Two Time-Series Analyses of the Impact of Antibiotic Consumption and Alcohol-Based Hand Disinfection on the Incidences of Nosocomial Methicillin-Resistant<i>Staphylococcus aureus</i>Infection and<i>Clostridium difficile</i>Infection

Kaier, Klaus; Hagist, Christian; Frank, Uwe; Conrad, Andreas; Meyer, Elisabeth

doi:10.1086/596605

Cited by 98 publications

(115 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The use of broad-spectrum ␤-lactams, cephalosporins, fluoroquinolones, clindamycin, and macrolides has been associated with increasing CDI incidence (30)(31)(32). Through the study period, there were no significant changes in the consumption of these antibiotics, and, although infectious disease consultants were regularly involved in antibiotic therapy prescribing for infected patients in all wards, no antimicrobial stewardship programs were implemented at that time.…”

Section: Discussionmentioning

confidence: 99%

Clostridium difficile PCR Ribotype 018, a Successful Epidemic Genotype

et al. 2015

View full text Add to dashboard Cite

e Clostridium difficile infection (CDI) became a public health problem for the global spreading of the so-called hypervirulent PCR ribotypes (RTs) 027 and 078, associated with increases in the transmission and severity of the disease. However, especially in Europe, several RTs are prevalent, and the concept of hypervirulence is currently debated. We investigated the toxin and resistance profiles and the genetic relatedness of 312 C. difficile strains isolated in a large Italian teaching hospital during a 5-year period. We evaluated the role of CDI-related antibiotic consumption and infection control practices on the RT predominance in association with their molecular features and transmission capacity. Excluding secondary cases due to nosocomial transmission, RT018 was the predominant genotype (42.4%) followed by RT078 (13.6%), while RT027 accounted for 0.8% of the strains. RT078 was most frequently isolated from patients in intensive care units. Its prevalence significantly increased over time, but its transmission capacity was very low. In contrast, RT018 was highly transmissible and accounted for 95.7% of the secondary cases. Patients with the RT018 genotype were significantly older than those with RT078 and other RTs, indicating an association between epidemic RT and age. We provide here the first epidemiological evidence to consider RT018 as a successful epidemic genotype that deserves more attention in clinical practice.C lostridium difficile infection (CDI) is one of the most common hospital-acquired infections and the main known cause of antibiotic-associated diarrhea in hospitals in industrialized countries (1). Previous antibiotic treatment, hospitalization, old age, and underlying diseases represent major risk factors for CDI. The disease spectrum ranges from mild diarrhea to severe pseudomembranous enterocolitis, sepsis, and death (2, 3).In the past decade, many countries in North America and Europe have registered an increase in CDI rates and related severity and mortality (4, 5). These epidemiological changes coincided with the emergence and epidemic spread of C. difficile strains belonging to the PCR ribotype (RT) 027/North American pulsedfield gel electrophoresis type 1 (NAP1) (6). Indeed, RT027 became the predominant strain in many geographical regions, as documented in different epidemiological studies, and, since 2005, several countries have conducted epidemiological surveillance to monitor its spread (7,8). It has been reported to occur in at least 38 U.S. states and in 16 European countries, being also responsible for outbreaks (7, 9). Moreover, an increase in community-acquired CDI has been reported; in Europe, this phenomenon correlates with the diffusion of RT078/NAP7 or NAP8 which, like RT027, has been associated with higher disease severity and attributable mortality (1, 10).RT027 and RT078 are often referred to as hypervirulent genotypes of C. difficile, but this definition is not without controversy. Though this term denotes an increase in virulence, it has often been misused to ident...

show abstract

Section: Discussionmentioning

confidence: 99%

Clostridium difficile PCR Ribotype 018, a Successful Epidemic Genotype

et al. 2015

View full text Add to dashboard Cite

show abstract

“…Interestingly, the C. difficile incidence increased following ABHR implementation (five new cases compared to zero cases in the preceding 12 months), but that study was limited to one small ward in a single institution and, therefore, was insufficiently powered to allow firm conclusions. Several more recent and larger in vivo studies evaluating CDI incidence following ABHR implementation have been performed (26,94,170,200,184,199 (185). The procurement of soap and ABHR and hospital bed occupancy data were monitored in relation to quarterly mandatory reports of methicillin-resistant Staphylococcus aureus (MRSA)/methicillin-sensitive S. aureus (MSSA) bacteremia and CDI.…”

Section: Alcohol-based Hand Hygiene and Risk Of CDImentioning

confidence: 99%

“…The CDI incidence did not increase despite increased ABHR usage (185). In a recent study, Kaier et al built a multivariate regression model to identify the dynamic relationship between antibiotic exposure, ABHR, and the incidence of MRSA and CDI (94). The increased usage of ABHR over the 44-month study period negatively impacted MRSA incidence but did not correlate (positively or negatively) with CDI incidence (94).…”

Section: Alcohol-based Hand Hygiene and Risk Of CDImentioning

confidence: 99%

The Changing Epidemiology of Clostridium difficile Infections

et al. 2010

View full text Add to dashboard Cite

SUMMARY The epidemiology of Clostridium difficile infection (CDI) has changed dramatically during this millennium. Infection rates have increased markedly in most countries with detailed surveillance data. There have been clear changes in the clinical presentation, response to treatment, and outcome of CDI. These changes have been driven to a major degree by the emergence and epidemic spread of a novel strain, known as PCR ribotype 027 (sometimes referred to as BI/NAP1/027). We review the evidence for the changing epidemiology, clinical virulence and outcome of treatment of CDI, and the similarities and differences between data from various countries and continents. Community-acquired CDI has also emerged, although the evidence for this as a distinct new entity is less clear. There are new data on the etiology of and potential risk factors for CDI; controversial issues include specific antimicrobial agents, gastric acid suppressants, potential animal and food sources of C. difficile, and the effect of the use of alcohol-based hand hygiene agents.

show abstract

“…A number of studies have shown that improvements in hand hygiene are associated with lower healthcare-associated infection rates, and/or reductions in MDRO transmission and acquisition. [7][8][9][10] Nonetheless, compliance with hand hygiene recommendations is often poor, with studies reporting rates as low as 20 -30%. [11][12][13] The adequate disinfection of hands is easily accomplished by using an alcoholic hand rub, with or without additional disinfectants, e.g.…”

Section: Prevention Of Transmissionmentioning

confidence: 99%