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Zhou Y, Wu Y, Zeng H, Chen C, Xie Q, He L. [Analysis of Clostridioides difficile infection characteristics and risk factors in patients hospitalized for diarrhea in 3 university hospitals in a mid-south city of China]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2024; 44:998-1003. [PMID: 38862459 DOI: 10.12122/j.issn.1673-4254.2024.05.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2024]
Abstract
OBJECTIVE To investigate the characteristics of Clostridioides difficile infection (CDI) in patients hospitalized for diarrhea and analyze the risk factors for CDI. METHODS Stool samples were collected from 306 patients with diarrhea hospitalized in 3 university hospitals in a mid-south city of China from October to December, 2020. C. difficile was isolated by anaerobic culture, and qRT-PCR was used to detect the expressions of toxin A (tcdA) and B (tcdB) genes and the binary toxin genes (cdtA and cdtB). Multilocus sequence typing (MLST) was performed for the isolated strains without contaminating strains as confirmed by 16S rDNA sequencing. Etest strips were used to determine the drug resistance profiles of the isolated strains, and the risk factors of CDI in the patients were analyzed. RESULTS CDI was detected in 25 (8.17%) out of the 306 patients. All the patients tested positive for tcdA and tcdB but negative for the binary toxin genes. Seven noncontaminated C. difficile strains with 5 ST types were isolated, including 3 ST54 strains and one strain of ST129, ST98, ST53, and ST631 types each, all belonging to clade 1 and sensitive to metronidazole and vancomycin. Hospitalization within the past 6 months (OR= 3.675; 95% CI: 1.405-9.612), use of PPIs (OR=7.107; 95% CI: 2.575-19.613), antibiotics for ≥1 week (OR=7.306; 95% CI: 2.274-23.472), non-steroidal anti-inflammatory drugs (OR=4.754; 95% CI: 1.504-15.031) in the past month, and gastrointestinal disorders (OR=5.050; 95% CI: 1.826-13.968) were all risk factors for CDI in the patients hospitalized for diarrhea. CONCLUSION The CDI rate remains low in the hospitalized patients with diarrhea in the investigated hospitals, but early precaution measures are recommended when exposure to the risk factors is reported to reduce the risk of CDI in the hospitalized patients.
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Affiliation(s)
- Y Zhou
- School of Public Health, Xiangnan University, Chenzhou 423000, China
| | - Y Wu
- National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China
| | - H Zeng
- School of Public Health, Xiangnan University, Chenzhou 423000, China
| | - C Chen
- School of Public Health, Xiangnan University, Chenzhou 423000, China
| | - Q Xie
- School of Public Health, Xiangnan University, Chenzhou 423000, China
| | - L He
- School of Public Health, Xiangnan University, Chenzhou 423000, China
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Brajerova M, Zikova J, Krutova M. Clostridioides difficile epidemiology in the Middle and the Far East. Anaerobe 2022; 74:102542. [PMID: 35240336 DOI: 10.1016/j.anaerobe.2022.102542] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 02/14/2022] [Accepted: 02/20/2022] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Clostridioides difficile is an important pathogen of healthcare-associated gastrointestinal infections. Recently, an increased number of C. difficile infection (CDI) surveillance data has been reported from Asia. The aim of this review is to summarize the data on the prevalence, distribution and molecular epidemiology of CDI in the Middle and the Far East. METHODS Literature was drawn from a search of PubMed up to September 30, 2021. RESULTS The meta-analysis of data from 111 studies revealed the pooled CDI prevalence rate in the Middle and the Far East of 12.4% (95% CI 11.4-13.3); 48 studies used PCR for CDI laboratory diagnoses. The predominant types (RT)/sequence type (ST) differ between individual countries (24 studies, 14 countries). Frequently found RTs were 001, 002, 012, 017, 018 and 126; RT017 was predominant in the Far East. The epidemic RT027 was detected in 8 countries (22 studies), but its predominance was reported only in three studies (Israel and Iran). The contamination of vegetable and meat or meat products and/or intestinal carriage of C. difficile in food and companion animals have been reported; the C. difficile RTs/STs identified overlapped with those identified in humans. CONCLUSIONS A large number of studies on CDI prevalence in humans from the Middle and the Far East have been published; countries with no available data were identified. The number of studies on C. difficile from non-human sources is limited. Comparative genomic studies of isolates from different sources are needed.
