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1.
Fernanda Spad?o Juliana Gerhardt Thais Guimar?es Frederico Dulley Jo?o Nóbrega de Almeida Junior Marjorie Vieira Batista Maria Aparecida Shikanai-Yasuda Anna Sara Levin Silvia Figueiredo Costa 《Revista do Instituto de Medicina Tropical de S?o Paulo》2014,56(4):325-331
We describe the rate of incidence of Clostridium
difficile-associated diarrhea (CDAD) in hematologic and patients
undergone stem cell transplant (HSCT) at HC-FMUSP, from January 2007 to June 2011,
using two denominators 1,000 patient and 1,000 days of neutropenia and the risk
factors associated with the severe form of the disease and death. The ELISA method
(Ridascreen-Biopharm, Germany) for the detections of toxins A/B was used to identify
C. difficile. A multivariate analysis was performed to evaluate
potential factors associated with severe CDAD and death within 14 days after the
diagnosis of CDAD, using multiple logistic regression. Sixty-six episodes were
identified in 64 patients among 439 patients with diarrhea during the study period.
CDA rate of incidence varied from 0.78 to 5.45 per 1,000 days of neutropenia and from
0.65 to 5.45 per 1,000 patient-days. The most common underlying disease was acute
myeloid leukemia 30/64 (44%), 32/64 (46%) patients were neutropenic, 31/64 (45%)
undergone allogeneic HSCT, 61/64 (88%) had previously used antibiotics and 9/64 (13%)
have severe CDAD. Most of the patients (89%) received treatment with oral
metronidazole and 19/64 (26%) died. The independent risk factors associated with
death were the severe form of CDAD, and use of linezolid. 相似文献
2.
Jung KS Park JJ Chon YE Jung ES Lee HJ Jang HW Lee KJ Lee SH Moon CM Lee JH Shin JK Jeon SM Hong SP Kim TI Kim WH Cheon JH 《Gut and liver》2010,4(3):332-337
Background/Aims
The incidence of treatment failure or recurrence of Clostridium difficile-associated diarrhea (CDAD) following metronidazole treatment has increased recently. We studied the treatment failure, recurrence rate, and risk factors predictive of treatment failure and recurrence after metronidazole treatment for CDAD.Methods
We retrospectively identified consecutive patients who were admitted and treated for CDAD at a single tertiary institution in Korea over a recent 10-year period (i.e., 1998-2008).Results
Metronidazole was administered as the initial treatment to 111 of 117 patients (94.9%) with CDAD. Fourteen patients (12.6%) had no clinical response to the metronidazole treatment, and in 13 patients (13.4%) CDAD recurred after successful metronidazole treatment. Diabetes mellitus (p=0.014) and sepsis (p=0.002) were independent risk factors for metronidazole treatment failure. Patients who had received surgery within 1 month before CDAD developed were more likely to experience a recurrence after metronidazole treatment (p=0.032). Vancomycin exhibited a higher response rate after treatment failure, and metronidazole showed a reasonable response rate in the treatment of recurrence. Treatment failure and recurrence rates increased with time after metronidazole treatment for CDAD over the 10-year study period.Conclusions
Our data suggest that diabetes mellitus and sepsis are independent risk factors for metronidazole treatment failure, and that operation history within 1 month of development of CDAD is a predictor of a recurrence after metronidazole treatment. 相似文献3.
