The effect of hospital-acquired infection with <i>Clostridium difficile</i> on length of stay in hospital

Forster, Alan J.; Taljaard, Monica; Oake, Natalie; Wilson, Kumanan; Roth, Virginia; Walraven, Carl van

doi:10.1503/cmaj.110543

Cited by 83 publications

(78 citation statements)

References 23 publications

(29 reference statements)

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“…Because local injection of CLR dsRNA universally improved all end points of TxA-induced ileitis examined, our current findings suggest efficacy for encapsulated or luminal delivery of dsRNA to alter local inflammation in the gastrointestinal tract. This approach may be highly relevant, because C. difficile infections extend hospitalization (27).…”

Section: Discussionmentioning

confidence: 99%

Local injection of dsRNA targeting calcitonin receptor-like receptor (CLR) ameliorates Clostridium difficile toxin A-induced ileitis

Bhargava¹,

Clifton²,

Mhaske³

et al. 2012

Proc. Natl. Acad. Sci. U.S.A.

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Enteritis caused by Clostridium difficile toxin (Tx) is a nosocomial disease of increasing clinical concern, but the local mediators of C. difficile TxA inflammation are unknown. The potent vasodilator calcitonin gene-related peptide mediates neurogenic inflammation via the calcitonin receptor-like receptor (CLR). Here we examined the ileum-specific effects of reducing CLR on TxA ileitis by local preinjection of double-stranded RNAs. Treatment with CLR dsRNA for 7 d decreased CLR immunoreactivity, whereas treatment with non-CLR dsRNA did not. Subsequent injection of TxA in the same location increased CLR in rats treated with non-CLR dsRNA but not in rats treated with CLR dsRNA, documenting that local injection of dsRNA is effective in preventing the increase in CLR immunoreactivity in response to local TxA. After non-CLR dsRNA pretreatment, TxA induced robust intestinal secretion, myeloperoxidase activity, and histopathologic indications of inflammation including epithelial damage, congestion, neutrophil infiltration, loss of mucin from goblet cells, and increase in mast cell numbers. After CLR dsRNA pretreatment, TxA-induced changes in intestinal secretion and histopathologic inflammation were improved, including normal mucin staining and fewer resident mast cells. Loss of CLR prevented TxA-mediated activation of NF-κB and concomitant increases in pERK1/2 and TNF-α mRNA. Locally produced CLR plays a proinflammatory role in TxA ileitis via MAPK signaling and TNF-α. The results reported here strongly suggest that a local injection of dsRNA targeting CLR could be an effective local therapeutic approach at the inflammation site in the treatment of a growing, clinically relevant hospital-acquired disease, C. difficile infection.

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Section: Discussionmentioning

confidence: 99%

Local injection of dsRNA targeting calcitonin receptor-like receptor (CLR) ameliorates Clostridium difficile toxin A-induced ileitis

Bhargava¹,

Clifton²,

Mhaske³

et al. 2012

Proc. Natl. Acad. Sci. U.S.A.

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“…In line with the data for Spain obtained in this study, a recent retrospective cohort study found an adjusted median excess LOS attributable to CDI of 6 days. 35 Various limitations of this study can be identified. First, there were differences in data collection and reporting between the different institutions.…”

Section: Discussionmentioning

confidence: 96%

The impact of Clostridium difficile infection on resource use and costs in hospitals in Spain and Italy: a matched cohort study

Asensio

Bella

Vecchio

et al. 2015

International Journal of Infectious Diseases

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“…Similarly, we do not know whether longer length of stay was due to infection or was a risk factor for infection. However, Forster et al [13] similarly found C difficile infection increased length of stay independent of baseline risk of death. Third, coding reliability is always an issue with administrative databases and may affect results of studies using these databases.…”

Section: Discussionmentioning

confidence: 96%

Clostridium difficile Colitis in Patients Undergoing Lower-extremity Arthroplasty: Rare Infection With Major Impact

Maltenfort

Morrison

Parvızı

2013

Clinical Orthopaedics &Amp; Related Research

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Background The prevalence of Clostridium difficile colitis is reportedly increasing in surgical patients and can negatively impact their outcome. However, as yet there are no clear estimates of the C difficile infection colitis rate and its consequences among patients undergoing total joint arthroplasty (TJA). Questions/purposes We asked: (1) What is the rate of C difficile colitis in TJA patients? (2) What are the risk factors of C difficile colitis in these patients? And (3) what is the effect of C difficile colitis on length of stay, in-hospital mortality, and estimated total charges? Methods Using ICD-9-CM diagnosis and procedure codes, we queried the Nationwide Inpatient Sample database for patients undergoing TJA for the years 2002 to 2010. Demographic data, comorbidities, occurrence of C difficile colitis, length of hospital stay, mortality, and hospital charges were extracted. Logistic regression was performed to identify predictors of C difficile colitis and its impact on in-hospital mortality.

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The effect of hospital-acquired infection with Clostridium difficile on length of stay in hospital

Cited by 83 publications

References 23 publications

Local injection of dsRNA targeting calcitonin receptor-like receptor (CLR) ameliorates Clostridium difficile toxin A-induced ileitis

Local injection of dsRNA targeting calcitonin receptor-like receptor (CLR) ameliorates Clostridium difficile toxin A-induced ileitis

The impact of Clostridium difficile infection on resource use and costs in hospitals in Spain and Italy: a matched cohort study

Clostridium difficile Colitis in Patients Undergoing Lower-extremity Arthroplasty: Rare Infection With Major Impact

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