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PubMed2003

Clostridium difficile infections related to antibiotic use and infection control facilities in two university hospitals.

We investigated whether a reduction in antibiotic use at the Aker University Hospital (Aker) led to a reduction in Clostridium difficile-associated diarrhoea (CDAD). We compared the incidence of CDAD in Aker and Tromsoe University Hospitals (Tromsoe) and related it to antibiotic use and facilities for infection control between 1993-2001. For this purpose we also performed point prevalence studies. Total antibiotic use was the same in the two hospitals. In spite of a reduction in the use of broad-spectrum antibiotics in Aker the incidence of CDAD increased during 1993-1999. In Tromsoe the use of broad-spectrum antibiotics and clindamycin was two to three times higher than in Aker, but until 1999 the incidence of CDAD remained constant and only half that of Aker. After 1999 the incidence of CDAD was halved in Aker, and increased three-fold in Tromsoe. Point prevalence studies in 2001 revealed an equal prevalence of antibiotic-associated diarrhoea. The facilities for infection control were better in Tromsoe. The percentage of single rooms were 8% in Aker and 14% in Tromsoe, and the percentage of single rooms with a WC was 6% in Aker and 12% in Tromsoe. The bed occupancy was much higher in Aker than in Tromsoe. Lack of facilities for infection control and higher bed occupancy could have contributed to the higher incidence of CDAD in Aker in spite of decreased use of broad-spectrum antibiotics and clindamycin. To limit CDAD in hospitals the focus must be on both rational antibiotic use and infection control.

Anti-Bacterial Agents↗
PubMed1992

Occult gastrointestinal malignancies producing metastatic Clostridium septicum infections in diabetic patients.

BACKGROUND: Clostridial soft-tissue infections usually occur from traumatic injury but may be related to unrecognized gastrointestinal malignancy. Overwhelming sepsis with Clostridium septicum developed in five diabetic patients within 24 hours of onset of disease, and their course is reviewed. METHODS: The personal experience of the author in four cases is reviewed. RESULTS: Patients were seen within 12 to 24 hours of the onset of the disease with painful, rapidly spreading, gas-producing infection of the lower extremity (three patients), upper extremity (one patient), or pelvis (one patient), with severe sepsis in four of five patients. Three of the five patients had pertinent past histories that should have led to the prevention of the disease. CONCLUSIONS: Urgent laparotomy should be performed in otherwise healthy diabetic patients who had rapidly progressive, necrotizing, gas-producing infections with no obvious source. Metastatic spread can recur if the focus is not eradicated. All diabetic patients with guaiac-positive stools should have a gastrointestinal evaluation, including colonoscopy if barium enema is normal.

Aged↗
PubMedDate not supplied

Low levels of coagulation inhibitors in patients with Clostridium difficile infection.

To investigate levels of coagulation inhibitors in sera from patients with Clostridium difficile-associated diarrhoea and colitis, commercially available antigen assays were used for immunochemical determination of antithrombin III, protein C and free protein S. Sera from patients with Clostridium difficile-associated diarrhoea and colitis showed significantly lowered levels of all measured inhibitors as compared to controls (Student's t test). Protein C (mean +/- SD): 0.70 +/- 0.30 vs. 1.28 +/- 0.23, t = 6.61, p less than 0.001; antithrombin: 0.70 +/- 0.21 vs. 0.90 +/- 0.17, t = 3.12, p less than 0.01; free protein S: 0.27 +/- 0.06 vs. 0.37 +/- 0.08, t = 3.7, p less than 0.001. Infection with C. difficile may lead to loss of coagulation inhibitors and constitutes a risk for thromboembolic complications.

Aged↗
PubMed2001

Failure of single-toxin assays to detect clostridium difficile infection in pediatric inflammatory bowel disease.