Bryan F Curtin Yousef Zarbalian Mark H Flasar Erik von Rosenvinge 《World journal of gastroenterology : WJG》2013,19(46):8647-8651
AIM:To assess adherence with the the Society for Healthcare Epidemiology of America(SHEA)/the Infectious Diseases Society of America(IDSA)guidelines for management of Clostridium difficile(C.difficile)-associated disease(CDAD)at a tertiary medical center.METHODS:All positive C.difficile stool toxin assays in adults between May 2010 and May 2011 at the University of Maryland Medical Center were identified.CDAD episodes were classified as guideline adherent or nonadherent and these two groups were compared to determine demographic and clinical factors predictive of adherence.Logistic regression analysis was performed to assess the effect of multiple predictors on guideline adherence.RESULTS:320 positive C.difficile stool tests were identified in 290 patients.Stratified by disease severity criteria set forth by the SHEA/IDSA guidelines,42.2%of cases were mild-moderate,48.1%severe,and 9.7%severe-complicated.Full adherence with the guidelines was observed in only 43.4%of cases.Adherence was65.9%for mild-moderate CDAD,which was significantly better than in severe cases(25.3%)or severe-complicated cases(35.5%)(P<0.001).There was no difference in demographics,hospitalization,ICU exposure,recurrence or 30-d mortality between adherent and non-adherent groups.A multivariate model revealed significantly decreased adherence for severe or severecomplicated episodes(OR=0.18,95%CI:0.11-0.30)and recurrent episodes(OR=0.46,95%CI:0.23-0.95).CONCLUSION:Overall adherence with the SHEA/IDSA guidelines for management of CDAD at a tertiary medical center was poor;this was most pronounced in severe,severe-complicated and recurrent cases.Educational interventions aimed at improving guideline adherence are warranted. 相似文献
4.
《American journal of infection control》2019,47(8):1028-1029
This study was a retrospective chart review from January 1, 2015 through June 30, 2017, comparing the incidence of Clostridium difficile-associated diarrhea (CDAD) in patients taking select broad spectrum antibiotics with probiotics versus without probiotics. The purpose was to determine if probiotic use was associated with a reduction in the incidence of CDAD. A total of 5,574 hospital encounters were reviewed, showing a 0.96% incidence of CDAD in patients receiving a probiotic compared to a 2.19% incidence of CDAD in patients with no probiotic (risk ratio = 0.442; P = .00743). These findings show probiotic use was associated with a statistically significant lower incidence of positive C. difficile test results compared to no probiotic use. 相似文献
5.
Mohit Girotra Vivek Kumar Javaid M. Khan Pamela Damisse Rtika R. Abraham Vikas Aggarwal Sudhir K. Dutta 《Saudi Journal Of Gastroenterology》2012,18(2):133-139
Background/Aim:
Clostridium difficile infection (CDI) can affect up to 8% of hospitalized patients. Twenty-five percent CDI patients may develop C. difficile associated diarrhea (CDAD) and 1–3% may progress to fulminant C. difficile colitis (FCDC). Once developed, FCDC has higher rates of complications and mortality.Patients and Methods:
A 10-year retrospective review of FCDC patients who underwent colectomy was performed and compared with randomly selected age- and sex-matched non-fulminant CDAD patients at our institution. FCDC (n=18) and CDAD (n=49) groups were defined clinically, radiologically, and pathologically. Univariate analysis was performed using Chi-square and Student''s t test followed by multivariate logistic regression to compute independent predictors.Results:
FCDC patients were significantly older (77 ± 13 years), presented with triad of abdominal pain (89%), diarrhea (72%), and distention (39%); 28% had prior CDI and had greater hemodynamic instability. In contrast, CDAD patients were comparatively younger (65 ± 20 years), presented with only 1 or 2 of these 3 symptoms and only 5% had prior CDI. No significant difference was noted between the 2 groups in terms of comorbid conditions, use of antibiotics, or proton pump inhibitor. Leukocytosis was significantly higher in FCDC patients (18.6 ± 15.8/mm3 vs 10.7 ± 5.2/mm3; P=0.04) and further increased until the point of surgery. Use of antiperistaltic medications was higher in FCDC than CDAD group (56% vs 22%; P=0.01).Conclusions:
Our data suggest several clinical and laboratory features in CDI patients, which may be indicative of FCDC. These include old age (>70 years), prior CDI, clinical triad of increasing abdominal pain, distention and diarrhea, profound leukocytosis (>18,000/mm3), hemodynamic instability, and use of antiperistaltic medications. 相似文献6.
