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Matthew L Rubinstein, Colleen S Kraft, J Scott Parrott
Background Diagnostic test accuracy (DTA) systematic reviews (SRs) characterize a test's potential for diagnostic quality and safety. However, interpreting DTA measures in the context of SRs is challenging. Further, some evidence grading methods (e.g. Centers for Disease Control and Prevention, Division of Laboratory Systems Laboratory Medicine Best Practices method) require determination of qualitative effect size ratings as a contributor to practice recommendations. This paper describes a recently developed effect size rating approach for assessing a DTA evidence base...
September 22, 2018: Diagnosis
Taojun He, Samuel E Kaplan, Luz A Gomez, Xuedong Lu, Lakshmi V Ramanathan, Mini Kamboj, Yi-Wei Tang
Fecal calprotectin (fCPT) has been used as a surrogate marker for assessment of intestinal inflammation. We explore the utility of fCPT values as a diagnostic aid in cancer patients with suspected Clostridium difficile infection (CDI). A total of 232 stool specimens submitted for GeneXpert C. difficile PCR testing were included in the study. All specimens were tested for fCPT and toxin/GDH antigens. Clinical severity of CDI cases was determined by the IDSA/SHEA criteria. Significant differences of median fCPT values between CDI (n = 117, Median 183...
September 21, 2018: European Journal of Clinical Microbiology & Infectious Diseases
María D Esteban-Vasallo, Javier de Miguel-Díez, Ana López-de-Andrés, Valentín Hernández-Barrera, Rodrigo Jiménez-García
AIMS: To examine trends in the incidence, characteristics and in-hospital outcomes of Clostridium difficile infection (CDI) hospitalizations from 2001 to 2015; to compare clinical variables among patients according to the diagnosis position (primary or secondary) of CDI and to identify factors associated with in-hospital mortality (IHM). METHODS: We performed a retrospective study using the Spanish National Hospital Discharge Database, 2001-2015. We included patients that had CDI as primary or secondary diagnosis in their discharge report...
September 18, 2018: Journal of Hospital Infection
Michael G Dieterle, Krishna Rao, Vincent B Young
Clostridium difficile is the leading infectious cause of antibiotic-associated diarrhea and colitis. C. difficile infection (CDI) places a heavy burden on the healthcare system, with nearly half a million infections yearly and an approximate 20% recurrence risk after successful initial therapy. The high incidence has driven new research on improved prevention such as the emerging use of probiotics, intestinal microbiome manipulation during antibiotic therapies, vaccinations, and newer antibiotics that reduce the disruption of the intestinal microbiome...
September 21, 2018: Annals of the New York Academy of Sciences
Juan Muñoz-Miralles, Bruno C Trindade, Pablo Castro-Córdova, Ingrid L Bergin, Leslie A Kirk, Fernando Gil, David M Aronoff, Daniel Paredes-Sabja
AIM: To evaluate the effect on the nonsteroidal anti-inflammatory drug indomethacin on Clostridium difficile infection (CDI) severity. MATERIALS & METHODS: Indomethacin was administered in two different mouse models of antibiotic-associated CDI in two different facilities, using a low and high dose of indomethacin. RESULTS: Indomethacin administration caused weight loss, increased the signs of severe infection and worsened histopathological damage, leading to 100% mortality during CDI...
September 21, 2018: Future Microbiology
James Wei Tatt Toh, Kevin Phan, Grahame Ctercteko, Nimalan Pathma-Nathan, Toufic El-Khoury, Arthur Richardson, Gary Morgan, Reuben Tang, Mingjuan Zeng, Susan Donovan, Daniel Chu, Gregory Kennedy, Kerry Hitos
BACKGROUND: There is significant variation in the use of mechanical bowel preparation and oral antibiotics prior to left-sided elective colorectal surgery. There has been no consensus internationally. METHODS: This was a retrospective analysis of the 2015 American College of Surgeons National Surgical Quality Improvement Program database. Patients were divided into four groups: those who had mechanical bowel preparation with oral antibiotics, mechanical bowel preparation alone, oral antibiotics alone and no preparation...
September 20, 2018: International Journal of Colorectal Disease
Jason Zou, Victor Leung, Sylvie Champagne, Michelle Hinch, Anna Wong, Elisa Lloyd-Smith, Trong Tien Nguyen, Marc G Romney, Azra Sharma, Michael Payne, Christopher F Lowe
The clinical significance of indeterminate (PCR+/Tox-) results for patients tested with a two-step algorithm for Clostridium difficile infection (CDI) is uncertain. We aimed to evaluate the clinical presentation and 8-week outcomes of patients with indeterminate test results. Patients with stool samples testing positive by PCR and negative by toxin A/B immunoassay between February 1, 2017, and April 30, 2018, were assessed by antimicrobial stewardship program (ASP) clinicians and classified as colonized or infected...
