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Aspectos clínicos e biológicos da diarréia por Clostridium difficile em pacientes hematológicos e transplantados de medula óssea; Biological and clinical aspects of diarrhea by Clostridium difficile in patients with hematological and bone marrow transplantation

Spadão, Fernanda de Souza
Fonte: Biblioteca Digitais de Teses e Dissertações da USP Publicador: Biblioteca Digitais de Teses e Dissertações da USP
Tipo: Dissertação de Mestrado Formato: application/pdf
Publicado em 27/03/2012 PT
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Introdução: A diarréia por Clostridium difficile é uma das principais causas de diarréia infecciosa associada à assistência à saúde. Objetivo: Descrever os casos e a incidência de diarréia por C. difficile em pacientes hematológicos e TCTH internados na enfermaria da Hematologia e do Transplante de Medula óssea do Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP). Métodos: Foi utilizada uma ficha para coleta de dados de todos os pacientes na unidade de hematologia e TCTH do HC-FMUSP que tinham resultado positivo para toxina A/B do C. difficile durante o período de janeiro 2007 a junho de 2011 e criado um banco de dados no programa Epiinfo. Os desfechos avaliados foram forma grave de doença e óbito até 14 dias da diarréia. Qui-quadrado para tendência foi usado para avaliar a incidência de diarréia por C. difficile durante o período do estudo. Resultados: Um total de 69 episódios foi identificado em 64 pacientes em 439 pacientes suspeitos. Na distribuição temporal o qui-quadrado para tendência evidenciou que o número de casos suspeitos de diarréia por C. difficile permaneceu estável (p=0,418), em contraste com o aumento do número de casos confirmados (p=0,0006). A incidência de diarréia por C. difficile por 1.000 pacientes variou de 0...

Prevalence of Clostridium spp. and Clostridium difficile in children with acute diarrhea in São Paulo city, Brazil

Ferreira,Claudia EA; Nakano,Viviane; Durigon,Edison L; Avila-Campos,Mario J
Fonte: Instituto Oswaldo Cruz, Ministério da Saúde Publicador: Instituto Oswaldo Cruz, Ministério da Saúde
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/06/2003 EN
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Species of Clostridium are widely distributed in the environment, inhabiting both human and animal gastrointestinal tracts. Clostridium difficile is an important pathogen associated with outbreaks of pseudomembranous colitis and other intestinal disorders, such as diarrhea. In this study, the prevalence of Clostridium spp. and C. difficile, from hospitalized children with acute diarrhea, was examined. These children were admitted to 3 different hospitals for over 12 months. Eighteen (20%) and 19 (21%) stool specimens from children with (90) and without (91) diarrhea respectively, were positive to clostridia. Only 10 C. difficile strains were detected in 5.5% of the stool samples of children with diarrhea. None healthy children (without diarrhea) harbored C. difficile. From these 10 C. difficile, 9 were considered as toxigenic and genotyped as tcdA+/tcdB+ or tcdA-/tcdB+, and 1 strain as nontoxigenic (tcdA-/tdcB-). They were detected by the citotoxicity on VERO cells and by the multiplex-polymerase chain reaction. Thirty clinical fecal extracts produced minor alterations on VERO cells. The presence of C. difficile as a probable agent of acute diarrhea is suggested in several countries, but in this study, the presence of these organisms was not significant. More studies will be necessary to evaluate the role of clostridia or C. difficile in diarrhoeal processes in children.

Factors associated with Clostridium difficile diarrhea in a hospital in Beijing, China