BACKGROUND:
The incidence and severity of Clostridium difficile infections are increasing, and there is a need to optimize the prevention of complicated disease.OBJECTIVE:
To identify modifiable processes of care associated with an altered risk of C difficile complications.METHODS:
A retrospective cohort study (with prospective case ascertainment) of all C difficile infections during 2007/2008 at a tertiary care hospital was conducted.RESULTS:
Severe complications were frequent (occurring in 97 of 365 [27%] C difficile episodes), with rapid onset (median three days postdiagnosis). On multivariable analysis, nonmodifiable predictors of complications included repeat infection (OR 2.67), confusion (OR 2.01), hypotension (OR 0.97 per increased mmHg) and elevated white blood cell count (OR 1.04 per 109 cells/L). Protection from complications was associated with initial use of vancomycin (OR 0.24); harm was associated with ongoing use of exacerbating antibiotics (OR 3.02).CONCLUSION:
C difficile infections often occur early in the disease course and are associated with high complication rates. Clinical factors that predicted a higher risk of complications included confusion, hypotension and leukocytosis. The most effective ways to improve outcomes for patients with C difficile colitis are consideration of vancomycin as first-line treatment for moderate to severe cases, and the avoidance of unnecessary antibiotics. 相似文献7.
Orna Nitzan Mazen Elias Bibiana Chazan Raul Raz Walid Saliba 《World journal of gastroenterology : WJG》2013,19(43):7577-7585
Clostridium difficile(C.difficile)is the leading cause of antibiotic associated colitis and nosocomial diarrhea.Patients with inflammatory bowel disease(IBD)are at increased risk of developing C.difficile infection(CDI),have worse outcomes of CDI-including higher rates of colectomy and death,and experience higher rates of recurrence.However,it is still not clear whether C.difficile is a cause of IBD or a consequence of the inflammatory state in the intestinal environment.The burden of CDI has increased dramatically over the past decade,with severe outbreaks described in many countries,which have been attributed to a new and more virulent strain.A parallel rise in the incidence of CDI has been noted in patients with IBD.IBD patients with CDI tend be younger,have less prior antibiotic exposure,and most cases of CDI in these patients represent outpatient acquired infections.The clinical presentation of CDI in these patients can be unique-including diversion colitis,enteritis and pouchitis,and typical findings on colonoscopy are often absent.Due to the high prevalence of CDI in patients hospitalized with an IBD exacerbation,and the prognostic implications of CDI in these patients,it is recommended to test all IBD patients hospitalized with a disease flare for C.difficile.Treatment includes general measures such as supportive care and infection control measures.Antibiotic therapy with either oral metronidazole,vancomycin,or the novel antibiotic-fidaxomicin,should be initiated as soon as possible.Fecal macrobiota transplantation constitutes another optional treatment for severe/recurrent CDI.The aim of this paper is to review recent data on CDI in IBD:role in pathogenesis,diagnostic methods,optional treatments,and outcomes of these patients. 相似文献
8.
Peter Bossuyt Jan Verhaegen Gert Van Assche Paul Rutgeerts Séverine Vermeire 《Journal of Crohn's and Colitis》2009,3(1):4-7
Introduction and aimOver the last decade a rise in Clostridium difficile-associated diarrhea (CDAD) has been observed. A higher incidence of CDAD has also been suggested in patients with inflammatory bowel disease (IBD), and may be a challenging factor in the differential diagnosis of flares. It is unclear if the increase is caused by the enhanced use of immunosuppressive therapy in IBD. We investigated if CDAD infection is increasing in IBD patients and evaluated outcome and possible predisposing factors.MethodsThrough an electronic database of the Laboratory of Microbiology of our hospital (tertiary referral center), all stool samples from patients admitted for diarrhea and hospitalized on gastroenterology wards between January 2000 and January 2008 were reviewed for diagnosis of CDAD. For analysis, we compared two periods of equal duration.ResultsA total of 57 patients were diagnosed with CDAD, of whom 26.3% had concomitant IBD. A 3.75-fold increase in CDAD was observed between period 1 and period 2, irrespective of underlying IBD and with a comparable total number of analyzed stool samples between both periods. Non-IBD patients were significantly older. Antibiotic use three months prior to the infection was higher in non-IBD (29/42 or 69%) than in IBD patients (6/15 or 42%) (p = 0.047). Nine IBD patients were on concomitant immunomodulators, and this was not different between period 1 and period 2. Most patients had a successful outcome and only one patient with ulcerative colitis needed semi-urgent colectomy. Two patients died in the non-IBD group. The duration of hospital stay was significantly lower in IBD patients.ConclusionWe observed a significant rise in CDAD in both IBD and non-IBD. The clinical outcome was favorable with only one IBD patient needing semi-urgent colectomy. Because C. difficile can mimic an IBD flare, it is essential that clinicians are vigilant to this complication. The use of immunosuppressive drugs in IBD does not influence the risk. 相似文献
9.
