1
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Baek JE, Choi IH, Cho YW, Kim J, Lee YJ, Kim MC, Kim KO, Cho YS. Clinical characteristics and outcomes of Clostridioides difficile infection in the intensive care unit: a KASID multi-centre study. J Hosp Infect 2023; 139:106-112. [PMID: 37451405 DOI: 10.1016/j.jhin.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 07/07/2023] [Accepted: 07/07/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Despite the growing clinical and economic burden of Clostridioides difficile infection (CDI), data on CDI in the intensive care unit (ICU) in the Asia-Pacific region are lacking. METHODS This retrospective study analysed 191 patients who were treated with CDI in the ICUs of three hospitals in South Korea from January 2017 to May 2021. Backward-stepwise multiple logistic regression was used to identify factors influencing the treatment response and mortality. RESULTS Fifty-eight patients (30.4%) were considered immunocompromised. The mean Charlson comorbidity index was 5.65 ± 2.39 (10-year survival rate: 21%), the APACHE II score was 20.86 ± 7.78 (mortality rate: 40%), the ATLAS score was 5.45 ± 1.59 (cure rate: 75%), and the SOFA score was 7.97 ± 4.03 (mortality rate: 21.5%). Fifty-eight (30.4%) of the CDI cases were severe and 40 (20.9%) were fulminant. Oral vancomycin or oral metronidazole was the most frequently first-line treatments (N = 57; 32.6%). The 10-day response rate was 59.7% and the eight-week overall mortality rate was 41.4%. Fulminant CDI (OR 0.230; 95% CI 0.085-0.623) and each one-unit increment in the SOFA score (OR 0.848; 95% CI 0.759-0.947) were associated with treatment failure. High APACHE II (OR 0.355; 95% CI 0.143-0.880) and SOFA (OR 0.164; 95% CI 0.061-0.441) scores were associated with higher mortality. CONCLUSIONS High-risk patients in the ICU had a higher mortality rate and a lower cure rate of CDI. Further research is required to provide more accurate prediction scoring systems and better clinical outcomes.
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Affiliation(s)
- J E Baek
- Division of Gastroenterology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - I H Choi
- Division of Gastroenterology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Y W Cho
- Division of Gastroenterology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - J Kim
- Division of Gastroenterology, Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Republic of Korea
| | - Y J Lee
- Division of Gastroenterology, Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Republic of Korea
| | - M C Kim
- Division of Gastroenterology, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Republic of Korea
| | - K O Kim
- Division of Gastroenterology, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Republic of Korea
| | - Y-S Cho
- Division of Gastroenterology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
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2
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Covino M, Gallo A, Pero E, Simeoni B, Macerola N, Murace CA, Ibba F, Landi F, Franceschi F, Montalto M. Early Prognostic Stratification of Clostridioides difficile Infection in the Emergency Department: The Role of Age and Comorbidities. J Pers Med 2022; 12:jpm12101573. [PMID: 36294712 PMCID: PMC9604882 DOI: 10.3390/jpm12101573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 09/07/2022] [Accepted: 09/20/2022] [Indexed: 11/16/2022] Open
Abstract
Clostridioides difficile infection (CDI) represents a significant cause of morbidity and mortality, mainly in older and frail subjects. Early identification of outcome predictors, starting from emergency department (ED) admission, could help to improve their management. In a retrospective single-center study on patients accessing the ED for diarrhea and hospitalized with a diagnosis of CDI infection, the patients’ clinical history, presenting symptoms, vital signs, and laboratory exams at ED admission were recorded. Quick sequential organ failure assessments (qSOFA) were conducted and Charlson’s comorbidity indices (CCI) were calculated. The primary outcomes were represented by all-cause in-hospital death and the occurrence of major cumulative complications. Univariate and multivariate Cox regression analyses were performed to establish predictive risk factors for poor outcomes. Out of 450 patients, aged > 81 years, dyspnea at ED admission, creatinine > 2.5 mg/dL, white blood cell count > 13.31 × 109/L, and albumin < 30 µmol/L were independently associated with in-hospital death and major complications (except for low albumin). Both in-hospital death and major complications were not associated with multimorbidity. In patients with CDI, the risk of in-hospital death and major complications could be effectively predicted upon ED admission. Patients in their 8th decade have an increased risk independent of comorbidities.