Lv,Z.; Peng,G.L.; Su,J.R.
Fonte: Associação Brasileira de Divulgação Científica Publicador: Associação Brasileira de Divulgação Científica
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/12/2014 EN
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66.41%
Clostridium difficile is the most common cause of hospital-acquired diarrhea in patients treated with antibiotics, chemotherapeutic agents, and other drugs that alter the normal equilibrium of the intestinal flora. A better understanding of the risk factors for C. difficile-associated disease (CDAD) could be used to reduce the incidence of CDAD and the costs associated with its treatment. The aim of this study was to identify the risk factors for CDAD in a cohort of Chinese patients in a Beijing hospital. Medical charts of a total of 130 inpatients (62 males and 68 females) with hospital-acquired diarrhea (45 with CDAD; 85 without CDAD) were retrospectively reviewed. C. difficile toxins A and B were detected in fecal samples using enzyme-linked fluorescence assays. The drugs used by patients with and without CDAD before the onset of diarrhea were compared. Factors that differed significantly between the two groups by univariate analysis were analyzed by multivariate analysis using a logistic regression model. Multivariate analysis showed that cephalosporin treatment was associated with a significantly higher risk of CDAD in hospitalized patients, while treatment with glycopeptides was significantly associated with a reduction in CDAD (P<0.001 for cephalosporin; P=0.013 for glycopeptides). Our data confirmed previous findings that empirical treatment with cephalosporins is positively associated with CDAD compared to individuals using other CDAD-related drugs. Additionally...

Clinical risk factors for Clostridium difficile-associated diseases

Cho,Sung Min; Lee,Jae Joon; Yoon,Hee Jung
Fonte: Brazilian Society of Infectious Diseases Publicador: Brazilian Society of Infectious Diseases
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/06/2012 EN
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Many factors appear to influence the chance of acquiring Clostridium difficile (C. difficile) infection, and an accurate identification of risk factors could be beneficial in many ways. Thus, in the present study, clinical risk factors for C. difficile-associated disease (CDAD) in Korea were identified. A total of 93 patients who met the inclusion criteria and 186 age/gender/ward/admission period-matched control patients were included in this study. Statistically significant associations were found with presence of chronic lung diseases (odds ratio [OR], 3.41; 95% confidence interval [CI], 1.25-9.32; p = 0.017), presence of ileus (OR, 10.05; 95% CI, 2.42-41.80; p = 0.001), presence of intensive care unit (ICU) stay (OR, 9.79; 95% CI, 3.03-31.68; p < 0.001), use of cephalosphorins (OR, 3.30; 95% CI, 1.13-9.62; p = 0.029), history of surgery (OR, 10.89; 95% CI, 3.96-29.92; p < 0.001), and history of long-term care facility stay (OR, 14.90; 95% CI, 4.02-55.26; p < 0.001). Awareness of CDAD is critical to provide appropriate clinical care. Surveillance of the national incidence rate and multicenter studies are needed, and the potential value of a C. difficile vaccine should be studied.

Recent changes in Clostridium difficile infection

Silva Júnior,Moacyr
Fonte: Instituto Israelita de Ensino e Pesquisa Albert Einstein Publicador: Instituto Israelita de Ensino e Pesquisa Albert Einstein
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/03/2012 EN
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66.39%
Clostridium difficile is the main cause of nosocomial diarrhea. Diarrhea associated with C. difficile has increased incidence, morbidity, and mortality in the last few years. The major related risk factors include use of antibiotics, elderly patients and prolonged hospital stay. Many patients receive combinations of antibiotics or multiple antibiotics, which represents the main risk to develop diarrhea associated to C. difficile or its recurrence. Therefore, interventions to improve antibiotic prescribing, as well as compliance with infection control measures can reduce hospital-acquired C. difficile infections. This review addresses the epidemiological changes in C. difficile disease and its treatment.

Characterization of a Toxin A-Negative, Toxin B-Positive Strain of Clostridium difficile Responsible for a Nosocomial Outbreak of Clostridium difficile-Associated Diarrhea

