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C Difficile

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23 papers 25 to 100 followers Questioning Medicine Podcast Material
By Joe Weatherly FM/Hospitalist-CoFounder of QuestioningMedicine and PCRAP contributor.
Fernanda C Lessa, Yi Mu, Wendy M Bamberg, Zintars G Beldavs, Ghinwa K Dumyati, John R Dunn, Monica M Farley, Stacy M Holzbauer, James I Meek, Erin C Phipps, Lucy E Wilson, Lisa G Winston, Jessica A Cohen, Brandi M Limbago, Scott K Fridkin, Dale N Gerding, L Clifford McDonald
BACKGROUND: The magnitude and scope of Clostridium difficile infection in the United States continue to evolve. METHODS: In 2011, we performed active population- and laboratory-based surveillance across 10 geographic areas in the United States to identify cases of C. difficile infection (stool specimens positive for C. difficile on either toxin or molecular assay in residents ≥ 1 year of age). Cases were classified as community-associated or health care-associated...
February 26, 2015: New England Journal of Medicine
Curtis J Donskey, Sirisha Kundrapu, Abhishek Deshpande
Asymptomatic carriage of toxigenic strains of Clostridium difficile is common in health care facilities and the community. However, infection control efforts have traditionally focused almost entirely on symptomatic patients. There is now growing concern that asymptomatic carriers may be an underappreciated source of transmission. This article provides an overview of the pathogenesis and epidemiology of C difficile colonization, reviews the evidence that asymptomatic carriers shed spores and contribute to transmission, and examines practical issues related to prevention of transmission from carriers...
March 2015: Infectious Disease Clinics of North America
Iris Figueroa, Stuart Johnson, Susan P Sambol, Ellie J C Goldstein, Diane M Citron, Dale N Gerding
Our study sought to compare the strain types of Clostridium difficile causing initial and recurrent episodes of C. difficile infection (CDI) in adult patients with a first episode of CDI or 1 prior episode of CDI within the previous 90 days. Strains originated from patients who had been entered into two phase 3 randomized clinical trials of fidaxomicin versus vancomycin. Isolates of C. difficile from the initial and recurrent episodes within 28 (± 2) days of cure of CDI were compared using restriction endonuclease analysis (REA) typing...
August 2012: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
Stephen M Brecher, Susan M Novak-Weekley, Elisabeth Nagy
Single molecular or multistep assays (glutamate dehydrogenase, toxin A/B, ± molecular) are recommended for the diagnosis of CDI in patients with clinically significant diarrhea. Rapid and accurate tests can improve resource allocations and improve patient care. Enzyme immunoassay (EIA) for toxins A/B is too insensitive for use as a stand-alone assay. This guideline will examine the use of molecular tests and multitest algorithms for the diagnosis of Clostridium difficile infection (CDI). These new tests, alone or in a multistep algorithm consisting of >1 assay, are more expensive than the older EIA assays; however, rapid and accurate testing can save money overall by initiating appropriate treatment and infection control protocols sooner and by possibly reducing length of hospital stay...
October 2013: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
Oliver A Cornely, Mark A Miller, Thomas J Louie, Derrick W Crook, Sherwood L Gorbach
Recurrence of Clostridium difficile infection (CDI) occurs in approximately 25% of successfully treated patients. Two phase 3 randomized, double-blind trials were conducted at 154 sites in the United States, Canada, and Europe to compare fidaxomicin vs vancomycin in treating CDI. Patients with CDI received fidaxomicin 200 mg twice daily or vancomycin 125 mg 4 times daily for 10 days. The primary end point was clinical cure of CDI at end of treatment, and a secondary end point was recurrence during the 28 days following clinical cure...
August 2012: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
Blessing O Adamu, Trevor D Lawley
Faecal microbiota transplantation (FMT) has been used for more than five decades to treat a variety of intestinal diseases associated with pathological imbalances within the resident microbiota, termed dysbiosis. FMT has been particularly effective for treating patients with recurrent Clostridium difficile infection who are left with few clinical options other than continued antibiotic therapy. Our increasing knowledge of the structure and function of the human intestinal microbiota and C. difficile pathogenesis has led to the understanding that FMT promotes intestinal ecological restoration and highlights the microbiota as a viable therapeutic target...