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Affiliation(s)
- Marcello Covino
- Department of Emergency Medicine, Fondazione Policlinico Universitario “A. Gemelli”, IRCCS, Largo A. Gemelli, 8, 00168 Rome, Italy
| | - Antonella Gallo
- Department of Geriatrics and Orthopedics, Fondazione Policlinico Universitario “A. Gemelli”, IRCCS, Largo A. Gemelli, 8, 00168 Rome, Italy
- Correspondence:
| | - Erika Pero
- Department of Geriatrics and Orthopedics, Fondazione Policlinico Universitario “A. Gemelli”, IRCCS, Largo A. Gemelli, 8, 00168 Rome, Italy
| | - Benedetta Simeoni
- Department of Emergency Medicine, Fondazione Policlinico Universitario “A. Gemelli”, IRCCS, Largo A. Gemelli, 8, 00168 Rome, Italy
| | - Noemi Macerola
- Department of Geriatrics and Orthopedics, Fondazione Policlinico Universitario “A. Gemelli”, IRCCS, Largo A. Gemelli, 8, 00168 Rome, Italy
| | - Celeste Ambra Murace
- Department of Geriatrics and Orthopedics, Fondazione Policlinico Universitario “A. Gemelli”, IRCCS, Largo A. Gemelli, 8, 00168 Rome, Italy
| | - Francesca Ibba
- Department of Geriatrics and Orthopedics, Fondazione Policlinico Universitario “A. Gemelli”, IRCCS, Largo A. Gemelli, 8, 00168 Rome, Italy
| | - Francesco Landi
- Department of Geriatrics and Orthopedics, Fondazione Policlinico Universitario “A. Gemelli”, IRCCS, Largo A. Gemelli, 8, 00168 Rome, Italy
- Department of Geriatrics and Orthopedics, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168 Rome, Italy
| | - Francesco Franceschi
- Department of Emergency Medicine, Fondazione Policlinico Universitario “A. Gemelli”, IRCCS, Largo A. Gemelli, 8, 00168 Rome, Italy
- Department of Emergency Medicine, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168 Rome, Italy
| | - Massimo Montalto
- Department of Geriatrics and Orthopedics, Fondazione Policlinico Universitario “A. Gemelli”, IRCCS, Largo A. Gemelli, 8, 00168 Rome, Italy
- Department of Geriatrics and Orthopedics, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168 Rome, Italy
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3
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Zhang VRY, Woo ASJ, Scaduto C, Cruz MTK, Tan YY, Du H, Feng M, Siah KTH. Systematic review on the definition and predictors of severe Clostridiodes difficile infection. J Gastroenterol Hepatol 2021; 36:89-104. [PMID: 32424877 DOI: 10.1111/jgh.15102] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 05/02/2020] [Accepted: 05/11/2020] [Indexed: 12/18/2022]
Abstract
Clostridiodes difficile infection (CDI) is one of the most common hospital-acquired infections with high mortality rates. Optimal management of CDI depends on early recognition of severity. However, currently, there is no acceptable standard of prediction. We reviewed severe CDI predictors in published literature and its definition according to clinical guidelines. We systematically reviewed studies describing clinical predictors for severe CDI in medical databases (Cochrane, EMBASE, Global Health Library, and MEDLINE/PubMed). They were independently evaluated by two reviewers. Six hundred thirty-three titles and abstracts were screened, and 31 studies were included. We excluded studies that were restricted to a specific patient population. There were 16 articles that examined mortality in CDI, as compared with 15 articles investigating non-mortality outcomes of CDI. The commonest risk factors identified were comorbidities, white blood cell count, serum albumin level, age, serum creatinine level and intensive care unit admission. Generally, the studies had small patient populations, were retrospective in nature, and mostly from Western centers. The commonest severe CDI criteria in clinical guidelines were raised white blood cell count, followed by low serum albumin and raised serum creatinine levels. There was no commonly agreed upon definition of severe CDI severity in the literature. Current clinical guidelines' definitions for severe CDI are heterogeneous. Hence, there is a need for prospective multi-center studies using standardized protocol for biospecimen investigation collection and shared data on outcomes of patients in order to devise a universally accepted definition for severe CDI.