Alfa, Michelle J.; Kabani, Amin; Lyerly, David; Moncrief, Scott; Neville, Laurie M.; Al-Barrak, Ali; Harding, Godfrey K. H.; Dyck, Brenda; Olekson, Karen; Embil, John M.
Fonte: American Society for Microbiology Publicador: American Society for Microbiology
Tipo: Artigo de Revista Científica
Publicado em /07/2000 EN
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66.44%
Clostridium difficile-associated diarrhea (CAD) is a very common nosocomial infection that contributes significantly to patient morbidity and mortality as well as to the cost of hospitalization. Previously, strains of toxin A-negative, toxin B-positive C. difficile were not thought to be associated with clinically significant disease. This study reports the characterization of a toxin A-negative, toxin B-positive strain of C. difficile that was responsible for a recently described nosocomial outbreak of CAD. Analysis of the seven patient isolates from the outbreak by pulsed-field gel electrophoresis indicated that this outbreak was due to transmission of a single strain of C. difficile. Our characterization of this strain (HSC98) has demonstrated that the toxin A gene lacks 1.8 kb from the carboxy repetitive oligopeptide (CROP) region but apparently has no other major deletions from other regions of the toxin A or toxin B gene. The remaining 1.3-kb fragment of the toxin A CROP region from strain HSC98 showed 98% sequence homology with strain 1470, previously reported by M. Weidmann in 1997 (GenBank accession number Y12616), suggesting that HSC98 is toxinotype VIII. The HSC98 strain infecting patients involved in this outbreak produced the full spectrum of clinical illness usually associated with C. difficile-associated disease. This pathogenic spectrum was manifest despite the inability of this strain to alter tight junctions as determined by using in vitro tissue culture testing...

Clostridium difficile-associated diarrhoea.

Wight, N.; Curtis, H.; Hyde, J.; Borriello, S. P.; Mahida, Y. R.
Fonte: BMJ Group Publicador: BMJ Group
Tipo: Artigo de Revista Científica
Publicado em /11/1998 EN
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At our hospital, the number of cases of Clostridium difficile-associated diarrhoea increased from 29 in 1993 to 210 in 1995. The case notes of 110 patients with C difficile-associated diarrhoea during the first 6 months of 1995 were analysed retrospectively. The majority of the patients (106) had received antibiotics before the onset of diarrhoea; 46 had received three or more different antibiotics and 28 had received metronidazole. In 19 patients, the first stool sample after the onset of diarrhoea was negative for C difficile cytotoxin, with a mean delay of 8.2 days before a positive stool sample. We conclude that C difficile-associated diarrhoea was associated with the usage of multiple antibiotics, and that metronidazole did not protect against colonisation by C difficile. We also recommend that more than one stool sample should be tested for the C difficile cytotoxin.

Infection of hamsters with the UK Clostridium difficile ribotype 027 outbreak strain R20291

Buckley, Anthony M.; Spencer, Janice; Candlish, Denise; Irvine, June J.; Douce, Gillian R.
Fonte: Society for General Microbiology Publicador: Society for General Microbiology
Tipo: Artigo de Revista Científica
Publicado em /08/2011 EN
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Clostridium difficile is the main cause of antibiotic-associated disease, a disease of high socio-economical importance that has recently been compounded by the global spread of the 027 (BI/NAP1/027) ribotype. C. difficile cases attributed to ribotype 027 strains have high recurrence rates (up to 36 %) and increased disease severity. The hamster model of infection is widely accepted as an appropriate model for studying aspects of C. difficile host–pathogen interactions. Using this model we characterized the infection kinetics of the UK 2006 outbreak strain, R20291. Hamsters were orally given a dose of clindamycin, followed 5 days later with 10 000 C. difficile spores. All 100 % of the hamsters succumbed to infection with a mean time to the clinical end point of 46.7 h. Colonization of the caecum and colon were observed 12 h post-infection reaching a maximum of approximately 3×104 c.f.u. per organ, but spores were not detected until 24 h post-infection. At 36 h post-infection C. difficile numbers increased significantly to approximately 6×107 c.f.u. per organ where numbers remained high until the clinical end point. Increasing levels of in vivo toxin production coincided with increases in C. difficile numbers in organs reaching a maximum at 36 h post-infection in the caecum. Epithelial destruction and polymorphonuclear leukocyte (PMN) recruitment occurred early on during infection (24 h) accumulating as gross microvilli damage...