María E Negrón Herman W Barkema Kevin Rioux Jeroen De Buck Sylvia Checkley Marie-Claude Proulx Alexandra Frolkis Paul L Beck Levinus A Dieleman Remo Panaccione Subrata Ghosh Gilaad G Kaplan 《Journal canadien de gastroenterologie》2014,28(7):373-380
BACKGROUND:
The impact of Clostridium difficile infections among ulcerative colitis (UC) patients is well characterized. However, there is little knowledge regarding the association between C difficile infections and postoperative complications among UC patients.OBJECTIVE:
To determine whether C difficile infection is associated with undergoing an emergent colectomy and experiencing postoperative complications.METHODS:
The present population-based case-control study identified UC patients admitted to Calgary Health Zone hospitals for a flare between 2000 and 2009. C difficile toxin tests ordered in hospital or 90 days before hospital admission were provided by Calgary Laboratory Services (Calgary, Alberta). Hospital records were reviewed to confirm diagnoses and to extract clinical data. Multivariate logistic regression analyses were performed among individuals tested for C difficile to examine the association between C difficile infection and emergent colectomy and diagnosis of any postoperative complications and, secondarily, an infectious postoperative complication. Estimates were presented as adjusted ORs with 95% CIs.RESULTS:
C difficile was tested in 278 (58%) UC patients and 6.1% were positive. C difficile infection was associated with an increased risk for emergent colectomy (adjusted OR 3.39 [95% CI 1.02 to 11.23]). Additionally, a preoperative diagnosis of C difficile was significantly associated with the development of postoperative infectious complications (OR 4.76 [95% CI 1.10 to 20.63]).CONCLUSION:
C difficile diagnosis worsened the prognosis of UC by increasing the risk of colectomy and postoperative infectious complications following colectomy. Future studies are needed to explore whether early detection and aggressive management of C difficile infection will improve UC outcomes. 相似文献10.
Mary C. Rea Clarissa S. Sit Evelyn Clayton Paula M. O'Connor Randy M. Whittal Jing Zheng John C. Vederas R. Paul Ross Colin Hill 《Proceedings of the National Academy of Sciences of the United States of America》2010,107(20):9352-9357
The last decade has seen numerous outbreaks of Clostridium difficile-associated disease (CDAD), which presented significant challenges for healthcare facilities worldwide. We have identified and purified thuricin CD, a two-component antimicrobial that shows activity against C. difficile in the nanomolar range. Thuricin CD is produced by Bacillus thuringiensis DPC 6431, a bacterial strain isolated from a human fecal sample, and it consists of two distinct peptides, Trn-α and Trn-β, that act synergistically to kill a wide range of clinical C. difficile isolates, including ribotypes commonly associated with CDAD (e.g., ribotype 027). However, this bacteriocin thuricin CD has little impact on most other genera, including many gastrointestinal commensals. Complete amino acid sequencing using infusion tandem mass spectrometry indicated that each peptide is posttranslationally modified at its respective 21st, 25th, and 28th residues. Solution NMR studies on [13C,15N] Trn-α and [13C,15N]Trn-β were used to characterize these modifications. Analysis of multidimensional NOESY data shows that specific cysteines are linked to the α-carbons of the modified residues, forming three sulfur to α-carbon bridges. Complete sequencing of the thuricin CD gene cluster revealed genes capable of encoding two S′-adenosylmethionine proteins that are characteristically associated with unusual posttranslational modifications. Thuricin CD is a two-component antimicrobial peptide system with sulfur to α-carbon linkages, and it may have potential as a targeted therapy in the treatment of CDAD while also reducing collateral impact on the commensal flora. 相似文献
11.