September 20, 2018: European Journal of Clinical Microbiology & Infectious Diseases
J Justin Mulvey, Eric R Littmann, Lilan Ling, Michael R McDevitt, Eric G Pamer, David A Scheinberg
Background: Amine-modified carbon nanotubes are drug delivery platforms with great potential that have not yet been applied in human clinical trials. Although modified nanotube vectors have the ability to carry multiple effectors, targeting agents, and even wrapped RNA, reports on unmodified, insoluble carbon nanotubes have highlighted inflammation in organs, including the intestine, with disruption of its resident microbiota. Disruption of the microbiota may allow for colonization by pathogenic bacteria, such as Clostridoidies difficile , stimulate immunoinfiltrates into the lamina propria or alter the absorption of therapeutics...
2018: International Journal of Nanomedicine
Lotte Steuten, Janne Mewes, Isabelle Lepage-Nefkens, Hubertus Vrijhoef
Antibiotics (AB) can reduce morbidity and mortality in the treatment of patients with sepsis and chronic obstructive pulmonary disease (COPD) exacerbations. Yet, AB overuse or misuse increases antibiotic resistance (ABR) and Clostridium difficile infections (CDI). This study projected the expected impact of a procalcitonin (PCT) biomarker testing strategy on incremental ABR cases and CDI, and costs of care in a population of patients hospitalized with suspected sepsis or a COPD exacerbation, in three European countries: the United Kingdom, Germany, and the Netherlands...
September 2018: Omics: a Journal of Integrative Biology
Gayatri Vedantam, Joshua Kochanowsky, Jason Lindsey, Michael Mallozzi, Jennifer Lising Roxas, Chelsea Adamson, Farhan Anwar, Andrew Clark, Rachel Claus-Walker, Asad Mansoor, Rebecca McQuade, Ross Calvin Monasky, Shylaja Ramamurthy, Bryan Roxas, V K Viswanathan
Morbidity and mortality attributed to Clostridium difficile infection (CDI) have increased over the past 20 years. Currently, antibiotics are the only US FDA-approved treatment for primary C. difficile infection, and these are, ironically, associated with disease relapse and the threat of burgeoning drug resistance. We previously showed that non-toxin virulence factors play key roles in CDI, and that colonization factors are critical for disease. Specifically, a C. difficile adhesin, Surface Layer Protein A (SlpA) is a major contributor to host cell attachment...
2018: Frontiers in Microbiology
Louis-Charles Fortier
Bacteriophages (phages) are bacterial viruses that parasitize bacteria. They are highly prevalent in nature, with an estimated 1031 viral particles in the whole biosphere, and they outnumber bacteria by at least 10-fold. Hence, phages represent important drivers of bacterial evolution, although our knowledge of the role played by phages in the mammalian gut is still embryonic. Several pathogens owe their virulence to the integrated phages (prophages) they harbor, which encode diverse virulence factors such as toxins...
2018: Frontiers in Microbiology
Toshio Ohshima, Takako Osaki, Yukari Yamamoto, Satomi Asai, Hayato Miyachi, Shigeru Kamiya
In recent years, the diagnostic method of choice for Clostridium difficile infection (CDI) is a rapid enzyme immunoassay in which glutamate dehydrogenase (GDH) antigen and C. difficile toxin can be detected ( C. DIFF QUIK CHEK COMPLETE®: Alere Inc.) (QUIK CHEK). However, the clinical significance remains unclear in cases which demonstrate a positive result for GDH antigen and are negative for toxin. In this study, we used the QUIK CHEK test kit on fecal samples with an additional toxin detection step using toxigenic culture assay for the above cases...
September 19, 2018: Journal of Clinical Microbiology
Gregory R Madden, Brenda E Heon, Costi D Sifri
Copper-impregnated surfaces and linens have been shown to reduce infections and multidrug-resistant organism (MDRO) acquisition in healthcare settings. However, retrospective analyses of copper linen deployment at a 40-bed long-term acute-care hospital demonstrated no significant reduction in incidences of healthcare facility-onset Clostridium difficile infection or MDRO acquisition.
September 20, 2018: Infection Control and Hospital Epidemiology
Reece Miller, Jonathan E Heinlen
BACKGROUND: Clostridium difficile infection (CDI) is an important cause of hospital acquired morbidity with implications for quality of care. Radical cystectomy is a surgical procedure associated with high rates of morbidity one of which is a high rate of CDI. The rate of CDI among patients undergoing radical cystectomy may be estimated based on the reports from single institutions or by querying national databases. This study aims to compare rates of CDI reported in single institution series with rates obtained from national datasets...