Antibiotic Exposure and Risk of Clostridium difficile Infection: A Retrospective Cohort Study

Stevens, Vanessa W. ; van Wijngaarden, Edwin
Fonte: Universidade de Rochester Publicador: Universidade de Rochester
Tipo: Tese de Doutorado
ENG
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Thesis (Ph.D.)--University of Rochester. School of Medicine & Dentistry. Dept. of Community and Preventive Medicine, 2010.; Clostridium difficile Infection (CDI) is a major cause of hospital-acquired diarrhea and is most commonly associated with changes in normal intestinal flora caused by administration of antibiotics. The recent emergence of strains of C. difficile demonstrating new antimicrobial resistance patterns may mean that antibiotics that have seldom been implicated in the past now confer a greater risk of CDI. Few studies have examined increases in the risk of CDI associated with total cumulative dose, duration, or number of antibiotics. Therefore, a retrospective cohort study was conducted to determine the incidence of CDI at Strong Memorial Hospital in 2005 among hospitalizations during which two or more consecutive days of antibiotics were prescribed, and to examine the class, total dose (measured in Defined Daily Doses (DDD)), days, and number of antibiotics in relation to CDI. 10,154 hospitalizations were included in the study. Dose-response relationships were observed, with increasing exposure conferring increasing CDI risk for all dose-related antibiotic measures evaluated. For instance, the risk of CDI for hospitalizations in the second...

CbpA: a novel surface exposed adhesin of Clostridium difficile targeting human collagen

TULLI, LORENZA
Fonte: La Sapienza Universidade de Roma Publicador: La Sapienza Universidade de Roma
Tipo: Tese de Doutorado
EN
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66.38%
Clostridium difficile is the leading cause of antibiotic-associated diarrhea and pseudomembranous colitis. While toxins A and B are primarily responsible for the pathogenesis, determinants of bacterial adherence are also essential for intestinal colonization process. We focused our study on a novel member of the MSCRAMM family, named CbpA (Collagen binding protein A) for its adhesive properties towards these components of the extracellular matrix (ECM). We demonstrate that CbpA, which carries an LPXTG-like cell wall anchoring domain, is expressed on the bacterial surface of C. difficile and that the recombinant form binds at high affinity to collagen I and V (apparent KD in the order of 10-8 and 10-9 M respectively). Such evidences were confirmed by confocal microscopy studies showing the association of the protein with Type I and V collagen fibers produced in human fibroblasts and mouse intestinal tissues. However, the collagen binding activity of the wild-type C. difficile 630 strain was indistinguishable to cbpA knock-out strain. To overcome this apparent clostridial adherence redundancy, we engineered a Lactococcus lactis strain for the heterologous expression of CbpA. By this approach, we were able to demonstrate that when exposed on the surface of L. Lactis...

Outbreak of Clostridium difficile PCR ribotype 027-the recent experience of a regional hospital

Oleastro, M.; Coelho, M.; Gião, M.; Coutinho, S.; Mota, S.; Santos, A.; Rodrigues, J.; Faria, D.
Fonte: BioMed Central Publicador: BioMed Central
Tipo: Artigo de Revista Científica
Publicado em 17/04/2014 ENG
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Background: Clostridium difficile infection (CDI) is the leading cause of healthcare-associated diarrhea, and several outbreaks with increased severity and mortality have been reported. In this study we report a C. difficile PCR ribotype 027 outbreak in Portugal, aiming to contribute to a better knowledge of the epidemiology of this agent in Europe. Methods: Outbreak report with retrospective study of medical records and active surveillance data of all inpatients with the diagnosis of CDI, from 1st January to 31th December 2012, in a Portuguese hospital. C. difficile isolates were characterized regarding ribotype, toxin genes and moxifloxin resistance. Outbreak control measures were taken, concerning communication, education, reinforcement of infection control measures, optimization of diagnosis and treatment of CDI, and antibiotic stewardship. Results: Fifty-three inpatients met the case definition of C. difficile-associated infection: 55% males, median age was 78.0 years (interquartile range: 71.0-86.0), 75% had co-morbidities, only 15% had a nonfatal condition, 68% had at least one criteria of severe disease at diagnosis, 89% received prior antibiotherapy, 79% of episodes were nosocomial. CDI rate peak was 13.89/10,000 bed days. Crude mortality rate at 6 months was 64.2% while CDI attributable cause was 11.3%. Worse outcome was related to older age (P = 0.022)...

