Reduced Clostridioides difficile infection in a pragmatic stepped-wedge initiative using admission surveillance to detect colonization

Peterson, Lance R.; O’Grady, Sean; Keegan, Mary; Fisher, Adrienne; Zelencik, Shane; Kufner, Bridget; Shah, Mona D.; Lim, Rachel; Schora, Donna; Das, Sanchita; Singh, Kamaljit

doi:10.1371/journal.pone.0230475

Cited by 5 publications

(9 citation statements)

References 38 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The results obtained in our study showed that the only patient diagnosed with gastroenteritis with Rotavirus developed the 'unsubtype-able' form of PI-IBS. They is also an argument for the prevention of enteral infection from the hospital admission, thus avoiding subsequent development of long-term medical conditions such as PI-IBS (43).…”

Section: Discussionmentioning

confidence: 99%

Post‑infectious irritable bowel syndrome after a laboratory‑proven enteritis

et al. 2020

View full text Add to dashboard Cite

There are scarce data on risk factors for post-infectious irritable bowel syndrome (PI-IBS). The objective of this study was to determine the risk factors of developing PI-IBS following an acute infectious gastroenteritis (AGE) episode in which, by laboratory tests, the etiological agent was isolated. The study was conducted on patients admitted to a tertiary center of infectious diseases during three consecutive years. The patients were divided into two groups: a group consisting of patients admitted with AGE (with an isolated etiological agent) and a control group consisting of patients admitted for an acute upper respiratory tract infection (URTI). The subjects were recalled in our center 6 months after the admission and were evaluated with Rome III IBS diagnostic questionnaire and Bristol Stool Form Scale. The questionnaires were paper printed and directly filled in by the subjects. The response rate in the case group was 5% and in the control group 100%. The prevalence of PI-IBS was higher in patients with AGE, presenting a relative risk (RR) of 4.16 [95% confidence interval (CI), 1.89-9.17], statistically significant (P<0.001) vs. URTI. From 28 female patients, 22 patients (79%) developed PI-IBS and from 17 male patients, 3 patients (18%) had developed PI-IBS with a risk of 4.4 (95% CI, 1.56-12.65), P<0.001. Regarding the infectious etiology of the AGE, Campylobacter jejuni had the highest risk of developing PI-IBS, RR=1.2 (95% CI, 0.13-3.11), P=0.04 compared with the other agents with a lower risk. The risk to develop PI-IBS after AGE infection is 4.16 higher than after URTI. Female sex is a risk factor for PI-IBS, 79% of the female patients developed PI-IBS after AGE. The incidence of PI-IBS is highest in patients with Campylobacter jejuni AGE compared with the other agents.

show abstract

Section: Discussionmentioning

confidence: 99%

Post‑infectious irritable bowel syndrome after a laboratory‑proven enteritis

et al. 2020

View full text Add to dashboard Cite

show abstract

“… Selection of patients for carrier detection has been done in a variety of ways: all emergency department admissions, 131 all new admissions to specific high-risk wards, 132 and all admitted patients who had been previously hospitalized within 2 months, and/or had a past C. difficile positive test, and/or were in a long-term care facility in the prior 6 months. 133 If a patient has diarrhea but is thought to be a carrier of C. difficile with an alternative diarrheal etiology (eg, NAAT positive, toxin EIA negative), contact precautions should still be employed. For asymptomatic carriers, all components of contact precautions for C. difficile carriers may not be required.…”

Section: Section 4: Recommended Strategies For CDI Preventionmentioning

confidence: 99%

Strategies to prevent Clostridioides difficile infections in acute-care hospitals: 2022 Update

Kociolek

Gerding

Carrico

et al. 2023

Infect. Control Hosp. Epidemiol.