September 15, 2018: Urologic Oncology
Andrew W Dick, Jeneita M Bell, Nimalie D Stone, Ashley M Chastain, Mark Sorbero, Patricia W Stone
BACKGROUND: Health care-associated infections pose a significant problem in nursing homes (NHs). The Long-term Care Facility Component of the National Healthcare Safety Network (NHSN) was launched in 2012, and since then, enrollment of NHs into NHSN has been deemed a national priority. Our goal was to understand the characteristics of NHs reporting to the NHSN compared to other NHs across the country. METHODS: To meet this goal, we quantified the characteristics of NHs by NHSN enrollment status and reporting consistency using the Certification and Survey Provider Enhanced Reporting (CASPER) data linked to NHSN enrollment and reporting data...
September 15, 2018: American Journal of Infection Control
Christopher Staley, Thomas Kaiser, Byron P Vaughn, Carolyn T Graiziger, Matthew J Hamilton, Tauseef Ur Rehman, Kevin Song, Alexander Khoruts, Michael J Sadowsky
BACKGROUND: Fecal microbiota transplantation (FMT) is an effective treatment for recurrent Clostridium difficile infection (rCDI). The use of freeze-dried, encapsulated donor material for FMT (cap-FMT) allows for an easy route of administration and remains clinically effective in the majority of rCDI patients. We hypothesized that specific shifts in the microbiota in response to cap-FMT could predict clinical outcome. We further evaluated the degree of donor microbiota engraftment to determine the extent that donor transfer contributed to recovery...
September 18, 2018: Microbiome
Archana Asundi, Maggie Stanislawski, Payal Mehta, Anna E Barón, Howard Gold, Hillary Mull, P Michael Ho, Kalpana Gupta, Westyn Branch-Elliman
BACKGROUND: The rate of cardiovascular implantable electronic device (CIED) infection is increasing coincident with an increase in the number of device procedures. Preprocedural antimicrobial prophylaxis reduces CIED infections; however, there is no evidence that prolonged postprocedural antimicrobials additionally reduce risk. Thus, we sought to quantify the harms associated with this approach. OBJECTIVE: To measure the association between Clostridium difficile infection (CDI), acute kidney injury (AKI) and receipt of prolonged postprocedural antimicrobials...
September 2018: Infection Control and Hospital Epidemiology
Erik R Dubberke, Kimberly A Reske, Tiffany Hink, Jennie H Kwon, Candice Cass, Jahnavi Bongu, Carey-Ann D Burnham, Jeffrey P Henderson
OBJECTIVE: To determine the prevalence of Clostridium difficile colonization among patients who meet the 2017 IDSA/SHEA C. difficile infection (CDI) Clinical Guideline Update criteria for the preferred patient population for C. difficile testing. DESIGN: Retrospective cohort. SETTING: Tertiary-care hospital in St. Louis, Missouri.PatientsPatients whose diarrheal stool samples were submitted to the hospital's clinical microbiology laboratory for C...
September 18, 2018: Infection Control and Hospital Epidemiology
Jennifer Brite, Tracy McMillen, Elizabeth Robilotti, Janet Sun, Hoi Yan Chow, Frederic Stell, Susan K Seo, Donna McKenna, Janet Eagan, Marisa Montecalvo, Donald Chen, Kent Sepkowitz, Mini Kamboj
OBJECTIVE: To determine the effectiveness of ultraviolet (UV) environmental disinfection system on rates of hospital-acquired vancomycin-resistant enterococcus (VRE) and Clostridium difficile. DESIGN: Using active surveillance and an interrupted time-series design, hospital-acquired acquisition of VRE and C. difficile on a bone marrow transplant (BMT) unit were examined before and after implementation of terminal disinfection with UV on all rooms regardless of isolation status of patients...
September 18, 2018: Infection Control and Hospital Epidemiology
Gabriel Ramírez-Vargas, Diana López-Ureña, Adriana Badilla, Josué Orozco-Aguilar, Tatiana Murillo, Priscilla Rojas, Thomas Riedel, Jörg Overmann, Gabriel González, Esteban Chaves-Olarte, Carlos Quesada-Gómez, César Rodríguez
The population structure of Clostridium difficile currently comprises eight major genomic clades. For the highly divergent C-I clade, only two toxigenic strains have been reported, which lack the tcdA and tcdC genes and carry a complete locus for the binary toxin (CDT) next to an atypical TcdB monotoxin pathogenicity locus (PaLoc). As part of a routine surveillance of C. difficile in stool samples from diarrheic human patients, we discovered three isolates that consistently gave negative results in a PCR-based screening for tcdC...
September 17, 2018: Scientific Reports
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