Clostridium-difficile-Nachweis bei CF-Patienten: Prävalenz, klinische und sonographische Befunde bei Patienten der Tübinger Universitäts-Kinderklinik; Clostridium-difficile-detection in CF-patients: prevalence, clinical and sonographical findings in patients of the Department of Paediatrics at the University of Tuebingen

Dietsche, Birgit
Fonte: Universität Tübingen Publicador: Universität Tübingen
Tipo: Dissertation; info:eu-repo/semantics/doctoralThesis
DE_DE
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Patienten mit Zystischer Fibrose (CF) sind durch häufige Krankenhausaufenthalte und Antibiotikatherapien eine Risikogruppe für Clostridium difficile (CD)-Infektionen. Ob­wohl CF-Patienten älteren Studien zufolge keine erhöhte Inzidenz von symptomati­schen CD-Infektionen aufweisen, gab es jedoch immer wieder Berichte von schweren, teils auch atypisch (d.h. ohne Durchfall und mit variabler abdominaler Symptomatik) verlaufenden CD-Infektionen. Zudem treten bei CF-Patienten häufig Darmwandver­dickungen auf, deren Pathomechanismus bislang noch unklar ist und die möglicher­weise mit einer CD-Infektion in Verbindung stehen könnten. In dieser Studie sollte der Frage nach der CD-Prävalenz im Stuhl bei CF-Patienten und der klinischen Relevanz von CD-Infektionen sowie krankheitsspezifischen Auswirkungen auf den Darm bei CF-Patienten nachgegangen werden. In einer Querschnittstudie wurde zum einen die Prävalenz von CD-Stämmen und der CD-Toxin-Ausscheidung im Stuhl im Vergleich zu früheren Studien und zu anderen Risiko-Patienten aus demselben Klinikum ermittelt. Zum anderen wurden mögliche durch eine CD-Infektion assoziierte klinische Symptome und Risikofaktoren für eine CD-Infektion erfasst. In einer Längsschnittstudie wurde innerhalb von zwei Jahren die Häufigkeit von CD-assoziierten Kolitiden unter Antibiotikatherapie bestimmt. 65 Patienten der Tübinger CF-Ambulanz nahmen an der Querschnittuntersuchung teil. Sie wiesen im Vergleich zu einer Kontrollgruppe (29 Patienten der hämato-onkologi­schen Ambulanz Tübingen) eine signifikant höhere Prävalenz von CD auf (63% vs. 7%). Dabei nahm die Besiedlungsrate mit zunehmendem Alter ab (>80% im ersten LJ. auf 25% im 18. LJ). Die insgesamt sehr hohe CD-Prävalenz zeigte sich unabhängig von einer aktuellen Antibiotikagabe und Aufenthalt in stationären Einrichtungen inner­halb der letzten zwei Jahre. Der Einfluss von Antibiotika war zusätzlich in der Längs­schnittstudie an 19 Patienten genauer untersucht worden: Bemerkenswerterweise zeigte sich auch unter Antibiose eine relative Konstanz im CD-Besiedlungsstatus...

L’expérience de l’isolement de contact à l’hôpital pour des personnes âgées lors d’une infection au Clostridium difficile

Larivière, Nathalie
Fonte: Université de Montréal Publicador: Université de Montréal
Tipo: Thèse ou Mémoire numérique / Electronic Thesis or Dissertation
FR
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Sommaire La situation actuelle des infections nosocomiales dans les établissements de santé est préoccupante. En ce qui concerne le Clostridium difficile (C. difficile), son émergence et son impact sur la morbidité et la mortalité sont bien connus. De plus, la population vieillissante est à risque élevé d’avoir des diarrhées associées au C. difficile et, de ce fait, de se retrouver en isolement de contact. Les personnes âgées sont déjà vulnérables au moment d’une hospitalisation, alors qu’en est-il lors d’un isolement de contact relié à une infection au C. difficile? Dans cette perspective, les connaissances sur l’expérience des personnes âgées lors d’un isolement étant peu développées, cette étude s’est intéressée au vécu des personnes âgées durant l’isolement de contact et aux effets de cet isolement sur leur vécu. Le but de cette étude phénoménologique, prenant appui sur la Théorie de l’humain en devenir de Parse (2003), était de décrire et comprendre l’expérience de personnes âgées de 75 ans et plus lors d’un isolement de contact en milieu hospitalier causé par une infection au C. difficile. Ainsi, des entrevues semi-structurées furent réalisées auprès de cinq personnes âgées qui ont accepté de participer à l’étude...