October 2013: Current Opinion in Microbiology
Els van Nood, Anne Vrieze, Max Nieuwdorp, Susana Fuentes, Erwin G Zoetendal, Willem M de Vos, Caroline E Visser, Ed J Kuijper, Joep F W M Bartelsman, Jan G P Tijssen, Peter Speelman, Marcel G W Dijkgraaf, Josbert J Keller
BACKGROUND: Recurrent Clostridium difficile infection is difficult to treat, and failure rates for antibiotic therapy are high. We studied the effect of duodenal infusion of donor feces in patients with recurrent C. difficile infection. METHODS: We randomly assigned patients to receive one of three therapies: an initial vancomycin regimen (500 mg orally four times per day for 4 days), followed by bowel lavage and subsequent infusion of a solution of donor feces through a nasoduodenal tube; a standard vancomycin regimen (500 mg orally four times per day for 14 days); or a standard vancomycin regimen with bowel lavage...
January 31, 2013: New England Journal of Medicine
Laurica A Petrella, Susan P Sambol, Adam Cheknis, Kristin Nagaro, Yin Kean, Pamela S Sears, Farah Babakhani, Stuart Johnson, Dale N Gerding
BACKGROUND: An epidemic strain of Clostridium difficile designated by restriction endonuclease analysis (REA) as group BI has caused multiple outbreaks of severe C. difficile infection (CDI). The treatment response of patients infected with this strain is uncertain. METHODS: Clostridium difficile isolates were collected from 2 phase 3 clinical trials comparing fidaxomicin to vancomycin and typed using REA. Clinical cure and recurrence outcomes were analyzed by strain type of the infecting organism, BI and non-BI, using both univariate and multivariate analyses...
August 2012: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
L Clifford McDonald, Bruno Coignard, Erik Dubberke, Xiaoyan Song, Teresa Horan, Preeta K Kutty
BACKGROUND: The epidemiology of Clostridium difficile-associated disease (CDAD) is changing, with evidence of increased incidence and severity. However, the understanding of the magnitude of and reasons for this change is currently hampered by the lack of standardized surveillance methods. OBJECTIVE AND METHODS: An ad hoc C. difficile surveillance working group was formed to develop interim surveillance definitions and recommendations based on existing literature and expert opinion that can help to improve CDAD surveillance and prevention efforts...
February 2007: Infection Control and Hospital Epidemiology
Thomas J Louie, Kris Cannon, Brendan Byrne, Judy Emery, Linda Ward, Melissa Eyben, Walter Krulicki
The microflora-sparing properties of fidaxomicin were examined during the conduct of a randomized clinical trial comparing vancomycin 125 mg 4 times per day versus fidaxomicin 200 mg twice per day for 10 days as treatment of Clostridium difficile infection (CDI). Fecal samples were obtained from 89 patients (45 received fidaxomicin, and 44 received vancomycin) at study entry and on days 4, 10, 14, 21, 28, and 38 for quantitative cultures for C. difficile and cytotoxin B fecal filtrate concentrations. Additionally, samples from 10 patients, each receiving vancomycin or fidaxomicin, and 10 samples from healthy controls were analyzed by quantitative real-time polymerase chain reaction with multiple group-specific primers to evaluate the impact of antibiotic treatment on the microbiome...
August 2012: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
A Adler, Y Schwartzberg, Z Samra, O Schwartz, Y Carmeli, M J Schwaber
In June 2012, Israeli guidelines for laboratories were published defining the recommended methods for diagnosis of Clostridium difficile infection (CDI). We conducted this survey to examine the effects of the new recommendations on the proportions of rejected and positive samples by the different methods. A survey was mailed to the directors of all general hospital (GH) and health maintenance organization (HMO) clinical microbiology laboratories. The report was divided into two periods, before and after implementation of the guidelines...
November 2014: Clinical Microbiology and Infection
Jessica Cohen, Brandi Limbago, Ghinwa Dumyati, Stacy Holzbauer, Helen Johnston, Rebecca Perlmutter, John Dunn, Joelle Nadle, Carol Lyons, Erin Phipps, Zintars Beldavs, Leigh Ann Clark, Fernanda C Lessa
We describe the adoption of nucleic acid amplification tests (NAAT) for Clostridium difficile diagnosis and their impact on stool rejection policies and C. difficile positivity rates. Of the laboratories with complete surveys, 51 (43%) reported using NAAT in 2011. Laboratories using NAAT had stricter rejection policies and increased positivity rates.
February 2014: Journal of Clinical Microbiology
Michael R Kolber, Ben Vandermeer, G Michael Allan
No abstract text is available yet for this article.
