTIVE:To establish national prevalence rates of N-CDAD.METHODS:For six weeks in 1997, selected CHEC sites tested all diarrheal stools from inpatients for eitherC difficiletoxin orC difficilebacteria with evidence of toxin production. Questionnaires were completed for patients with positive stool assays who met the case definitions.RESULTS:Nineteen health care facilities in eight provinces participated in the project. The overall prevalence of N-CDAD was 13.0% (95% CI 9.5% to 16.5%). The mean number of N-CDAD cases were 66.3 cases/100,000 patient days (95% CI

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“…20 Clinical improvement should be expected within 2 days after vancomycin and 3 days after metronidazole. [21][22][23][24][25][26] In our case, no clinical improvement was observed after administration of vancomycin alone. The patient's condition and the results of laboratory and colonoscopic examinations deteriorated further in spite of administration of the recommended oral vancomycin dosage of 125 mg four times a day, which should result in an approximate 300-1000 mg/l stool concentration.…”

Section: Discussionmentioning

confidence: 86%

Pseudomembraneous clostridium after autologous bone marrow transplantation

Kavan

Sochor

Nyč

et al. 1998

Bone Marrow Transplant

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Summary:Clostridium difficile (C. difficile) pseudomembraneous colitis was diagnosed in a 13-year-old boy with Hodgkin's disease 3 months after autologous bone marrow transplantation. Hematopoiesis was fully reconstituted at the time. C. difficile infection occurred after gall bladder empyema had been treated conservatively with i.v. antibiotics and prophylactic 4-week administration of oral amoxicillin. C. difficile colitis was diagnosed early and intensive supportive therapy combined with administration of i.v. and subsequently oral vancomycin therapy failed. It is a phenomenon rarely seen and successful eradication of the clostridium infection was only achieved by a combination of higher dose vancomycin with metronidazole. During the post-colitis recovery the patient experienced a relapse of Hodgkin's disease and died following further surgical intervention 137 days post-transplantation.

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Is Clostridium Difficile Endemic in Chronic-Care Facilities?

Cited by 173 publications

References 23 publications

Clostridium difficile in a geriatric unit: a prospective epidemiological study employing a novel S-layer typing method

Clostridium difficile in a geriatric unit: a prospective epidemiological study employing a novel S-layer typing method

N‐CDAD in Canada: Results of the Canadian Nosocomial Infection Surveillance Program 1997 N‐CDAD Prevalence Surveillance Project

Pseudomembraneous clostridium after autologous bone marrow transplantation

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