Factores asociados a la infección para Clostridium difficile en un hospital universitario de Bogotá

Marín, Juliana
Fonte: Facultad de Medicina Publicador: Facultad de Medicina
Tipo: info:eu-repo/semantics/bachelorThesis; info:eu-repo/semantics/acceptedVersion Formato: application/pdf
Publicado em 07/07/2014 SPA
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Introducción La infección por Clostridium difficile, es una de las causas más frecuentes de diarrea nosocomial con una alta morbimortalidad, con un aumento exponencial en su incidencia, en Estados Unidos se duplicó, de 261 casos x 100.000 en 1993 pasó a 546 x 100.000 en 2003 2, y en Canadá se encontraron datos similares con un aumento de 4.5 veces, en 1991 de 35.6 casos x 100.000 a 156.3 casos por 100.000 en 2004 3 . Se han descrito varios factores asociados Materiales y Métodos Se trata de un estudio descriptivo de tipo serie de casos en el que se evaluaron pacientes con diagnóstico de infección por C. Difficile y los factores asociados en un Hospital Universitario entre febrero de 2010 hasta septiembre de 2011 Resultados Se recolectaron 31 pacientes la edad promedio fue de 58 años con un rango entre 18 y 93 años, de los cuales 19 (61%) fueron mujeres y 12 (39%) hombres. El factor asociado a la infección por C. Difficile más frecuentemente encontrado fue el uso de inhibidores de bomba de protones con 54.84% (n=17) .No se encontraron pacientes VIH positivos o con diagnóstico de enfermedad inflamatoria intestinal. Ningún paciente presentó complicaciones asociadas a la infección ni mortalidad alguna. Conclusión El factor asociado que más se presentó fue el uso de antimicrobianos en los quince dias previos al inicio del cuadro en el 74% de los pacientes lo que coincide con lo presentado en la literatura mundial.; Introduction Infection with Clostridium difficile ...

Clostridium difficile infection: molecular and epidemiology study

Isidro, Joana Vanessa Duarte
Fonte: Universidade de Lisboa Publicador: Universidade de Lisboa
Tipo: Dissertação de Mestrado
Publicado em //2015 ENG
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66.55%
Tese de mestrado, Biologia (Biologia Molecular e Genética), Universidade de Lisboa, Faculdade de Ciências, 2015; Clostridium difficile is the leading cause of antibiotic-associated diarrhea in developed countries. Elderly hospitalized patients taking antibiotics are the main group at risk of infection. Since 2000, several countries have reported an increased incidence and severity of CDI associated with the emergence of the epidemic RT027. This clone produces Toxin A (TcdA), Toxin B (TcdB) and an additional binary toxin, Clostridium difficile transferase (CDT), has a deletion at position 117 in the tcdC gene (negative regulator of toxin production) and is highly resistant to fluoroquinolones. However, CDI epidemiology is highly variable, as other hypervirulent RTs have also started to emerge, and is still largely unknown in our country. In the present study, 286 C. difficile strains sent from 22 Portuguese hospitals were characterized regarding PCR ribotype, toxin profile, tcdC mutations, antimicrobial susceptibility to MXF, VAN, MTZ, IMP, RIF and TGC, and mechanisms of antimicrobial resistance. Most patients (73.4%) were aged ≥65 years and at least 54.9% had taken antibiotics in the previous months; 76.5% of the cases were healthcare facility-associated (HCFA) and 12.6% were community-associated (CA). Among the 84 distinct RTs found...