July 2014: American Journal of Gastroenterology
Marije K Bomers, Michiel A van Agtmael, Hotsche Luik, Christina M J E Vandenbroucke-Grauls, Yvo M Smulders
OBJECTIVES: Early and rapid identification of Clostridium difficile infections (CDI) is important to prevent transmission. In this study we assessed the diagnostic accuracy of a trained detection dog for detecting CDI cases on hospital wards in an outbreak setting. METHODS: During a CDI outbreak in a large Dutch university hospital, we screened affected hospital wards repeatedly with a trained detection dog. The dog's response was compared to the clinical diagnosis, supported by laboratory results...
November 2014: Journal of Infection
Judith Maria Wenisch, Susanne Equiluz-Bruck, Marta Fudel, Ingun Reiter, Andrea Schmid, Erna Singer, Andreas Chott
Clostridium difficile infections (CDI) in hospitalized patients are known to be closely related to antibiotic exposure. Although several substances can cause CDI, the risk differs between individual agents. In Vienna and other eastern parts of Austria, CDI ribotype 027 is currently highly prevalent. This ribotype has the characteristic of intrinsic moxifloxacin resistance. Therefore, we hypothesized that moxifloxacin restriction can decrease the number of CDI cases in hospitalized patients. Our antibiotic stewardship (ABS) group applied an information campaign on CDI and formal restriction of moxifloxacin in Wilhelminenspital (Vienna, Austria), a 1,000- bed tertiary care hospital...
September 2014: Antimicrobial Agents and Chemotherapy
Eric T Lofgren, Stephen R Cole, David J Weber, Deverick J Anderson, Rebekah W Moehring
BACKGROUND: Clostridium difficile is a health care-associated infection of increasing importance. The purpose of this study was to estimate the time until death from any cause and time until release among patients with C. difficile, comparing the burden of those in the intensive care unit (ICU) with those in the general hospital population. METHODS: A parametric mixture model was used to estimate event times, as well as the case-fatality ratio in ICU and non-ICU patients within a cohort of 609 adult incident cases of C...
July 2014: Epidemiology
Faisal Alasmari, Sondra M Seiler, Tiffany Hink, Carey-Ann D Burnham, Erik R Dubberke
BACKGROUND: Clostridium difficile infection (CDI) incidence has increased dramatically over the last decade. Recent studies suggest that asymptomatic carriers may be an important reservoir of C. difficile in healthcare settings. We sought to identify the prevalence and risk factors for asymptomatic C. difficile carriage on admission to the hospital. METHODS: Patients admitted to Barnes-Jewish Hospital without diarrhea were enrolled from June 2010 through October 2011...
July 15, 2014: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
Marya D Zilberberg, Kimberly Reske, Margaret Olsen, Yan Yan, Erik R Dubberke
BACKGROUND: Recurrent Clostridium difficile infection (rCDI) affects 10% to 25% of patients with initial CDI (iCDI). Initiation of new therapies that reduce recurrences rests on identifying patients at high risk for rCDI at iCDI onset. OBJECTIVE: To develop a predictive model for rCDI based on factors present at iCDI onset. DESIGN: Retrospective cohort study. SETTING: Large urban academic medical center. PATIENTS: All adult patients with an inpatient iCDI from January 1, 2003 to December 31, 2009...
July 2014: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
Stephen J Allen, Kathie Wareham, Duolao Wang, Caroline Bradley, Hayley Hutchings, Wyn Harris, Anjan Dhar, Helga Brown, Alwyn Foden, Michael B Gravenor, Dietrich Mack
BACKGROUND: Antibiotic-associated diarrhoea (AAD) occurs most frequently in older (≥65 years) inpatients exposed to broad-spectrum antibiotics. When caused by Clostridium difficile, AAD can result in life-threatening illness. Although underlying disease mechanisms are not well understood, microbial preparations have been assessed in the prevention of AAD. However, studies have been mostly small single-centre trials with varying quality, providing insufficient data to reliably assess effectiveness...
October 12, 2013: Lancet
Carolyn V Gould, Jonathan R Edwards, Jessica Cohen, Wendy M Bamberg, Leigh Ann Clark, Monica M Farley, Helen Johnston, Joelle Nadle, Lisa Winston, Dale N Gerding, L Clifford McDonald, Fernanda C Lessa
Nucleic acid amplification testing (NAAT) is increasingly being adopted for diagnosis of Clostridium difficile infection (CDI). Data from 3 states conducting population-based CDI surveillance showed increases ranging from 43% to 67% in CDI incidence attributable to changing from toxin enzyme immunoassays to NAAT. CDI surveillance requires adjustment for testing methods.
November 2013: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
2014-08-29 14:06:46
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