Achuta Kumar Guddati Gagan Kumar Shahryar Ahmed Muhammad Ali Nilay Kumar Parameswaran Hari Nanda Venu 《International journal of hematology》2014,99(6):758-765
Hematopoietic stem cell transplant (HSCT) recipients are at a high risk of Clostridium difficile-associated disease (CDAD) given frequent hospitalizations, prolonged antibiotic usage and altered integrity of intestinal mucosa. The prevalence and trends of CDAD in HSCT patients have not been extensively studied. In this study, the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes were used to identify CDAD in HSCT patients using a nationwide inpatient sample in the United States from 2000 to 2009. The prevalence of CDAD and in-hospital mortality in HSCT were investigated and compared to those without any transplants. Multivariate analysis was performed to identify if BMT and graft versus host disease (GVHD) were independently associated with mortality in CDAD patients. Of the 344,507 HSCT discharges, 4.7 % had CDAD. This was about 5 times higher when compared to non-transplant discharges. During engraftment admission, rates of CDAD were higher in allogenic group (8.4 vs. 5.7 %, p < 0.001). In subsequent admissions, those with GVHD had higher rates of CDAD (5.7 vs. 3.2 %, p < 0.001). On adjusted analysis in patients with CDAD, during engraftment admission, allogenic group had significantly higher mortality when compared with non-transplants (OR 3.7). Notably, there was no significant difference in mortality between patients with and without CDAD during the engraftment period for the allogeneic group. In subsequent admissions, there was higher mortality in those with GVHD (OR 4.8). Though the prevalence of CDAD in non-transplant population doubled (from 0.44 % in 2000 to 0.99 % in 2008), it has remained stable in HSCT patients (from 4.8 % in 2000 to 5.6 % in 2008). HSCT and GVHD are independently associated with CDAD though its presence does not affect mortality. 相似文献
12.
Luca Mellace Dario Consonni Gaia Jacchetti Marta Del Medico Riccardo Colombo Marta Velati Simone Formica Maria Domenica Cappellini Silvana Castaldi Giovanna Fabio 《Internal and emergency medicine》2013,8(8):717-723
Clostridium difficile-associated disease (CDAD) is a growing health care problem. Elderly patients with multiple comorbidities and repeated hospitalization are at high risk for developing the disease. Few data are available on epidemiology of CDAD in Italy and no studies have focused on CDAD burden in internal medicine wards. We retrospectively analysed all CDAD cases in four internal medicine wards of a city hospital in northern Italy and reviewed the medical records of patients who developed CDAD during hospitalization. We identified 146 newly acquired cases, yielding a cumulative incidence of 2.56 per 100 hospitalizations and an incidence rate of 23.3 per 10,000 patient-days. Main risk factors were advanced age and length of hospitalization. A high proportion of CDAD patients had several comorbidities and had been treated with more than one antibiotic. The incidence is among the highest previously reported, this may be due to the characteristics of patients admitted to internal medicine wards and to the wards per se. We conclude that efforts are needed to reduce CDAD’s burden in this setting, paying attention to logistics, patients care and antibiotic use. 相似文献
13.
Vaishnavi C 《Indian journal of gastroenterology》2011,30(6):245-254
Clostridium difficile is recognized globally as an important enteric pathogen associated with considerable morbidity and mortality due to the widespread
use of antibiotics. The overall incidence of C. difficile-associated diarrhea (CDAD) is increasing due to the emergence of a hypervirulent strain known as NAP1/BI/027. C. difficile acquisition by a host can result in a varied spectrum of clinical conditions inclusive of both colonic and extracolonic manifestations.