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Affiliation(s)
- Valencia Ru Yan Zhang
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Aaron Shu Jeng Woo
- Gastroenterology and Hepatology Service, Sengkang General Hospital, Singapore
| | - Christina Scaduto
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Maria Teresa Kasunuran Cruz
- Division of Advanced Internal Medicine, University Medicine Cluster, National University Hospital, Singapore
| | - Yan Yuan Tan
- Alliance Healthcare Group, Singapore.,Babylon Health, Singapore
| | - Hao Du
- Saw Swee Hock School of Public Health, National University Health System, National University of Singapore, Singapore
| | - Mengling Feng
- Saw Swee Hock School of Public Health, National University Health System, National University of Singapore, Singapore
| | - Kewin Tien Ho Siah
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Division of Gastroenterology and Hepatology, University Medicine Cluster, National University Hospital, Singapore
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4
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Aguilar RC, Salmanton-García J, Carney J, Böll B, Kochanek M, Jazmati N, Cornely OA, Vehreschild MJGT. Clostridioides difficile infections in the intensive care unit: a monocentric cohort study. Infection 2020; 48:421-427. [PMID: 32212102 PMCID: PMC7256083 DOI: 10.1007/s15010-020-01413-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 03/11/2020] [Indexed: 11/29/2022]
Abstract
Introduction Patient-level data from Clostridioides difficile infections (CDI) treated in an intensive care setting is limited, despite the growing medical and financial burden of CDI. Methods We retrospectively analyzed data from 100 medical intensive care unit patients at the University Hospital Cologne with respect to demography, diagnostics, severity scores, treatment, and outcome. To analyze factors influencing response to treatment and death, a backward-stepwise multiple logistic regression model was applied. Results Patients had significant comorbidities including 26% being immunocompromised. The mean Charlson Comorbidity Index was 6.3 (10-year survival rate of 2.25%). At the time of diagnosis, the APACHE II was 17.4±6.3 (predicted mortality rate of 25%), and the ATLAS score was 5.2±1.9 (predicted cure rate of 75%). Overall, 47% of CDI cases were severe, 35% were complicated, and 23% were both. At least one concomitant antibiotic was given to 74% of patients. The cure rate after 10 and 90 days was 56% and 51%, respectively. Each unit increment in APACHE II score was associated with poorer treatment response (OR 0.931; 95% CI 0.872–0.995; p = 0.034). Age above 65 years was associated with death (OR 2.533; 95% CI 1.031–6.221; p = 0.043), and overall mortality at 90 days was 56%. Conclusions CDI affects a high-risk population, in whom predictive scoring tools are not accurate, and outcomes are poor despite intensive treatment. Further research in this field is warranted to improve prediction scoring and patient outcomes. Electronic supplementary material The online version of this article (10.1007/s15010-020-01413-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Rebeca Cruz Aguilar
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Cologne, Germany
| | - Jon Salmanton-García
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Cologne, Germany
| | - Jonathan Carney
- Department of Internal Medicine, Zentrum für Innere Medizin, Infectious Diseases, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
| | - Boris Böll
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Cologne, Germany.,Center for Integrated Oncology CIO Köln/Bonn, Medical Faculty, University of Cologne, Cologne, Germany
| | - Matthias Kochanek
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Cologne, Germany.,Center for Integrated Oncology CIO Köln/Bonn, Medical Faculty, University of Cologne, Cologne, Germany
| | - Nathalie Jazmati
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Cologne, Germany.,Labor Dr. Wisplinghoff, Cologne, Germany
| | - Oliver A Cornely
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Cologne, Germany.,German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany.,Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany.,Center for Integrated Oncology CIO Köln/Bonn, Medical Faculty, University of Cologne, Cologne, Germany.,Clinical Trials Centre Cologne (ZKS Köln), University of Cologne, Cologne, Germany.,Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany
| | - Maria J G T Vehreschild
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Cologne, Germany. .,Department of Internal Medicine, Zentrum für Innere Medizin, Infectious Diseases, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany. .,German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany.
