The Simple Predictors of Pseudomembranous Colitis in Patients with Hospital-Acquired Diarrhea: A Prospective Observational Study

Yang, Bo; Ju, Byung; Kim, Eun Jung; Lee, Ji Un; Kim, Mi Hee; Kang, Jin Gu; Kim, Hyoung Su; Kim, Kyung Ho; Jang, Myoung Kuk; Lee, Jin Heon; Kim, Hak Yang; Shin, Woon Geon

doi:10.5009/gnl.2014.8.1.41

Cited by 9 publications

(7 citation statements)

References 22 publications

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“…[ 25 , 26 , 41 , 44 , 45 , 49 , 56 , 68 ] A total of 16 countries were represented, with China contributing the largest number of studies. Twenty-five studies were from East Asia[ 9 , 22 , 24 , 26 , 28 , 34 – 37 , 39 – 42 , 44 , 52 – 54 , 56 , 58 – 61 , 67 , 70 , 71 ], 16 from South Asia[ 23 , 25 , 27 , 29 , 31 , 33 , 43 , 46 , 51 , 55 , 62 – 64 , 66 , 68 , 69 ] and 10 from the Middle East. [ 30 , 32 , 38 , 45 , 47 – 50 , 57 , 65 ] The mean age of included patients was 60 years (data from 24 studies) and just fewer than half the cohort were women (43%, 34 studies).…”

Section: Resultsmentioning

confidence: 99%

The emergence of Clostridium difficile infection in Asia: A systematic review and meta-analysis of incidence and impact

et al. 2017

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BackgroundClostridium difficile infection (CDI) is the most common healthcare associated infection and is highly prevalent in Europe and North America. Limited data is available on the prevalence of CDI in Asia. However, secular increases in prevalence of risk factors for CDI suggest that it may be emerging as a major cause of morbidity, highlighting the urgent need for a systematic study of the prevalence of CDI in Asia.MethodsWe systematically searched PubMed/Medline and Embase for publications from Asia between 2000–16 examining prevalence of CDI. A random-effects meta-analysis was performed to calculate the pooled prevalence of CDI in Asia and to identify subgroups and regions at high risk.ResultsOur meta-analysis included 51 studies from throughout Asia including 37,663 patients at risk among whom confirmed CDI was found in 4,343 patients. The pooled proportion of confirmed CDI among all patients with diarrhea was 14.8% with a higher prevalence in East Asia (19.5%), compared with South Asia (10.5%) or the Middle East (11.1%). There were an estimated 5.3 episodes of CDI per 10,000 patient days, similar to rates reported from Europe and North America. Infections due to hypervirulent strains were rare. CDI-related mortality was 8.9%.ConclusionsIn a meta-analysis of 51 studies, we observed similar rates of CDI in Asia in comparison to Europe and North America. Increased awareness and improved surveillance of Clostridium difficile is essential to reduce incidence and morbidity.

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Section: Resultsmentioning

confidence: 99%

The emergence of Clostridium difficile infection in Asia: A systematic review and meta-analysis of incidence and impact

et al. 2017

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“…This systematic review and meta-analysis which includes 56 studies and 356683 subjects[ 2 , 3 , 11 , 19 , 22 - 27 , 34 , 38 - 43 , 91 - 112 , 116 - 123 , 133 - 140 ] found a signi-ficant association between PPI therapy and the risk for CDI development. Both the overall pooled estimates (OR = 1.99, CI: 1.73-2.30, P < 0.001) and subgroup analyses showed a significant increased risk for CDI in patients on PPI therapy compared to nonusers, despite substantial statistical heterogeneity among studies and evidence of publication bias.…”

Section: Discussionmentioning

confidence: 99%

Proton pump inhibitors therapy and risk of Clostridium difficile infection: Systematic review and meta-analysis