Repeated occurrence of CDAD, manifested by the sudden re-appearance of diarrhea and other symptoms usually within a week of
stopping treatment, makes it a difficult clinical problem. C. difficile infection has also been reported to be involved in exacerbation of inflammatory bowel diseases. The first step in the management
of a suspected CDAD case is the withdrawal of the offending agent and changing the antibiotic regimens. Antimicrobial therapy
directed against C. difficile viz. metronidazole for mild cases and vancomycin for severe cases is needed. For patients with ileus, oral vancomycin with
simultaneous intravenous (IV) metronidazole and intracolonic vancomycin may be given. Depending on the severity of disease,
the further line of management may include surgery, IV immunoglobulin treatment or high dose of vancomycin. Adjunctive measures
used for CDAD are probiotics and prebiotics, fecotherapy, adsorbents and immunoglobulin therapy. Among the new therapies fidaxomicin
has recently been approved by the American Food and Drugs Administration for treatment of CDAD. 相似文献
14.
15.
Meghraj Ingle Abhijit Deshmukh Devendra Desai Philip Abraham Anand Joshi Tarun Gupta Camilla Rodrigues 《Indian journal of gastroenterology》2013,32(3):179-183
Introduction
Clostridium difficile-associated diarrhea (CDAD) is an increasing problem. Recent reports suggest presence of community acquired CDAD (CA CDAD). Studies in India have shown varied results.Aims
The following are the aims of this study: (a) the prevalence of CDAD and CA CDAD in patients with acute diarrhea; (b) the incremental yield of second stool sample for the diagnosis of C. difficile infection (CDI); and (c) the risk factors for CDI.Patients and Methods
Patients with acute diarrhea (<4 weeks) between April 2009 and December 2010 had two stool sample tested for C. difficile toxin (CDT) by enzyme-linked immunofluorescent assay. Demographic, clinical data, risk factors, clinical course, complications, treatment, and response were noted.Results
Of 150 patients (mean age, 47.3 years; 76 males), 12 (8 %) had their first stool sample positive for CDT. Two patients (1.3 %) had community acquired CDI. The study group was compared with 138 patients (“control group”, stool samples negative for CDT). Compared to the controls, the study group were more likely to have had intensive care unit (ICU) stay (p?=?0.018) and tube feeding (p?=?0.035). Eleven patients were treated with metronidazole. One patient did not respond to metronidazole and was treated with vancomycin. No patient developed complications of CDAD.Conclusions
The prevalence of CDAD in our population was 8 % and of CA CDAD was 1.3 %. There was no advantage of testing two samples. ICU stay and tube feeding were major risk factors for the CDAD. Metronidazole was an effective first-line therapy. 相似文献16.
Purpose
New guidelines for the treatment of Clostridium difficile-associated diarrhea were published by the Infectious Disease Society of America (IDSA) in 2010, however, there has been no literature evaluating the effectiveness of these guidelines. The purpose of this study was to examine the clinical outcomes of Clostridium difficile infection including death, C difficile infection recurrence, toxic megacolon, and surgery between patients who received guideline-concordant therapy vs guideline-discordant therapy.Methods
Retrospective case-control study of hospitalized adults with C difficile infection presenting to a 420-bed tertiary care referral county teaching hospital. Patients were identified by International Classification of Diseases-9th Revision codes, and included if they were ≥18 years of age and treated for C difficile infection during their hospital visit. Complication rates (death, infection recurrence, toxic megacolon, and surgery) of patients with C difficile infection were measured to determine if following the IDSA guidelines improves outcomes.Results
Only 51.7% of the patients' prescribers followed the 2010 IDSA guidelines. Patients whose prescribers followed the IDSA guidelines experienced fewer complications than patients whose prescribers strayed from the guidelines (17.2% vs 56.3%, P <.0001). This difference was mainly due to a reduction in mortality (5.4% vs 21.8%, P = .0012) and infection recurrence (14% vs 35.6%, P = .0007). Patients who presented with severe and complicated disease received guideline-based therapy significantly less often than patients with mild disease (19.7%, 35.3%, and 81.2%, respectively, P <.0001).Conclusions
There was a significant reduction in C difficile infection recurrence and mortality when prescribers followed the IDSA/Society for Healthcare Epidemiology of America guidelines for treatment of C difficile infection. 相似文献17.