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5
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Cui Y, Dong D, Zhang L, Wang D, Jiang C, Ni Q, Wang C, Mao E, Peng Y. Risk factors for Clostridioides difficile infection and colonization among patients admitted to an intensive care unit in Shanghai, China. BMC Infect Dis 2019; 19:961. [PMID: 31711425 PMCID: PMC6849324 DOI: 10.1186/s12879-019-4603-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 10/28/2019] [Indexed: 12/17/2022] Open
Abstract
Background Clostridioides difficile is considered the main pathogen responsible for hospital-acquired infections. This prospective study determined the prevalence, molecular epidemiological characteristics, and risk factors for C. difficile infection (CDI) and C. difficile colonization (CDC) among patients in the intensive care unit (ICU) of a large-scale tertiary hospital in China, with the aim of providing strategies for efficient CDI and CDC prevention and control. Methods Stool samples were collected and anaerobically cultured for C. difficile detection. The identified isolates were examined for toxin genes and subjected to multilocus sequence typing. Patients were classified into CDI, CDC, and control groups, and their medical records were analyzed to determine the risk factors for CDI and CDC. Results Of the 800 patients included in the study, 33 (4.12%) and 25 (3.12%) were identified to have CDI and CDC, respectively. Associations with CDI were found for fever (OR = 13.993), metabolic disorder (OR = 7.972), and treatment with fluoroquinolone (OR = 42.696) or combined antibiotics (OR = 2.856). CDC patients were characterized by prolonged hospital stay (OR = 1.137), increased number of comorbidities (OR = 36.509), respiratory diseases (OR = 0.043), and treatment with vancomycin (OR = 18.168). Notably, treatment with metronidazole was found to be a protective factor in both groups (CDI: OR = 0.042; CDC: OR = 0.013). Eighteen sequence types (STs) were identified. In the CDI group, the isolated strains were predominantly toxin A and toxin B positive (A + B+) and the epidemic clone was genotype ST2. In the CDC group, the dominant strains were A + B+ and the epidemic clone was ST81. Conclusions The prevalences of CDC and CDI in our ICU were relatively high, suggesting the importance of routine screening for acquisition of C. difficile. Future prevention and treatment strategies for CDC and CDI should consider hospital stay, enteral nutrition, underlying comorbidities, and use of combined antibiotics. Moreover, metronidazole may be a protective factor for both CDI and CDC, and could be used empirically.
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Affiliation(s)
- Yingchao Cui
- Department of Laboratory Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin ER Road, Shanghai, 200025, China.,Faculty of Medical Laboratory Science, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin ER Road, Shanghai, 200025, China
| | - Danfeng Dong
- Department of Laboratory Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin ER Road, Shanghai, 200025, China
| | - Lihua Zhang
- Department of Laboratory Medicine, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, No. 1665 Kongjiang Road, Shanghai, 200092, China
| | - Daosheng Wang
- Department of Laboratory Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin ER Road, Shanghai, 200025, China
| | - Cen Jiang
- Department of Laboratory Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin ER Road, Shanghai, 200025, China
| | - Qi Ni
- Department of Laboratory Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin ER Road, Shanghai, 200025, China
| | - Chen Wang
- Department of Laboratory Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin ER Road, Shanghai, 200025, China
| | - Enqiang Mao
- Department of Emergency Intensive Care Unit, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin ER Road, Shanghai, 200025, China
| | - Yibing Peng
- Department of Laboratory Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin ER Road, Shanghai, 200025, China. .,Faculty of Medical Laboratory Science, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin ER Road, Shanghai, 200025, China.
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6
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Prechter F, Stallmach A. [Clostridium difficile in the intensive care unit]. Med Klin Intensivmed Notfmed 2018; 115:81-87. [PMID: 29995234 DOI: 10.1007/s00063-018-0459-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 05/22/2018] [Accepted: 06/10/2018] [Indexed: 10/28/2022]
Abstract
Clostridium difficile infections (CDI) are encountered in about 1-2% of patients in the intensive care unit (ICU) and pose a special challenge to those who provide care. Only little data regarding severity and management of CDI in ICU patients in Europe are available. Extrapolation of results from one patient population to another is often difficult. The comorbidities of those patients often limit the application of general recommendations concerning diagnosis and therapy. In addition, there are a relevant percentage of patients (10-20%) with asymptomatic C. difficile colonization. The relevance for the patient and for the risk of patient to patient infection is not yet fully understood. Based on available data, we give an overview of current challenges in the diagnosis, assessment of disease course, primary management options, and alternatives in special cases and treatment failures of CDI. We also discuss prevention of new CDI in the intensive care unit.