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Affiliation(s)
- Marie Brajerova
- Department of Medical Microbiology, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Czech Republic
| | - Jaroslava Zikova
- Department of Medical Microbiology, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Czech Republic; Department of Genetics and Microbiology, Faculty of Science, Charles University, Czech Republic
| | - Marcela Krutova
- Department of Medical Microbiology, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Czech Republic.
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Motamedi H, Fathollahi M, Abiri R, Kadivarian S, Rostamian M, Alvandi A. A worldwide systematic review and meta-analysis of bacteria related to antibiotic-associated diarrhea in hospitalized patients. PLoS One 2021; 16:e0260667. [PMID: 34879104 PMCID: PMC8654158 DOI: 10.1371/journal.pone.0260667] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 11/12/2021] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Antibiotic-associated diarrhea (AAD) is a major hospital problem and a common adverse effect of antibiotic treatment. The aim of this study was to investigate the prevalence of the most important bacteria that cause AAD in hospitalized patients. MATERIALS AND METHODS PubMed, Web of Science and Scopus databases were searched using multiple relevant keywords and screening carried out based on inclusion/exclusion criteria from March 2001 to October 2021. The random-effects model was used to conduct the meta-analysis. RESULTS Of the 7,377 identified articles, 56 met the inclusion criteria. Pooling all studies, the prevalence of Clostridioides (Clostridium) difficile, Clostridium perfringens, Klebsiella oxytoca, and Staphylococcus aureus as AAD-related bacteria among hospitalized patients were 19.6%, 14.9%, 27%, and 5.2%, respectively. The prevalence of all four bacteria was higher in Europe compared to other continents. The highest resistance of C. difficile was estimated to ciprofloxacin and the lowest resistances were reported to chloramphenicol, vancomycin, and metronidazole. There was no or little data on antibiotic resistance of other bacteria. CONCLUSIONS The results of this study emphasize the need for a surveillance program, as well as timely public and hospital health measures in order to control and treat AAD infections.
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Affiliation(s)
- Hamid Motamedi
- Department of Microbiology, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Student Research Committee, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Matin Fathollahi
- Department of Microbiology, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Student Research Committee, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Ramin Abiri
- Fertility and Infertility Research Center, Health Technology Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Sepide Kadivarian
- Department of Microbiology, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Student Research Committee, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mosayeb Rostamian
- Infectious Diseases Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Amirhooshang Alvandi
- Medical Technology Research Center, Health Technology Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Kannambath R, Biswas R, Mandal J, Vinod KV, Dubashi B, Parameswaran N. Clostridioides difficile Diarrhea: An Emerging Problem in a South Indian Tertiary Care Hospital. J Lab Physicians 2021; 13:346-352. [PMID: 34975254 PMCID: PMC8714319 DOI: 10.1055/s-0041-1731944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Abstract
Context Clostridioides difficile infection (CDI) is one of the most common infectious causes of hospital-acquired diarrhea. The actual burden of the disease is underestimated in India due to inadequate diagnostic methods and limited studies conducted.
Aims The aim of this study was to determine the burden and risk factors of CDI among patients with hospital-acquired diarrhea.
Methods and Materials Stool specimen of patients (age > 1 year) with hospital-acquired diarrhea were screened for glutamate dehydrogenase antigen and toxin using an enzyme immunoassay. If both antigen and toxin were present, it was reported as positive for toxigenic CDI. Samples positive for antigen and negative for toxin were further tested with Cepheid GeneXpert assay for detecting the toxin producing gene.
Results Of 75 patients (mean age 36.07 ± 20.79, 64% males), 14 (18.67%) patients were positive for toxigenic Clostridioides difficile (C. difficile) and 3 (4%) patients were nontoxigenic C. difficile. Addition of GeneXpert to the testing algorithm increased the yield of toxin detection in 5/14 patients who were negative by toxin assay. On analysis of risk factors, prolonged hospital stay was found to have significant association (p-value = 0.022). Patients with factors like intensive care unit stay, presence of diabetes mellitus as a comorbidity, and exposure to antibiotics like carbapenems and glycopeptides have been found to have a higher prevalence of CDI.