Ji Won Kim Kook Lae Lee Ji Bong Jeong Byeong Gwan Kim Sue Shin Joo Sung Kim Hyun Chae Jung In Sung Song 《World journal of gastroenterology : WJG》2010,16(28):3573-3577
AIM:To investigate the risk factors for Clostridiumdifficile-associated diarrhea(CDAD)recurrence,and its relationship with proton pump inhibitors(PPIs). METHODS:Retrospective data of 125 consecutive hospitalized patients diagnosed with CDAD between January 2006 and December 2007 were collected by medical chart review.Collected data included patient characteristics at baseline,underlying medical disease, antibiotic history before receiving a diagnosis of CDAD, duration of hospital stay,severity of CDAD,concu... 相似文献
18.
《American journal of infection control》2004,32(3):E4
BACKGROUND: Clostridium difficile–associated diarrhea (CDAD) is a common nosocomial infection. CDAD has been associated with prolonged use of antibiotics. C. difficile spores, which are present in stool, can live for up to 70 days and are often spread by the hands of healthcare professionals.METHODS: An increased rate of CDAD was noted in June and July 2002 at Barnes-Jewish Hospital, a 1442-bed tertiary care hospital in St. Louis, Missouri. The CDAD rate for the hospital in the first 5 months of 2002 was 2.8 cases/1000 patient-days. The rate in June and July was 6.2 cases/1000 patient-days (p<0.001). A computerized laboratory surveillance tool helped infection control specialists promptly identify the rise in CDAD rates. Unit-specific interventions were performed in two ICUs. The surgical ICU (SICU) (10.4 cases/1000 patient-days in July 2002) instituted enhanced environmental cleaning, including bleach, in rooms of CDAD patients. The medical ICU (MICU) (25 cases/1000 patient-days in June 2002) intensified active surveillance, including monthly reporting of CDAD rates to the ICU staff. Additionally in this unit, rooms of CDAD patients were bleached at discharge. A hospital-wide hand hygiene intervention was also implemented between January and April 2003.RESULTS: The hospital's overall CDAD rate decreased to 2.5 cases per 1000 patient-days in the last 5 months of 2002 (p<0.001). The CDAD rate in the SICU dropped to 4.8 cases/1000 patient-days (p=.20) after the start of the intervention. Since the implementation of the intervention in the MICU, the CDAD rate has decreased to 5.1 cases/1000 patient-days (p<0.001). The hospital CDAD rate dropped to 2.1 cases/1000 patient-days (p<0.001) in the months following the hand hygiene intervention.CONCLUSION: Early recognition allows prompt interventions to address infection control issues such as this increase in CDAD rates. The use of multidisciplinary interventions to reduce CDAD infection rates was a successful strategy in this case. 相似文献
19.
BackgroundClostridium difficile (C. difficile) is a gram-positive anaerobic bacillus capable of producing diarrhea or colitis in the hospitalized patient, particularly in those exposed to the use of antibiotics, and 6% to 38% mortality in patients with C. difficile-associated diarrhea (CDAD) has been described.AimsTo determine the hospital death rate in patients presenting with CDAD. As a secondary aim, hospital stay and risk factors for unfavorable outcome were recorded.MethodsA retrospective cohort study was carried out. The case records of hospitalized patients presenting with diarrhea and that tested positive for C. difficile through toxin A and B assays were reviewed. The number of non-surviving patients that presented with CDAD during hospitalization was recorded along with the principal factors associated with the worst outcome.ResultsOf the 66 patients enrolled in the study, 6 (9,1%) died during their hospitalization. The median age was lower in the group of surviving patients than in the group of non-surviving patients, with 51,5 years (range 36 to 66,75) and 81,5 years (range 69,5 to 83,25), respectively (p=0,002). Hospital stay was 32,50 days (range 8,25 to 64,25) in the group of non-surviving patients and was 6,5 days (range 4 to 15,75) (p=0,045) in the group with no deaths.ConclusionsThe elevated mortality found in the hospitalized CDAD patients in the Intensive Care Unit makes the maintenance of strict surveillance in this population imperative so there can be opportune detection and treatment. 相似文献
20.
Joseph Dylewski 《The Canadian Journal of Infectious Diseases & Medical Microbiology》2011,22(2):e12-e15