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Affiliation(s)
- F Prechter
- Klinik für Innere Medizin IV (Gastroenterologie, Hepatologie, Infektiologie, Interdisziplinäre Endoskopie), Universitätsklinikum Jena, Am Klinikum 1, 07740, Jena, Deutschland.
| | - A Stallmach
- Klinik für Innere Medizin IV (Gastroenterologie, Hepatologie, Infektiologie, Interdisziplinäre Endoskopie), Universitätsklinikum Jena, Am Klinikum 1, 07740, Jena, Deutschland
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7
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Salamonowicz M, Ociepa T, Frączkiewicz J, Szmydki-Baran A, Matysiak M, Czyżewski K, Wysocki M, Gałązka P, Zalas-Więcek P, Irga-Jaworska N, Drożyńska E, Zając-Spychała O, Wachowiak J, Gryniewicz-Kwiatkowska O, Czajńska-Deptuła A, Dembowska-Bagińska B, Chełmecka-Wiktorczyk L, Balwierz W, Bartnik M, Zielezińska K, Urasiński T, Tomaszewska R, Szczepański T, Płonowski M, Krawczuk-Rybak M, Pierlejewski F, Młynarski W, Gamrot-Pyka Z, Woszczyk M, Małas Z, Badowska W, Urbanek-Dądela A, Karolczyk G, Stolpa W, Sobol-Milejska G, Zaucha-Prażmo A, Kowalczyk J, Goździk J, Gorczyńska E, Jermakow K, Król A, Chybicka A, Ussowicz M, Kałwak K, Styczyński J. Incidence, course, and outcome of Clostridium difficile infection in children with hematological malignancies or undergoing hematopoietic stem cell transplantation. Eur J Clin Microbiol Infect Dis 2018; 37:1805-1812. [PMID: 29978303 PMCID: PMC6133038 DOI: 10.1007/s10096-018-3316-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Accepted: 06/26/2018] [Indexed: 12/13/2022]
Abstract
Clostridium difficile infection (CDI) is one of the most common causes of nosocomial infectious diarrhea in children during anticancer therapy or undergoing hematopoietic stem cell transplantation (HSCT) in Europe. Immunosuppression in these patients is a risk factor for CDI. Malignant diseases, age, acute graft-versus-host disease (aGVHD), HLA mismatch, or use of total body irradiation may play an important role in CDI course. The aim of this study was to evaluate the incidence, course, and outcome of CDI in children treated for malignancy or undergoing HSCT. Between 2012 and 2015, a total number of 1846 patients were treated for malignancy in Polish pediatric oncological centers (PHO group) and 342 underwent transplantation (HSCT group). In PHO group, episodes of CDI occurred in 210 patients (14%). The incidence of CDI was higher in patients with hematological malignancies in comparison to that with solid tumors. Patients with acute myeloblastic leukemia had shorter time to episode of CDI than those with acute lymphoblastic leukemia. Patients over 5 years and treated for acute leukemia had more severe clinical course of disease in PHO group. In HSCT group, CDI occurred in 29 (8%) patients. The incidence of CDI was higher in patients transplanted for acute leukemia. The recurrence rate was 14.7% in PHO and 20.7% in HSCT patients. CDI incidence was highest in patients with hematological malignancies. Most of patients experienced mild CDI. Age < 5 years and diagnosis other than acute leukemia were the positive prognostic factors influencing clinical CDI course.
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Affiliation(s)
- Małgorzata Salamonowicz
- Department of Pediatric Stem Cell Transplantation, Hematology and Oncology, Medical University, Wroclaw, Borowska Street 213, 50-556, Wrocław, Poland.