OBJECTIVES: The aims of this retrospective study were 1) to determine the ability of single-toxin assays for Clostridium difficile to detect infection among pediatric patients with inflammatory bowel disease (IBD) and 2) to determine the toxin assays routinely used by pediatric tertiary care hospitals in the United States. METHODS: Stool specimens from patients with IBD (submitted from January, 1996, to August, 1999) were evaluated for the presence of C. difficile toxin A and toxin B. Toxin profile (toxin A alone, toxin B alone, toxin A and B together) was compared in positive specimens. A phone interview was conducted with representatives from laboratories in 22 pediatric hospitals to investigate which toxin assays were routinely used. RESULTS: A total of 697 specimens were submitted from 284 IBD patients. In all, 81 IBD patients (28.5%) had at least one documented infection. Toxin A assay failed to identify 41.5% of C. difficile infections. Toxin B assay failed to detect 34.9% of C. difficile infections. Toxin profile changed in 55% of patients with multiple infections. Of the hospitals surveyed, 59% did not test for both toxins. CONCLUSIONS: Single-toxin assays for C. difficile fail to detect a significant percentage of infections. The toxins identified during one infection are not predictive of the toxins identified in subsequent infections. Despite this, many pediatric hospitals do not routinely use both toxin assays to diagnose C. difficile infection. When infection is suspected, assays for C. difficile toxin A and toxin B should be requested.

Adolescent↗
PubMed1993

Clostridium difficile infection is a treatable cause of diarrhea in patients with advanced human immunodeficiency virus infection: a study of seven consecutive patients admitted from 1986 to 1992 to a university teaching hospital.

Of 427 human immunodeficiency virus-seropositive patients admitted to the Robert Wood Johnson University Hospital from January 1986 through August 1992, seven had Clostridium difficile enteric infection documented by the presence of cytotoxin B in the stool, without other enteric infection. All seven patients had AIDS, and all had recently received antibiotics. These patients had a severe clinical presentation of C. difficile infection. All patients had profound watery diarrhea, with a mean of 20 +/- 14 (SD) bowel movements per day. Four had fever > 38.5 degrees C, and another had hypothermia. Three patients had borderline hypotension, and another was orthostatic. The mean pulse was 119 +/- 26 (SD) beats/min. Five patients had abdominal pain and tenderness. Two had occult blood in the stool. Four had metabolic derangements such as hyponatremia, hypokalemia, or prerenal azotemia. Three of four patients undergoing abdominal roentgenography had radiographic findings consistent with severe colitis of colonic dilation, mural thumbprinting, or mural thickening. Sigmoidoscopic findings ranged from diffuse erythema to prominent pseudomembranes. During a mean interval of 14.3 +/- 6.2 (SD) days before institution of specific antibiotic therapy, the diarrhea spontaneously resolved in only one of the seven patients. In the others, the diarrhea resolved on average 7.3 +/- 4.0 (SD) days after instituting antibiotic therapy. During a mean follow-up of 4.4 +/- 6.3 (SD) months, only two patients redeveloped diarrhea. Both patients had recurrent C. difficile colitis; the symptoms again rapidly resolved after repeat antibiotic therapy. We conclude that in patients with AIDS C. difficile may present as a severe enteric infection with profound diarrhea due to immunosuppression, that the diarrhea may be prolonged and not remit spontaneously, and that the diarrhea usually rapidly resolves with specific antibiotic therapy.

AIDS-Related Opportunistic Infections↗
PubMed2002

[Epidemiology of Clostridium difficile infection].

Pseudomembranous colitis (PMC), antibiotic-associated diarrhoea (AAD), and colitis (AAC) caused by Clostridium difficile are recognized as complications of antibiotic treatment (cephalosporins, penicillins, clindamycin and others). Two groups are particularly at risk: older and immunocompromised patients. In recent years C. difficile has been recognized as a common nosocomial pathogen. To understand the epidemiology of the C. difficile infection, many outbreaks have been investigated by various methods. In the paper we reviewed different methods of C. difficile typing and discussed the epidemiology of C. difficile-associated infections in light of recent publications.

