Potential for Transmission of Spores by Patients Awaiting Laboratory Testing to Confirm Suspected <i>Clostridium difficile</i> Infection

Sunkesula, Venkata; Kundrapu, Sirisha; Jury, Lucy A.; Deshpande, Abhishek; Sethi, Ajay K.; Donskey, Curtis J.

doi:10.1086/669510

Cited by 29 publications

(12 citation statements)

References 9 publications

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“…Применение контактных мер предосторожности у пациентов с подозрением на ИКД является важным до получения подтверждающего результата лабораторного исследования, если это требует ожидания. В проспек тивном исследовании у 100 пациентов с подозрением на ИКД оценивались контаминация кожных покровов, а также среднее время до получения результатов иссле дований [218]. Возможность контаминации рук меди цинского персонала оценивали путем контакта стериль ными помещенными в перчатки руками с наиболее часто обследуемыми участками кожных покровов пациента, с последующим помещением перчаток на агар (создание отпечатка) для получения культуры C. difficile.…”

Section: резюме по научному обоснованиюunclassified

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2018

CMAC

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Section: резюме по научному обоснованиюunclassified

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2018

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“…Estos datos concuerdan con estudios clínicos donde 50% de los pacientes que se recuperan de un episodio de IACD se convierten en diseminadores asintomáticos de sus esporas por un período de 1-4 semanas después de la antibioterapia 26,38 . Un estudio reciente ha demostrado que las esporas de C. difficile son capaces de adherirse con una elevada eficiencia a células epiteliales in vitro, llegando a niveles de 60% de adherencia después de tres horas de infección 24 .…”

Section: Formación De La Espora De C Difficile Durante La Iacdunclassified

Esporas de Clostridium difficile y su relevancia en la persistencia y transmisión de la infección

Barra-Carrasco

Hernández-Rocha

Ibáñez

et al. 2014

Rev. chil. infectol.

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Clostridium difficile spores and its relevance in the persistence and transmission of the infection C. difficile is an anaerobic spore former pathogen and the most important etiologic agent of nosocomial and community acquired antibiotics associated diarrheas. C. difficile infections (CDI) are responsible for an elevated rate of morbidity in developed and developing countries. Although the major virulence factors responsible for clinical symptoms of CDI are the two toxins TcdA and TcdB, C. difficile spores are the main vehicle of infection, persistence and transmission of CDI. Recent work has unrevealed unique properties of C. difficile spores that make them remarkable morphotypes of persistence and transmission in the host, including their resistance to antibiotics, the host immune response and disinfectants. The present review summarizes relevant aspects of C. difficile spore biology that have major implications from a clinical and medical perspective.

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“…Nosocomial outbreaks occur regularly, posing a risk for patients due to C. difficile infection (CDI) attributed mortality and morbidity [2,3]. These outbreaks are associated with delayed diagnosis and absence of adequate infection prevention measures [4,5].…”

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confidence: 99%

Implementing a Clostridium difficile testing algorithm and its effect on isolation duration and treatment initiation: a pre- and post-implementation study

Vogelzang

Lankelma

Mansfeld

et al. 2020

Eur J Clin Microbiol Infect Dis

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A proportion of patients suspected of Clostridium difficile infection are unnecessarily placed in contact isolation. By introducing a random-access glutamate dehydrogenase (GDH) test for C. difficile, we aimed to reduce isolation time. In addition, we investigated whether the result of the toxin A&B enzyme immunoassay (EIA) was associated with the decision to initiate antibiotic treatment against C. difficile. This retrospective pre-and post-implementation study was from June 3, 2016, to June 4, 2018. Pre-implementation, only a NAAT was performed. In the post-implementation period, a GDH test was performed; if positive, a toxin A&B EIA followed the same day and subsequently a NAAT. Contact isolation for CDI was discontinued when the GDH test was negative. Median time in isolation was 50.8 h pre-implementation (n = 189) versus 28.0 h post-implementation (n = 119), p < 0.001. The GDH test had a negative predictive value of 98.8% (95% CI 97.9-99.4). In 7/31 (22.6%) patients with a positive NAAT and GDH test and a negative toxin A&B EIA, no antibiotics against C. difficile were initiated versus 4/28 (14.3%) patients who were NAAT, GDH and toxin A&B EIA positive. Introducing a random-access screening test resulted in a significant decrease in patient isolation time. The GDH test had a high negative predictive value making it suitable to determine whether contact isolation can be discontinued. Furthermore, the result of a toxin A&B EIA had limited added value on the percentage of patients in whom antibiotic treatment against C. difficile was initiated.

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Potential for Transmission of Spores by Patients Awaiting Laboratory Testing to Confirm Suspected Clostridium difficile Infection

Cited by 29 publications

References 9 publications

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Esporas de Clostridium difficile y su relevancia en la persistencia y transmisión de la infección

Implementing a Clostridium difficile testing algorithm and its effect on isolation duration and treatment initiation: a pre- and post-implementation study

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