| | - T Ociepa
- Department of Pediatric Hemato-Oncology and Gastroenterology, Pomeranian Medical University, Szczecin, Poland
| | - J Frączkiewicz
- Department of Pediatric Stem Cell Transplantation, Hematology and Oncology, Medical University, Wroclaw, Borowska Street 213, 50-556, Wrocław, Poland
| | - A Szmydki-Baran
- Department of Pediatric Hematology and Oncology, Medical University, Warszawa, Warszawa, Poland
| | - M Matysiak
- Department of Pediatric Hematology and Oncology, Medical University, Warszawa, Warszawa, Poland
| | - K Czyżewski
- Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University Torun, Bydgoszcz, Poland
| | - M Wysocki
- Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University Torun, Bydgoszcz, Poland
| | - P Gałązka
- Department of Pediatric Surgery, Collegium Medicum, Nicolaus Copernicus University Torun, Bydgoszcz, Poland
| | - P Zalas-Więcek
- Department of Microbiology, Collegium Medicum, Nicolaus Copernicus University Torun, Bydgoszcz, Poland
| | - N Irga-Jaworska
- Department of Pediatrics, Hematology and Oncology, Medical University, Gdansk, Gdansk, Poland
| | - E Drożyńska
- Department of Pediatrics, Hematology and Oncology, Medical University, Gdansk, Gdansk, Poland
| | - O Zając-Spychała
- Department of Pediatric Oncology, Hematology and Transplantology, University of Medical Sciences, Poznan, Poland
| | - J Wachowiak
- Department of Pediatric Oncology, Hematology and Transplantology, University of Medical Sciences, Poznan, Poland
| | | | - A Czajńska-Deptuła
- Department of Oncology, Children's Memorial Health Institute, Warszawa, Poland
| | | | - L Chełmecka-Wiktorczyk
- Department of Pediatric Oncology and Hematology, University Children's Hospital, Jagiellonian University Collegium Medicum, Krakow, Poland
| | - W Balwierz
- Department of Pediatric Oncology and Hematology, University Children's Hospital, Jagiellonian University Collegium Medicum, Krakow, Poland
| | - M Bartnik
- Department of Pediatric Hemato-Oncology and Gastroenterology, Pomeranian Medical University, Szczecin, Poland
| | - K Zielezińska
- Department of Pediatric Hemato-Oncology and Gastroenterology, Pomeranian Medical University, Szczecin, Poland
| | - T Urasiński
- Department of Pediatric Hemato-Oncology and Gastroenterology, Pomeranian Medical University, Szczecin, Poland
| | - R Tomaszewska
- Department of Pediatric Hematology and Oncology, Silesian Medical University, Zabrze, Poland
| | - T Szczepański
- Department of Pediatric Hematology and Oncology, Silesian Medical University, Zabrze, Poland
| | - M Płonowski
- Department of Pediatric Oncology and Hematology, Medical University, Bialystok, Bialystok, Poland
| | - M Krawczuk-Rybak
- Department of Pediatric Oncology and Hematology, Medical University, Bialystok, Bialystok, Poland
| | - F Pierlejewski
- Department of Pediatric Oncology, Hematology and Diabetology, Medical University, Lodz, Lodz, Poland
| | - W Młynarski
- Department of Pediatric Oncology, Hematology and Diabetology, Medical University, Lodz, Lodz, Poland
| | - Z Gamrot-Pyka
- Division of Pediatric Hematology and Oncology, Chorzow Pediatric and Oncology Center, Chorzow, Poland
| | - M Woszczyk
- Division of Pediatric Hematology and Oncology, Chorzow Pediatric and Oncology Center, Chorzow, Poland
| | - Z Małas
- Division of Pediatric Hematology and Oncology, Children Hospital, Olsztyn, Olsztyn, Poland
| | - W Badowska
- Division of Pediatric Hematology and Oncology, Children Hospital, Olsztyn, Olsztyn, Poland
| | - A Urbanek-Dądela
- Division of Pediatric Hematology and Oncology, Children Hospital, Kielce, Kielce, Poland
| | - G Karolczyk
- Division of Pediatric Hematology and Oncology, Children Hospital, Kielce, Kielce, Poland
| | - W Stolpa
- Division of Pediatric Oncology, Hematology and Chemotherapy, Department of Pediatric, Silesian Medical University, Katowice, Poland
| | - G Sobol-Milejska
- Division of Pediatric Oncology, Hematology and Chemotherapy, Department of Pediatric, Silesian Medical University, Katowice, Poland
| | - A Zaucha-Prażmo
- Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, Medical University, Lublin, Lublin, Poland
| | - J Kowalczyk
- Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, Medical University, Lublin, Lublin, Poland
| | - J Goździk
- Stem Cell Transplant Center, University Children's Hospital, Department of Clinical Immunology and Transplantology, Jagiellonian University Collegium Medicum, Krakow, Poland
| | - E Gorczyńska
- Department of Pediatric Stem Cell Transplantation, Hematology and Oncology, Medical University, Wroclaw, Borowska Street 213, 50-556, Wrocław, Poland
| | - K Jermakow
- Department of Microbiology, Medical University, Wroclaw, Wroclaw, Poland
| | - A Król
- Department of Pediatric Stem Cell Transplantation, Hematology and Oncology, Medical University, Wroclaw, Borowska Street 213, 50-556, Wrocław, Poland
| | - A Chybicka
- Department of Pediatric Stem Cell Transplantation, Hematology and Oncology, Medical University, Wroclaw, Borowska Street 213, 50-556, Wrocław, Poland