Conclusions The prevalence of CDI in our population was 18.67% and the major risk factor associated was prolonged hospital stay. The addition of GeneXpert for the detection of toxin gene increased the yield from 12 to 18.68%.
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Affiliation(s)
- Rachana Kannambath
- Department of Microbiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Rakhi Biswas
- Department of Microbiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Jharna Mandal
- Department of Microbiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Kolar V. Vinod
- Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Biswajit Dubashi
- Department of Medical Oncology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Narayanan Parameswaran
- Department of Paediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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Zhao C, Guo S, Jia X, Xu X. Distribution and risk factor analysis for Clostridium difficile-associated diarrhea among hospitalized children over one year of age. Pediatr Investig 2020; 4:37-42. [PMID: 32851340 PMCID: PMC7331383 DOI: 10.1002/ped4.12155] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 05/28/2019] [Indexed: 01/22/2023] Open
Abstract
IMPORTANCE Clostridium difficile-associated diarrhea (CDAD) is a severe type of antibiotic-associated diarrhea (AAD). However, the risk factors for CDAD in children with AAD have not yet been clarified. OBJECTIVE To investigate the distribution and risk factors for CDAD among hospitalized children in Beijing Children's Hospital. METHODS Stool samples from 197 children with AAD were tested for the C. difficile pathogenic genes (tcdA, tcdB, tcdC, tcdD, tcdE, cdtA, and cdtB) using polymerase chain reaction between January 2011 and January 2014. Children who tested positive for tcdA or tcdB were included in the CDAD group, and those remaining comprised the non-CDAD group. RESULTS The rate of CDAD among the 197 children with AAD was 42.6% (84/197). The age distribution was 1-15.6 years, among which the majority of children (54.8%, 46/84) were aged 1-4 years. Differences in the CDAD-positive rates among AAD children belonging to different age groups were not statistically significant. Univariate analysis revealed that the duration of antibiotic therapy, the length of hospitalization prior to diarrhea, and gastrointestinal tract operations were significant risk factors (P < 0.05). Children with CDAD underwent more antibiotic therapy and had longer periods of hospitalization prior to diarrhea onset than children in the non-CDAD group. Using multivariate regression analysis, hospitalization for ≥ 10 days prior to diarrhea was found to be an independent risk factor for CDAD. INTERPRETATION This study revealed that the length of hospitalization (≥ 10 days) prior to diarrhea was an independent risk factor for CDAD in children with AAD.
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Affiliation(s)
- Chunna Zhao
- Department of GastroenterologyBeijing Children’ s HospitalFaculty of Digestive DiseasesCapital Medical UniversityNational Clinical Research Center f or Digestive DiseasesBeijing100045China
| | - Shu Guo
- Department of GastroenterologyBeijing Children’ s HospitalFaculty of Digestive DiseasesCapital Medical UniversityNational Clinical Research Center f or Digestive DiseasesBeijing100045China
| | - Xiaoyun Jia
- Department of GastroenterologyBeijing Children’ s HospitalFaculty of Digestive DiseasesCapital Medical UniversityNational Clinical Research Center f or Digestive DiseasesBeijing100045China
| | - Xiwei Xu
- Department of GastroenterologyBeijing Children’ s HospitalFaculty of Digestive DiseasesCapital Medical UniversityNational Clinical Research Center f or Digestive DiseasesBeijing100045China
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Nasiri MJ, Goudarzi M, Hajikhani B, Ghazi M, Goudarzi H, Pouriran R. Clostridioides (Clostridium) difficile infection in hospitalized patients with antibiotic-associated diarrhea: A systematic review and meta-analysis. Anaerobe 2018; 50:32-37. [DOI: 10.1016/j.anaerobe.2018.01.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 01/25/2018] [Accepted: 01/28/2018] [Indexed: 02/08/2023]
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Ghoshal UC, Gwee KA, Holtmann G, Li Y, Park SJ, Simadibrata M, Sugano K, Wu K, Quigley EMM, Cohen H. The role of the microbiome and the use of probiotics in gastrointestinal disorders in adults in the Asia-Pacific region - background and recommendations of a regional consensus meeting. J Gastroenterol Hepatol 2018; 33:57-69. [PMID: 28589613 DOI: 10.1111/jgh.13840] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 05/28/2017] [Accepted: 05/30/2017] [Indexed: 12/11/2022]
Abstract
The Asia-Pacific region is diverse, with regard to ethnicity, culture, and economic development incorporating some of the world's least and most developed nations. Gastrointestinal diseases are common in the Asia-Pacific region, and their prevalence, presentation, and management vary considerably within the region. There is growing evidence for an important role for the human gut microbiota in gastrointestinal health. As a consequence, geographic variations in the composition of the gut microbiota may contribute to variations in both the prevalence and response to therapy of specific diseases. Probiotics have been proposed as a valuable option in the prevention and treatment of a number of gastrointestinal illnesses, but the quality of available evidence to support their efficacy is variable. A meeting of international experts in adult and pediatric gastroenterology was held at the Sorbonne University, Paris, France, on April 11 and 12, 2016, to discuss current evidence supporting the use of probiotics in gastrointestinal disorders in the Asia-Pacific region. This article provides an overview of the discussions held at this meeting and recommends the formation of an Asia-Pacific Consortium on Gut Microbiota similar to those established in Europe and North America.
