Mortality in Clostridium difficile infection

Bloomfield, Maxim G.; Carmichael, Andrew; Gkrania‐Klotsas, Effrossyni

doi:10.1097/meg.0b013e32835ed64d

Cited by 19 publications

(4 citation statements)

References 15 publications

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“…This number equated to an observed 30-day crude case fatality rate of 9.3% for patients with health care-associated infection, a rate that is similar to that reported in studies of hospitalized patients with C. difficile infection. [38][39][40] Since the mortality that is attributable to C. difficile infection is estimated Of the estimated cases of community-associated CDI, 82% were estimated to be associated with outpatient health care exposure. 11 CO-HCA denotes communityonset health care-associated infection, HO hospital onset, and NHO nursing home onset.…”

Section: Discussionmentioning

confidence: 99%

Burden of Clostridium difficile Infection in the United States

2015

N Engl J Med

153

106

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BackgroundThe magnitude and scope of Clostridium difficile infection in the United States continue to evolve. MethodsIn 2011, we performed active population-and laboratory-based surveillance across 10 geographic areas in the United States to identify cases of C. difficile infection (stool specimens positive for C. difficile on either toxin or molecular assay in residents ≥1 year of age). Cases were classified as community-associated or health care-associated. In a sample of cases of C. difficile infection, specimens were cultured and isolates underwent molecular typing. We used regression models to calculate estimates of national incidence and total number of infections, first recurrences, and deaths within 30 days after the diagnosis of C. difficile infection. ResultsA total of 15,461 cases of C. difficile infection were identified in the 10 geographic areas; 65.8% were health care-associated, but only 24.2% had onset during hospitalization. After adjustment for predictors of disease incidence, the estimated number of incident C. difficile infections in the United States was 453,000 (95% confidence interval [CI], 397,100 to 508,500). The incidence was estimated to be higher among females (rate ratio, 1.26; 95% CI, 1.25 to 1.27), whites (rate ratio, 1.72; 95% CI, 1.56 to 2.0), and persons 65 years of age or older (rate ratio, 8.65; 95% CI, 8.16 to 9.31). The estimated number of first recurrences of C. difficile infection was 83,000 (95% CI, 57,000 to 108,900), and the estimated number of deaths was 29,300 (95% CI, 16,500 to 42,100). The North American pulsed-field gel electrophoresis type 1 (NAP1) strain was more prevalent among health care-associated infections than among community-associated infections (30.7% vs. 18.8%, P<0.001) ConclusionsC. difficile was responsible for almost half a million infections and was associated with approximately 29,000 deaths in 2011. (Funded by the Centers for Disease Control and Prevention.

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Section: Discussionmentioning

confidence: 99%

Burden of Clostridium difficile Infection in the United States

2015

N Engl J Med

153

106

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“…The influence of hyperbilirubinemia on outcomes in severe sepsis has previously been described, as has the role of leukocytosis in acute care admissions, patients with pancreatitis, and patients with Clostridium difficile –associated colitis . Biliary stasis is known to result from sepsis, likely due to a multifactorial process (eg, chemokine-induced downregulation of bile uptake, endothelial damage by free radicals, and microthrombi of the vasculature of the biliary system) .…”

Section: Discussionmentioning

confidence: 99%

Association of Admission Laboratory Values and the Timing of Endoscopic Retrograde Cholangiopancreatography With Clinical Outcomes in Acute Cholangitis

et al. 2016

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White blood cell count greater than 20 000 cells/µL and total bilirubin level greater than 10 mg/dL are independent prognostic factors for adverse outcomes in AC. Consideration should be given to include these criteria in the Tokyo Guidelines severity assessment. Timing of endoscopic retrograde cholangiopancreatography does not appear to affect clinical outcomes in these patients. Management of AC has improved with time, with an overall shorter hospital length of stay, lower rate of intensive care unit admission, and a decreased adjusted mortality, demonstrating improvements in care efficiency and delivery.

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“…In geriatric patients, the severity of the disease course, the recurrence rates and the mortality are even higher [12–14]. …”

Section: Introductionmentioning

confidence: 99%

Asymptomatic and yet C. difficile-toxin positive? Prevalence and risk factors of carriers of toxigenic Clostridium difficile among geriatric in-patients

2016

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Background Clostridium difficile infections (CDI) are the most frequent cause of diarrhoea in hospitals. Geriatric patients are more often affected by the condition, by a relapse and complications. Therefore, a crucial question is how often colonization with toxigenic Clostridium difficile strains occurs in elderly patients without diarrhoea and whether there is a “risk pattern” of colonized patients that can be defined by geriatric assessment. Furthermore, the probability for those asymptomatic carriers to develop a symptomatic infection over time has not been sufficiently explored.MethodsWe performed a cohort study design to assess the association of clinical variables with Clostridium difficile colonization. The first stool sample of 262 consecutive asymptomatic patients admitted to a geriatric unit was tested for toxigenic Clostridium difficile using PCR (GeneXpert, Cepheid). A comprehensive geriatric assessment (CGA) including Barthel Index, Mini Mental State Examination (MMSE) and hand grip-strength was performed. In addition, Charlson Comorbidity Index, body mass index, number and length of previous hospital stays, previous treatment with antibiotics, institutionalization, primary diagnoses and medication were recorded and evaluated as possible risk factors of colonization by means of binary logistic regression. Secondly, we explored the association of C. difficile colonization with subsequent development of CDI during hospital stay.ResultsAt admission, 43 (16.4%) patients tested positive for toxin B by PCR. Seven (16.3%) of these colonized patients developed clinical CDI during hospital stay, compared to one out of 219 patients with negative or invalid PCR testing (Odds ratio 12,3; Fisher’s exact test: p = 0.000). Overall, 7 out of 8 (87.5%) CDI patients had been colonized at admission. Risk factors of colonization with C. difficile were a history of CDI, previous antibiotic treatment and hospital stays. The parameters of the CGA were not significantly associated with colonization.ConclusionColonization with toxigenic Clostridium difficile strains occurs frequently in asymptomatic patients admitted to a geriatric unit. Previous CDI, antibiotic exposure and hospital stay, but not clinical variables such as CGA, are the main factors associated with asymptomatic Clostridium difficile carriage. Colonization is a crucial risk factor for subsequent development of symptomatic CDI.

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Mortality in Clostridium difficile infection

Abstract: We have demonstrated in a prospective cohort of patients diagnosed with CDI that WBC and serum albumin, when used together, offer good risk predictive ability for mortality. Our results support the inclusion of these parameters in a clinically useful risk prediction model.

Cited by 19 publications

References 15 publications

Burden of Clostridium difficile Infection in the United States

Burden of Clostridium difficile Infection in the United States

Association of Admission Laboratory Values and the Timing of Endoscopic Retrograde Cholangiopancreatography With Clinical Outcomes in Acute Cholangitis

Asymptomatic and yet C. difficile-toxin positive? Prevalence and risk factors of carriers of toxigenic Clostridium difficile among geriatric in-patients

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