Universal screening for <i>Clostridioides difficile</i> at an urban academic medical center

Collison, Maggie; Murillo, Cynthia; Marrs, Rachel; Bartlett, Allison H.; Tešić, Vera; Beavis, Kathleen G.; Landon, Emily; Ridgway, Jessica P

doi:10.1017/ice.2020.428

Cited by 4 publications

(4 citation statements)

References 8 publications

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“…Overall, the C. difficile colonization rate in our study, 4%, is similar to the overall colonization rate of 4.2% at our institution that has been previously reported. 11 Our colonization rate is also similar to rates reported in the literature for both hospitalized patients in general and ICU patients in particular. Prevalence rates for hospitalized patients range from 3% to 21% in various studies.…”

Section: Discussionsupporting

confidence: 90%

“…8,9 Our institution implemented a C. difficile screening protocol upon admission for hospitalized patients that began in targeted units in July 2015 and expanded to include all admitted patients in 2018. 11 The program initially began with select general ward units from 2015 to 2017. In 2017, the program was rolled out in additional units including all our hospital's ICUs.…”

mentioning

confidence: 99%

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Clostridioides difficile colonization and the frequency of subsequent treatment for C. difficile infection in critically ill patients

MacKenzie

Murillo²,

Bartlett³

et al. 2023

Infect. Control Hosp. Epidemiol.

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Objective: To determine risk factors for Clostridioides difficile colonization and C. difficile infection (CDI) among patients admitted to the intensive care unit (ICU). Design: Retrospective observational cohort study. Setting: Tertiary-care facility. Patients: All adult patients admitted to an ICU from July 1, 2015, to November 6, 2019, who were tested for C. difficile colonization. Patients with CDI were excluded. Methods: Information was collected on patient demographics, comorbidities, laboratory results, and prescriptions. We defined C. difficile colonization as a positive nucleic acid amplification test for C. difficile up to 48 hours before or 24 hours after intensive care unit (ICU) admission without evidence of active infection. We defined active infection as the receipt of an antibiotic whose only indication is the treatment of CDI. The primary outcome measure was the development of CDI up to 30 days after ICU admission. Logistic regression was used to model associations between clinical variables and the development of CDI. Results: The overall C. difficile colonization rate was 4% and the overall CDI rate was 2%. Risk factors for the development of CDI included C. difficile colonization (aOR, 13.3; 95% CI, 8.3–21.3; P < .0001), increased ICU length of stay (aOR, 1.04; 95% CI, 1.03–1.05; P < .0001), and a history of inflammatory bowel disease (aOR, 3.8; 95% CI, 1.3–11.1; P = .02). Receipt of any antibiotic during the ICU stay was associated with a borderline increased odds of CDI (aOR, 1.9; 95% CI, 1.0–3.4; P = .05). Conclusion: C. difficile colonization is associated with the development of CDI among ICU patients.

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Section: Discussionsupporting

confidence: 90%

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confidence: 99%

Clostridioides difficile colonization and the frequency of subsequent treatment for C. difficile infection in critically ill patients

MacKenzie

Murillo²,

Bartlett³

et al. 2023

Infect. Control Hosp. Epidemiol.

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“…We should underscore that this approach does not mean that we screen for asymptomatic carriers who do not have diarrhea. 27,28 Finding that 46.6% of all PCR(+)/EIA(+) cases were from stool collected on HD 1 or 2 (Table 2) supports our hypothesis that many cases were POA but not being identified as such after the reporting rules became more stringent in 2015. This percentage exceeds the 25% hypothesized in our model (Fig.…”

Section: Discussionsupporting

confidence: 65%

Impact of a multipronged approach to reduce the incidence of Clostridioides difficile infections in hospitalized patients

Katzman

Cohrs

Hnatuck

et al. 2023

American Journal of Infection Control

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“…This two-step process ensures that patients with active CDI are treated and patients who are simply colonized with C. difficile undergo investigation for alternative causes for their symptoms. In a hospital-based study of universal screening for C. difficile , colonization via PCR testing was determined to be 4.2% of 47 048 patients screened over 3 years [35]. Asymptomatic carriage of C. difficile may be as high as 8% among patients with IBD [6].…”

Section: Clinical Features and Diagnosis Of Clostridioides Difficile ...mentioning

confidence: 99%

Diagnosis and management of Clostridioides difficile infection in patients with inflammatory bowel disease

Dalal

Allegretti

2021

Current Opinion in Gastroenterology

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Purpose of reviewClostridioides difficile infection (CDI) may complicate the course of ulcerative colitis and Crohn's disease. The clinical presentation of CDI in this population is often atypical, and patients may experience exacerbations of their underlying inflammatory bowel disease (IBD) secondary to C. difficile. In this review, we aim to review the risk factors, diagnosis, and management of CDI in the context of IBD.Recent findingsPatients with colonic involvement of their IBD are at higher risk for CDI and colonization may be more common than in the general population. Therefore, CDI is confirmed using a two-step approach to stool testing. Oral vancomycin or fidaxomicin are the preferred agents for nonfulminant disease, and oral metronidazole is no longer recommended as first-line therapy. For all patients with CDI recurrence, fecal microbiota transplant (FMT) should be considered, as this has been shown to be safe and effective. Among those who have worsening of their underlying IBD, retrospective research suggest that outcomes are improved for those who undergo escalation of immunosuppression with appropriate antimicrobial treatment of C. difficile, however prospective data are needed.SummaryCDI may complicate the course of IBD, however the presentation may not be typical. Therefore, all patients with worsening gastrointestinal symptoms should be evaluated for both CDI and IBD exacerbation. Providers should consider FMT for all patients with recurrent CDI as well as escalation of immunosuppression for patients who fail to improve with appropriate antimicrobial therapy.

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Universal screening for Clostridioides difficile at an urban academic medical center

Cited by 4 publications

References 8 publications

Clostridioides difficile colonization and the frequency of subsequent treatment for C. difficile infection in critically ill patients

Clostridioides difficile colonization and the frequency of subsequent treatment for C. difficile infection in critically ill patients

Impact of a multipronged approach to reduce the incidence of Clostridioides difficile infections in hospitalized patients

Diagnosis and management of Clostridioides difficile infection in patients with inflammatory bowel disease

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