| | - M Ussowicz
- Department of Pediatric Stem Cell Transplantation, Hematology and Oncology, Medical University, Wroclaw, Borowska Street 213, 50-556, Wrocław, Poland
| | - K Kałwak
- Department of Pediatric Stem Cell Transplantation, Hematology and Oncology, Medical University, Wroclaw, Borowska Street 213, 50-556, Wrocław, Poland
| | - J Styczyński
- Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University Torun, Bydgoszcz, Poland
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8
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Prechter F, Katzer K, Bauer M, Stallmach A. Sleeping with the enemy: Clostridium difficile infection in the intensive care unit. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2017; 21:260. [PMID: 29058580 PMCID: PMC5651627 DOI: 10.1186/s13054-017-1819-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 08/15/2017] [Accepted: 08/17/2017] [Indexed: 02/06/2023]
Abstract
Over the last years, there was an increase in the number and severity of Clostridium difficile infections (CDI) in all medical settings, including the intensive care unit (ICU). The current prevalence of CDI among ICU patients is estimated at 0.4–4% and has severe impact on morbidity and mortality. An estimated 10–20% of patients are colonized with C. difficile without showing signs of infection and spores can be found throughout ICUs. It is not yet possible to predict whether and when colonization will become infection. Figuratively speaking, our patients are sleeping with the enemy and we do not know when this enemy awakens. Most patients developing CDI in the ICU show a mild to moderate disease course. Nevertheless, difficult-to-treat severe and complicated cases also occur. Treatment failure is particularly frequent in ICU patients due to comorbidities and the necessity of continued antibiotic treatment. This review will give an overview of current diagnostic, therapeutic, and prophylactic challenges and options with a special focus on the ICU patient. First, we focus on diagnosis and prognosis of disease severity. This includes inconsistencies in the definition of disease severity as well as diagnostic problems. Proceeding from there, we discuss that while at first glance the choice of first-line treatment for CDI in the ICU is a simple matter guided by international guidelines, there are a number of specific problems and inconsistencies. We cover treatment in severe CDI, the problem of early recognition of treatment failure, and possible concepts of intensifying treatment. In conclusion, we mention methods for CDI prevention in the ICU.
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Affiliation(s)
- Florian Prechter
- Department of Internal Medicine IV, Jena University Hospital, Am Klinikum 1, 07743, Jena, Germany.
| | - Katrin Katzer
- Department of Internal Medicine IV, Jena University Hospital, Am Klinikum 1, 07743, Jena, Germany
| | - Michael Bauer
- Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Am Klinikum 1, 07743, Jena, Germany.,Center for Sepsis Control & Care, Jena University Hospital, Am Klinikum 1, 07743, Jena, Germany
| | - Andreas Stallmach
- Department of Internal Medicine IV, Jena University Hospital, Am Klinikum 1, 07743, Jena, Germany.,Center for Sepsis Control & Care, Jena University Hospital, Am Klinikum 1, 07743, Jena, Germany
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9
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Cózar-Llistó A, Ramos-Martinez A, Cobo J. Clostridium difficile Infection in Special High-Risk Populations. Infect Dis Ther 2016; 5:253-69. [PMID: 27515721 PMCID: PMC5019980 DOI: 10.1007/s40121-016-0124-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Indexed: 02/07/2023] Open
Abstract
Antibiotic use continues to be the most important risk factor for the development of Clostridium difficile infection (CDI) through disruption of the indigenous microbiota of the colon. This factor, together with environmental contamination, makes hospital and other healthcare facilities the perfect breeding ground for the infection. Several groups of patients are exposed to the hospital environment and, at the same time, affected by conditions that can make CDI more prevalent, more severe or make it present a different clinical picture. The list of such conditions appears too extensive to be reviewed in a single article. Nevertheless, several groups, including the critically ill, oncological patients, solid organ and hematopoietic transplant recipients, patients with inflammatory bowel disease, patients with kidney disease and pregnant women, have generated more attention and have been studied in more detail. On the other hand, pediatric patients constitute a controversial group because the large number of asymptomatic carriers makes interpretation of clinical findings and diagnostic tests difficult, as is the development of an appropriate approach to treatment. We present an in-depth discussion of CDI in these high-risk populations and we also review the issue of CDI in pediatric patients.