Age Factors↗
PubMed1991

[The Norrköping study. Cephalosporins are often the implicating factors in Clostridium difficile infections].

In a retrospective study carried out at Norrköping Central Hospital, the incidence of Clostridium difficile-associated diarrhoea and colitis was found to be correlated to in-patient consumption (in terms of defined daily doses) of the implicated anti-microbial agents. The third generation cephalosporin, cefotaxime, was implicated 38 times more often than small spectrum penicillins. In general, the cephalosporins were predominantly responsible, accounting for 46 per cent (67/147) of the episodes but only 12 per cent of overall consumption of antibiotics at the hospital. These findings are in accord with data previously published in the nationwide report by the Medical Product Agency, Uppsala.

Adolescent↗
PubMed2001

Clostridium difficile infection, hospital geography and time-space clustering.

To analyse spatial and temporal relationships of Clostridium difficile-associated disease in an inner-city hospital, we retrospectively evaluated 283 episodes of confirmed C. difficile diarrhoea in the Chelsea and Westminster Hospital between 1995 and 1998, against a background of relatively stable case mix, antibiotic usage and admission numbers, using Knox analysis to determine the presence of disease clustering in time and space. We found five time-space clusters on four medical wards and between two adjacent units. The clusters were not related to the overall case number on single wards, and were separated in time. Knox time-space analysis provides a simple screening tool to identify disease clusters, assess the efficacy of infection control measures and the influence of hospital geography and traffic. The results support the importance of infection control measures in the prevention of C. difficile-related disease.

Adult↗
PubMedDate not supplied

Clostridium difficile infection in a geriatric ward.

In a prospective, longitudinal study we searched for the presence of Clostridium difficile in the stools of 100 consecutively hospitalized elderly patients (mean age: 82; SD: 9.5 years). C. difficile was found on admission in 6 patients, 3 of whom were asymptomatic carriers. Ten patients acquired C. difficile during hospitalization. Four different types of C. difficile were isolated. The various types were clustered in time, indicating that the infection was acquired from the environment.

Journal Article↗
PubMed2005

Effect of phage infection on toxin production by Clostridium difficile.

Infection with Clostridium difficile and subsequent production of toxins A and B may result in C. difficile-associated diarrhoea and pseudomembranous colitis in hospital patients. The effect of four temperate phages, obtained by induction of clinical C. difficile isolates, on toxin production by C. difficile was determined. None of these phages converted a lysogenized non-toxigenic C. difficile strain to toxin production. One of the accessory toxin genes, tcdE, was detected in three phages, phiC2, phiC6 and phiC8; however, the non-repeating regions of tcdA and tcdB encoding the enzymic domains were not carried on phage DNA. Phage infection of toxigenic strains increased toxin B production in four of six lysogens, although the level of tcdB transcription as determined by real-time RT-PCR was not significantly altered. However, levels of toxin A transcription in two lysogens were significantly altered without any corresponding differences in toxin A production.

Bacterial Proteins↗
PubMed1989

Protein-losing enteropathy associated with Clostridium difficile infection.

A commercially available radial immunodiffusion assay was used to measure serum alpha-1-antitrypsin levels in stool samples from subjects aged over 60 years as a marker of protein-losing enteropathy. alpha 1-antitrypsin was found in all of 12 patients with colonoscopy-confirmed pseudomembranous colitis, 6 of 14 (43%) patients with Clostridium difficile diarrhoea without pseudomembranes, 6 of 12 (50%) nursing-home patients culture-positive for Cl difficile but negative for its cytotoxin, and none of 15 healthy control subjects. It is concluded that serum protein loss into the gastrointestinal tract can occur as a result of Cl difficile infection, that its presence correlates with the severity of disease, and that it may occur even in the absence of diarrhoea. The diagnosis of protein-losing enteropathy should be considered for all patients with Cl difficile infection, particularly elderly nursing-home patients, in whom the risk of Cl difficile disease and the frequency of severe malnutrition are high.

Adolescent↗