Trifan

Stanciu

Gîrleanu

et al. 2017

WJG

224

138

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AIMTo perform a systematic review and meta-analysis on proton pump inhibitors (PPIs) therapy and the risk of Clostridium difficile infection (CDI).METHODSWe conducted a systematic search of MEDLINE/PubMed and seven other databases through January 1990 to March 2017 for published studies that evaluated the association between PPIs and CDI. Adult case-control and cohort studies providing information on the association between PPI therapy and the development of CDI were included. Pooled odds ratios (ORs) estimates with 95% confidence intervals (CIs) were calculated using the random effect. Heterogeneity was assessed by I2 test and Cochran’s Q statistic. Potential publication bias was evaluated via funnel plot, and quality of studies by the Newcastle-Otawa Quality Assessment Scale (NOS).RESULTSFifty-six studies (40 case-control and 16 cohort) involving 356683 patients met the inclusion criteria and were analyzed. Both the overall pooled estimates and subgroup analyses showed increased risk for CDI despite substantial statistical heterogeneity among studies. Meta-analysis of all studies combined showed a significant association between PPI users and the risk of CDI (pooled OR = 1.99, CI: 1.73-2.30, P < 0.001) as compared with non-users. The association remained significant in subgroup analyses: by design-case-control (OR = 2.00, CI: 1.68-2.38, P < 0.0001), and cohort (OR = 1.98, CI: 1.51-2.59, P < 0.0001); adjusted (OR = 1.95, CI: 1.67-2.27, P < 0.0001) and unadjusted (OR = 2.02, CI: 1.41-2.91, P < 0.0001); unicenter (OR = 2.18, CI: 1.72-2.75, P < 0.0001) and multicenter (OR = 1.82, CI: 1.51-2.19, P < 0.0001); age ≥ 65 years (OR = 1.93, CI: 1.40-2.68, P < 0.0001) and < 65 years (OR = 2.06, CI: 1.11-3.81, P < 0.01). No significant differences were found in subgroup analyses (test for heterogeneity): P = 0.93 for case-control vs cohort, P = 0.85 for adjusted vs unadjusted, P = 0.24 for unicenter vs multicenter, P = 0.86 for age ≥ 65 years and < 65 years. There was significant heterogeneity across studies (I2 = 85.4%, P < 0.001) as well as evidence of publication bias (funnel plot asymmetry test, P = 0.002).CONCLUSIONThis meta-analysis provides further evidence that PPI use is associated with an increased risk for development of CDI. Further high-quality, prospective studies are needed to assess whether this association is causal.

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“…Increasing age increases the risk as well as the severity of CDI (5,6). Yang et al demonstrated age greater than 70 years (adjusted odds ratio [OR], 1.76; 95% confidence interval [CI], 1.12 to 2.75; p=0.01), to be an independent risk factor for CDI (7). However, in this study, age was not a risk factor for the development of CDI nor a marker of severity of disease, as outbreaks probably occurred in wards with relatively younger age groups and only a few patients were aged above 65 years.…”

Section: Discussionmentioning

confidence: 99%

“…Although some studies, including Yang et al, have suggested that female sex may be a predictor, it is difficult to explain the relationship between sex and CDI (7,8,9).…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Clostridium Difficile Infection in a Tertiary Care Hospital

Varma

Agrawal

Uppal

et al. 2018

IMMINV

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Introduction: Clostridium difficile infections have had significant morbidity and mortality in the last decade leading to high healthcare costs. Our prospective case-control study from October 2013 to May 2015 in a tertiary care hospital in rural India aimed to evaluate the risk factors, treatment, outcome, and complications of Clostridium difficile infections in hospitalized patients.Materials and Methods: The study involved a total of 183 patients, of which 61 were cases, and 122 were controls. Data was analyzed using multivariate logistic regression.Results: Antibiotic intake in the past four weeks (p=0.003), hypoalbuminemia (p=0.001) and duration of hospital stay before the onset of diarrhea (p<0.001) were proven to have significant risk. We subdivided cases into severe and non-severe cases, and we found that complications were statistically higher in severe cases (OR= 1.685, <0.001).Conclusion: Identifying severe cases and administering timely and appropriate treatment is prudent.

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The Simple Predictors of Pseudomembranous Colitis in Patients with Hospital-Acquired Diarrhea: A Prospective Observational Study

Cited by 9 publications

References 22 publications

The emergence of Clostridium difficile infection in Asia: A systematic review and meta-analysis of incidence and impact

The emergence of Clostridium difficile infection in Asia: A systematic review and meta-analysis of incidence and impact

Proton pump inhibitors therapy and risk of Clostridium difficile infection: Systematic review and meta-analysis

Risk Factors for Clostridium Difficile Infection in a Tertiary Care Hospital

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