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Affiliation(s)
- Alberto Cózar-Llistó
- Infectious Diseases Unit, Internal Medicine Department, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Antonio Ramos-Martinez
- Infectious Diseases Unit, Internal Medicine Department, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Javier Cobo
- Infectious Diseases Service, Hospital Universitario Ramón y Cajal, IRYCIS, Carretera de Colmenar Viejo Km 9.1, 28034, Madrid, Spain.
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10
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Affiliation(s)
- E. Schmutzhard
- Department of Neurology; Medical University Innsbruck; Innsbruck Austria
| | - B. Pfausler
- Department of Neurology; Medical University Innsbruck; Innsbruck Austria
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11
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Karanika S, Paudel S, Zervou FN, Grigoras C, Zacharioudakis IM, Mylonakis E. Prevalence and Clinical Outcomes of Clostridium difficile Infection in the Intensive Care Unit: A Systematic Review and Meta-Analysis. Open Forum Infect Dis 2015; 3:ofv186. [PMID: 26788544 PMCID: PMC4716350 DOI: 10.1093/ofid/ofv186] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 11/19/2015] [Indexed: 12/26/2022] Open
Abstract
We found that ICU setting is associated with higher Clostridium difficile infection (CDI) prevalence than general hospital population and 25% among CDI cases in ICU develop pseudomembranous colitis. CDI also affects adversely overall hospital mortality, ICU and overall hospital stay. Background. Intensive care unit (ICU) patients are at higher risk for Clostridium difficile infection (CDI). Methods. We performed a systematic review and meta-analysis of published studies from 1983 to 2015 using the PubMed, EMBASE, and Google Scholar databases to study the prevalence and outcomes of CDI in this patient population. Among the 9146 articles retrieved from the studies, 22 articles, which included a total of 80 835 ICU patients, were included in our final analysis. Results. The prevalence of CDI among ICU patients was 2% (95% confidence interval [CI], 1%–2%), and among diarrheic ICU patients the prevalence was 11% (95% CI, 6%–17%). Among CDI patients, 25% (95% CI, 5%–51%) were diagnosed with pseudomembranous colitis, and the estimated length of ICU stay before CDI acquisition was 10.74 days (95% CI, 5%–51%). The overall hospital mortality among ICU patients with CDI was 32% (95% CI, 26%–39%), compared with 24% (95% CI, 14%–36%) among those without CDI presenting a statistically significant difference in mortality risk (P = .030). It is worth noting that the length of ICU and hospital stay among CDI patients was significantly longer, compared with non-CDI patients (standardized mean of difference [SMD] = 0.49, 95% CI, .39%–.6%, P = .00 and SMD = 1.15, 95% CI, .44%–1.91%, P = .003, respectively). It is noteworthy that the morbidity score at ICU admission (Acute Physiology and Chronic Health Evaluation II [APACHE II]) was not statistically different between the 2 groups (P = .911), implying that the differences in outcomes can be attributed to CDI. Conclusions. The ICU setting is associated with higher prevalence of CDI. In this setting, CDI is associated with increased hospital mortality and prolonged ICU and overall hospital stay. These findings highlight the need for additional prevention and treatment studies in this setting.
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Affiliation(s)
- Styliani Karanika
- Infectious Diseases Division , Warren Alpert Medical School of Brown University, Rhode Island Hospital , Providence
| | - Suresh Paudel
- Infectious Diseases Division , Warren Alpert Medical School of Brown University, Rhode Island Hospital , Providence
| | - Fainareti N Zervou
- Infectious Diseases Division , Warren Alpert Medical School of Brown University, Rhode Island Hospital , Providence
| | - Christos Grigoras
- Infectious Diseases Division , Warren Alpert Medical School of Brown University, Rhode Island Hospital , Providence
| | - Ioannis M Zacharioudakis
- Infectious Diseases Division , Warren Alpert Medical School of Brown University, Rhode Island Hospital , Providence
| | - Eleftherios Mylonakis
- Infectious Diseases Division , Warren Alpert Medical School of Brown University, Rhode Island Hospital , Providence
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12
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Economic burden of Clostridium difficile associated diarrhoea: a cost-of-illness study from a German tertiary care hospital. Infection 2015; 43:707-14. [DOI: 10.1007/s15010-015-0810-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 06/11/2015] [Indexed: 12/18/2022]
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