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Affiliation(s)
- Uday C Ghoshal
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Kok-Ann Gwee
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Gerald Holtmann
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital Brisbane, University of Queensland, Brisbane, Queensland, Australia
| | - Yanmei Li
- Department of Gastroenterology, China-Japan Friendship Hospital, Beijing, China
| | - Soo Jung Park
- Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
| | - Marcellus Simadibrata
- Faculty of Medicine, University of Indonesia and Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia.,RSUPN Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Kentaro Sugano
- Department of Medicine, Division of Gastroenterology, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Kaichun Wu
- Fourth Military Medical University, Xi'an, China
| | - Eamonn M M Quigley
- Division of Gastroenterology and Hepatology, Lynda K and David M Underwood Center for Digestive Disorders, Houston Methodist Hospital, Houston, Texas, USA
| | - Henry Cohen
- Clínica de Gastroenterología, Facultad de Medicina, Montevideo, Uruguay
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Hospital acquired diarrhea in a burn center of Tehran. IRANIAN JOURNAL OF MICROBIOLOGY 2015; 7:310-4. [PMID: 26885330 PMCID: PMC4752684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND OBJECTIVES Incidence of hospital-acquired diarrhea has increased rapidly and burn patients are at high risk of getting it. Infection with C. difficile is the most common cause of antibiotic associated diarrhea. The aim of this study was to determine the baseline characteristics and clinical presentation of hospital-acquired diarrhea and compare C. difficile and non-C. difficile diarrhea in burn patients treated at a burn center. MATERIALS AND METHODS During a 1-year study all patients with hospital-acquired diarrhea at Motahari Burn Hospital, Tehran, Iran enrolled in this study. We compared patients with a stool sample positive for C. difficile toxin or tracing the antigen in patients who were negative for detection of toxin in their stool sample specimens. RESULTS Diarrhea developed in 37 patients out of 3200 admitted patients with a mean burn size of 34.8 ±20.1%. Among them, 8 patients had a positive result for C. difficile. The mean time between antibiotic therapy and occurrence of diarrhea was 9.5 ± 6.2 days. Nine (23.7%) patients died in the 7.8± 4.2 days, mostly due to co-morbidities. The mean duration of diarrhea was 3.6 ± 2 days. Twenty two (57.9%) patients were treated with oral metronidazol and eleven (28.9%) patients were treated with combination of metronidazole and vancomycin, higher rate of combination therapy was seen in Clostridium difficile CDI. CONCLUSION Overall, the prevalence of hospital-acquired diarrhea was 120/10,000 and 21% of them caused by infection with C. difficile. Presence of peripheral leukocytosis and colitis were the alarm sign for diagnosis of C. difficile infection.
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POLYMERASE CHAIN REACTION FOR THE DETECTION OF TOXIN A ( TCD A ) AND TOXIN B ( TCD B ) GENES OF CLOSTRIDIUM DIFFICILE ISOLATED FROM DIARRHOEAL CASES AND ANALYSIS OF THE CLINICAL SPECTRUM. ACTA ACUST UNITED AC 2015. [DOI: 10.14260/jemds/2015/721] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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