Alta incidencia de diarrea por Clostridium difficile en pacientes nefrológicos

Herrera R,Patricia; Cotera F,Alejandro; Fica C,Alberto; Galdo A,Teresa; Alvo A.,Miriam
Fonte: Sociedad Médica de Santiago Publicador: Sociedad Médica de Santiago
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/04/2003 ES
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66.49%
Background: Clostridium difficile is the main agent causing antimicrobial associated nosocomial diarrhea. Chronic renal failure is a risk factor for this type of diarrhea. Aim: To study the incidence and complications of Clostridium difficile diarrhea in a university hospital and among patients with renal diseases. Patients and methods: Retrospective review of all cases of Clostridium difficile diarrhea that occurred in a university hospital, between June 2000 and May 2001. Results: In the Nephrology Unit, 48 episodes of Clostridium difficile diarrhea occurred in 35 patients (7 cases per 100 discharges/year). This figure is higher than the global incidence in the hospital (0.53 cases per 100 discharges/year, p <0.001). The mean age of the 33 patients with renal diseases was 63 years old and 17 of them were female. Their main diagnoses were chronic renal failure in hemodialysis in 48%, uremic syndrome in 36% and renal transplant in 6%. Seventy nine percent had a history of antimicrobial use (42% quinolones and 36% cephalosporins). In 3 patients, the only risk factor was chronic renal failure. Seventy five percent responded to metronidazole and in 27%, diarrhea recidivated, compared with a 6% recurrence rate in other units, p <0.02). Eight patients died during hospital stay. Conclusions: Among patients with renal diseases...

Diagnóstico de diarrea por Clostridium difficile: en busca de un enfoque clínico más eficiente

Alvarez L,Manuel; González D,Robinson; Briceño L,Isabel; Cofre D,Colomba; Labarca L,Jaime; Vial C,Pablo; García C,Patricia
Fonte: Sociedad Médica de Santiago Publicador: Sociedad Médica de Santiago
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/06/2001 ES
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66.47%
Background: The clinical parameters for the suspicion of Clostridium difficile infections, namely the use of antimicrobials and diarrhea, have a low predictive value for the diagnosis. Aim: To search other clinical variables and determine a clinical prediction model for (Clostridium difficile diarrhea. Patients and methods: All patients to whom a Clostridium difficile study was requested, were prospectively studied during 5 months. Clinical variables of these patients were registered. The diagnosis of Clostridium difficile was done using the cytotoxicity test in fibroblast cultures. Results: Ninety two patients were analyzed and in 26, the diagnosis of Clostridium difficile was confirmed. A logistic regression model disclosed an age over 60 years old, the presence of mucus in the stools and a temperature over 37.8 °C in the previous 24 h, as significant predictors of the infection. The correlation of the model, between the predicted probability and the observed condition, was 81.5%. Conclusions: The presence of the clinical variables identified in this study are associated with a high probability of an infection by Clostridium difficile in patients with diarrhea and the recent use of antimicrobials (Rev Méd Chile 2001; 129: 620-625)

Clostridium difficile pilot study: effects of probiotic supplementation on the incidence of C. difficile diarrhoea

Plummer,Sue; Weaver,Mark A.; Harris,Janine C.; Dee,Phillipa; Hunter,John
Fonte: International Microbiology Publicador: International Microbiology
Tipo: info:eu-repo/semantics/article; journal article; info:eu-repo/semantics/publishedVersion Formato: text/html; application/pdf
Publicado em 01/03/2004 ENG
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Colonic infection with Clostridium difficile, leading to pseudomembranous colitis, is a common complication of antibiotic therapy, especially in elderly patients. It has been suggested that non-pathogenic probiotic bacteria might prevent the development and recurrence of C. difficile infection. This double-blind, placebo-controlled study examines the role of probiotic administration in the prevention of C. difficile-associated diarrhoea (CDAD) in elderly patients receiving antibiotic therapy. Consecutive patients (150) receiving antibiotic therapy were randomised to receive either a probiotic containing both Lactobacillus and Bifidobacterium or placebo for 20 days. Upon admission to hospital, bowel habit was recorded and a faecal sample taken. Trial probiotic or placebo was taken within 72 h of prescription of antibiotics, and a second stool sample was taken in the event of development of diarrhoea during hospitalisation or after discharge. Of the randomised patients, 138 completed the study, 69 with probiotics in conjunction with antibiotics and 69 with antibiotics alone. On the basis of development of diarrhoea, the incidence of samples positive for C. difficile-associated toxins was 2.9% in the probiotic group compared with 7.25% in the placebo-control group. When samples from all patients were tested (rather than just those developing diarrhoea) 46% of probiotic patients were toxin-positive compared with 78% of the placebo group.