View full text Add to dashboard Cite

Table 1. Summary of Recommendations to Prevent Clostridioides difficile Infection (CDI) Essential Practices 1. Encourage appropriate use of antimicrobials through implementation of an antimicrobial stewardship program. (Quality of evidence: MODERATE) a. Ensure appropriate use of antimicrobials for CDI treatment. b. Ensure appropriate use of non-CDI-treatment antimicrobials. 2. Implement diagnostic stewardship practices for ensuring appropriate use and interpretation of C. difficile testing. (Quality of evidence: LOW) a. Hospital infection prevention and control programs should work with their clinical microbiology laboratory to develop pre-agreed criteria for C. difficile testing, particularly if NAATs are used either as a standalone test or part of a multi-step testing algorithm. b. At minimum, C. difficile testing should be avoided in patients without clinically significant diarrhea, in those who have been tested in the prior 7 days, and in children aged <1 year. c. Ordering providers and bedside nurses should receive education about appropriate use and interpretation of C. difficile testing. d. If feasible, the electronic medical record system should be leveraged to provide computerized provider order entry support and/or monitoring for clinical testing criteria. 3. Use contact precautions for infected patients, single-patient room preferred. (Quality of evidence: LOW for hand hygiene; MODERATE for gloves; LOW for gowns; LOW for single-patient room) a. Perform hand hygiene based on CDC or WHO guidelines before and after entering the room (ie, immediately before donning and after removing personal protective equipment). b. Place patients with CDI on contact precautions to help reduce patient-to-patient spread of the organism. c. Cohorting of patients with CDI is acceptable when single private rooms are not available. d. Ensure that adequate supplies for contact precautions are readily available. e. Follow appropriate criteria for discontinuing contact precautions.4. Adequately clean and disinfect equipment and the environment of patients with CDI. (Quality of evidence: LOW for equipment; LOW for environment) a. C. difficile spores contaminate the environment in which patients are housed and the equipment used to care for them. b. Contaminated surfaces and equipment are potential reservoirs for transmission of C. difficile. c. Develop and implement protocols for disinfection of equipment and the environment. d. Dedicate noncritical patient care items, such as blood pressure cuffs, stethoscopes, and thermometers, to a single patient with C. difficile. 5. Assess the adequacy of room cleaning. (Quality of evidence: LOW) a. Work with the environmental services team to establish a process for assessing adequacy of room cleaning at a frequency that is feasible for the team.b. The process should focus on reviewing and improving cleaning/disinfection techniques. Important issues to address include proper dilution of cleaning/disinfection products, adequacy of cleaning/disinfection technique, cleaning "high-touch" surfac...

show abstract

“…CDI is the major cause of antibiotic-associated diarrhea and pseudomembranous colitis in United States (Curcio et al, 2019a). Indeed, CDI ranks above methicillin resistant Staphylococcus aureus (MRSA) as the leading cause of hospital-acquired infection (Meyer et al, 2012; Peterson et al, 2020; Public Health England (PHE), Health Protection Scotland, Public Health Wales, 2023). However, in developing countries, CDI epidemiology is underestimated due to limitations in surveillance protocols and diagnostic resources (Curcio et al, 2019b).…”

Section: Introductionmentioning

confidence: 99%

Genome sequence and characterization of a hypervirulent BI/NAP1/027Clostridioides difficile(CDC20121308)

Español,

Palumbo,

Barbero

et al. 2024

Preprint

View full text Add to dashboard Cite

Clostridioides difficile is a gram-positive bacterium implicated in antibiotic-associated diarrhea. The use of antibiotics alters the gut microbiota, rendering the host susceptible to infection by C. difficile. This pathogen colonizes the large intestine of humans and animals leading to asymptomatic carriage or clinical manifestations such as toxic megacolon and fulminant colitis depending on a wide range of pathogen and host factors. The emergence of BI/NAP1/027 strains in North America and the spread of these hypervirulent ribotypes worldwide have been linked to the increase in incidence and severity of C. difficile infections (CDI) over the last decade. In this work, we aimed to characterize the BI/NAP1/027 C. difficile commercial strain CDC20121308 widely employed in the study of host-pathogen interactions. The genome sequence was obtained using a whole-genome shotgun strategy. A total of 3,717 coding sequences (CDS) and 45 tRNAs were predicted. The annotation of the CDC20121308 strain identified 26% of CDS into RAST subsystems. We also detected the presence of RT 027 lineage markers such as thyA, cdtA, cdtB and tcdC 18bp-deletion. Moreover, the genome of CDC20121308 had 11 genes devoted to resistance to toxic compounds, antibiotics (e.g. Tetracycline (Tet) and Vancomycin (Van)) and disinfecting agents as predicted using CARD. C. difficile CDC20121308 resistance to Van and Tet was confirmed by broth microdilution assay. Crystal violet staining demonstrated biofilm formation, which could be associated with antibiotic resistance and pathogenicity. Additionally, we observed a spreading diffuse growth in soft agar tubes, suggesting a motile phenotype. Lastly, a genomic region containing Type 4 Secretory System components such as virD4, virB4, and virB6 was identified. In conclusion, our results allowed a genomic and functional characterization of the BI/NAP1/027 C. difficile CDC20121308 strain. We demonstrated the presence of several genes associated with pathogenesis that were validated by experimental assays. This study provides additional data for the use of this highly virulence commercial strain of epidemiological relevance in research works involving in vitro and in vivo approaches.

show abstract

Reduced Clostridioides difficile infection in a pragmatic stepped-wedge initiative using admission surveillance to detect colonization

Abstract: Background Clostridioides difficile Infection (CDI) is a persistent healthcare issue. In the US, CDI is the most common infectious cause of hospital-onset (HO) diarrhea. Objective Assess the impact of admission testing for toxigenic C. difficile colonization on the incidence of HO-CDI.

Cited by 5 publications

References 38 publications

Post‑infectious irritable bowel syndrome after a laboratory‑proven enteritis

Post‑infectious irritable bowel syndrome after a laboratory‑proven enteritis

Strategies to prevent Clostridioides difficile infections in acute-care hospitals: 2022 Update

Genome sequence and characterization of a hypervirulent BI/NAP1/027Clostridioides difficile(CDC20121308)

Contact Info

Product

Resources

About