The management of Clostridium difficile-associated diarrhoea in a community hospital

Tomkins,K; Raynor,J; Rothwell,L; DeSilva,J; Wilson,C
Fonte: West Indian Medical Journal Publicador: West Indian Medical Journal
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/01/2011 EN
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86.32%
OBJECTIVES: To review the management of patients with Clostridium difficile-associated diarrhoea (CDAD). METHODS: A retrospective study was conducted on 26 patients with clinical symptoms of CDAD and positive tests for C difficile toxins A and/or B in stool samples, over a 12- month period. Demographic and clinical data on the patients including use ofproton pump inhibitors (PPI), management of CDAD, and compliance with local Infection Prevention and Control Guidelines were examined. RESULTS: The majority ofpatients were over 45 years of age (24/26, 92.4%) and 42% (11/26) were over 80 years of age. At least 50% (13/26) of the patients had acquired CDAD in hospital, 15% (4/26) were community acquired and symptomatic at admission while the onset of diarrhoea following admission to hospital was not documented in 35% (9/26). Three (11%) patients had used PPI. Fifteen per cent (4/26) of patients had no history of previous antibiotic therapy; 40% (10/26) were treated with a cephalosporin, fluoroquinolone or a combination of at least two different classes of antibiotics; one (3%) patient was on augmentin and the antibiotic regime used was not documented in 42% (11/26) who also had previous antibiotic therapy. The conditions for which antibiotics were prescribed could not be ascertained in 58% (15/26) but among the remaining cases antibiotics had been prescribed for urinary tract infection...

Clostridium difficile outbreak in Costa Rica: control actions and associated factors

Wong-McClure,Roy A.; Guevara-Rodríguez,Moraima; Abarca-Gómez,Leandra; Solano-Chinchilla,Antonio; Marchena-Picado,Margarita; O'Shea,Michele; Badilla-Vargas,Xiomara
Fonte: Organización Panamericana de la Salud Publicador: Organización Panamericana de la Salud
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/12/2012 EN
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OBJECTIVE: To describe interventions implemented during a nosocomial outbreak of Clostridium difficile in a general hospital in Costa Rica from December 2009 to April 2010 in order to achieve outbreak control and the factors determined to be associated with C. difficile infection. METHODS: Laboratory-confirmed cases of C. difficile were analyzed to describe the outbreak pattern and intervention measures implemented. Cases were selected and recruited in a case-control study. Controls were selected from the same services and time period as the cases. Evaluated exposures included underlying medical conditions and treatments administered before the onset of symptoms. RESULTS: The mean ages in case and control groups were 62.3 and 55.3 years, respectively. Control measures included a hand-hygiene campaign, deep disinfection of hospital surfaces, strict isolation of cases, use of personal protection equipment, and restriction of antibiotic use. The adjusted attributable risks associated with the outbreak were diabetes [odds ratio (OR) 3.4, 95% confidence interval (CI) 1.5-7.7], chronic renal failure (OR 9.0, 95% CI 1.5-53.0), and prescribing ceftazidime (OR 33.3, 95% CI 2.9-385.5) and cefotaxime (OR 20.4, 95% CI 6.9-60.3). CONCLUSIONS: Timely implementation of control measures resulted in reduced infection transmission and successful control of the outbreak. Conditions associated with C. difficile infection were similar to those found in previously described outbreaks of this bacterium.