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Difficile Infection (difficile + infection)
Kinds of Difficile Infection Selected AbstractsSimilar geographic variations of mortality and hospitalization associated with IBD and Clostridium difficile colitisINFLAMMATORY BOWEL DISEASES, Issue 3 2010Amnon Sonnenberg MD Abstract Background: Superinfection with Clostridium difficile can aggravate the symptoms of preexisting inflammatory bowel disease (IBD). The study served to assess whether the geographic variation of IBD within the United States might be influenced by C. difficile infection. Methods: Hospitalization data of the Healthcare Cost and Utilization Project (HCUP) from 2001,2006 and mortality data from 1979,2005 of the US were analyzed by individual states. Hospitalization and mortality associated with Crohn's disease (CD), ulcerative colitis (UC), and C. difficile colitis were correlated with each other, using weighted least square linear regression with the population size of individual states as weight. Results: Among the hospitalization rates, there were strong correlations between both types of IBD, as well as each type of IBD with C. difficile colitis. Similarly, among the mortality rates there were strong correlations between both types of IBD, as well as each type of IBD with C. difficile colitis. Lastly, each type of hospitalization rate was also strongly correlated with each type of mortality rate. In general, hospitalization and mortality associated with IBD tended to be frequent in many of the northern states and infrequent in the Southwest and several southern states. Conclusions: The similarity in the geographic distribution of the 3 diseases could indicate the influence of C. difficile colitis in shaping the geographic patterns of IBD. It could also indicate that shared environmental risk factors influence the occurrence of IBD, as well as C. difficile colitis. (Inflamm Bowel Dis 2010) [source] Infection probability score, APACHE II and KARNOFSKY scoring systems as predictors of infection onset in haematology,oncology patientsJOURNAL OF CLINICAL NURSING, Issue 11-12 2010Eleni Apostolopolou Aim., To assess the predictive power of three systems: Infection Probability Score, APACHE II and KARNOFSKY score to the onset of healthcare-associated infections in haematology,oncology patients. Background., The high incidence of healthcare-associated infections is a frequent problem in haematology,oncology patients that affects morbidity and mortality of these patients. Design., A retrospective surveillance survey. Method., The survey was conducted for seven months in the haematology unit of a general hospital in Greece to assess the predictive power of Infection Probability Score, APACHE II and KARNOFSKY score to the onset of healthcare-associated infections. The sample consisted of 102 hospitalised patients. The diagnosis of healthcare-associated infections was based on the definitions proposed by CDC. Results., Among the participants, 53 (52%) were males and 49 (48%) were females with a mean age of 53ˇ30 (SD 18ˇ59) years old (range, 17,85 years). The incidence density of healthcare-associated infections (the number of new cases of healthcare-associated infections per 1000 patient-days) was 21ˇ8 infections per 1000 patient-days. Among the 102 patients, healthcare-associated infections occurred in 32 (31ˇ4%) patients who had a total of 48 healthcare-associated infections (47ˇ5%). Among the 38 patients with neutropenia, 26 (68ˇ4%) had more than one healthcare-associated infection. Of the 48 detected healthcare-associated infections, the most frequent type was blood-stream infection (n = 17, 35ˇ4%), followed by Clostridium difficile infection (n = 11, 22ˇ9%) and respiratory tract infection (n = 8, 3ˇ4%). The best cut-off value of Infection Probability Score (IPS) for the prediction of a healthcare-associated infection was 10 with sensitivity of 59ˇ4% and specificity of 74ˇ3%. Conclusions., Between the three different prognostic scoring systems, IPS had the best sensitivity in predicting healthcare-associated infections. Relevance to clinical practice., IPS is an effective tool and should be used from nurses for the early detection of haematology,oncology patients who are susceptible to the onset of a healthcare-associated infection. [source] What is the evidence for the use of probiotics in the treatment of inflammatory bowel disease?JOURNAL OF CLINICAL NURSING, Issue 7-8 2010Virginia A Cary Aims and objectives., The purpose of this article is to investigate the use of probiotics in the treatment of inflammatory bowel disease. Background., Probiotics have been successfully used to treat various acute illnesses such as Clostridium difficile infection, rotovirus diarrhoea and traveller's diarrhoea. Recently, some studies have reported success with probiotics in the treatment of chronic intestinal diseases such as inflammatory bowel disease. Design., Literature review. Methods., A literature search was performed to include studies on Bifidobacteria -fermented milk, Escherichia coli, Lactobacillus, Saccharomyces boulardii, VSL #3 and probiotic use. Results of the literature are analysed, and a discussion is made regarding evaluation of the literature and implications for care. Results., The majority of probiotics studied have proven to have beneficial effects in the treatment of inflammatory bowel disease, especially when taken as a dietary adjunctive to standard treatment. All probiotics studied, with the exception of Lactobacillus GG and LA1, demonstrated positive results. Conclusions., The increasing use of probiotics combined with the insufficient knowledge regarding the use of probiotics in treating inflammatory bowel disease requires that future multilevel, multicentre large randomised control trials be conducted to understand better the specific measures and effectiveness of such treatment. Relevance to clinical practice., Given that few clinical trials exist to study the potential role of probiotics in the treatment of inflammatory bowel disease, it is imperative that healthcare providers become knowledgeable about the use of probiotics and their effects on inflammatory bowel disease. [source] Feasibility and tolerability of probiotics for prevention of antibiotic-associated diarrhoea in hospitalized US military veteransJOURNAL OF CLINICAL PHARMACY & THERAPEUTICS, Issue 6 2008N. Safdar MD MS Summary Background:, Probiotics may be efficacious for the prevention of antibiotic-associated diarrhoea. The tolerability and acceptability of probiotics in an elderly US veteran population has not been assessed. Purpose:, To undertake a randomized trial to determine the tolerability and acceptability of a probiotic, FlorajenŽ in an elderly population with multiple comorbidities. Methods:, Pilot randomized double-blind trial comparing a probiotic, FlorajenŽ to placebo for the prevention of antibiotic-associated diarrhoea in elderly hospitalized patients receiving antibiotics. Results:, Forty patients were enrolled and randomized. Antibiotic-associated diarrhoea occurred in 6/16 (37%) in the placebo group and 4/23 (17%) patients in the FlorajenŽ group, (RR 1ˇ63, 95% CI 0ˇ73,3ˇ65, P = 0ˇ15). FlorajenŽ was well tolerated in the study population with no major side effects that necessitated discontinuation. Conclusions:, In this pilot study, FlorajenŽ was well tolerated in an elderly population, all of whom were taking several other medications. A larger study is needed to determine the effect of FlorajenŽ on antibiotic-associated diarrhoea and Clostridium difficile infection. [source] Nosocomial Clostridium difficile infection: Possible cause of anastomotic leakage after anterior resection of the rectumJOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 5 2007Anil Keshava [source] Proton pump inhibitors as a risk factor for paediatric Clostridium difficile infectionALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 7 2010R. TURCO Aliment Pharmacol Ther,31, 754,759 Summary Background, Proton pump inhibitors (PPIs) and H2 receptor antagonists (H2RAs) may play an important role on the onset of Clostridium difficile -associated disease (CDAD) in adults. The impact of Clostridium difficile on children treated with gastric acid-suppressing agents remains unknown. Aim, To investigate the relationship between CDAD and exposure to acid suppressive therapy in hospitalized paediatric patients. Methods, We reviewed the medical records of children, with a diagnosis of protracted diarrhoea and abdominal pain, whose stool was analysed for C. difficile toxins. We identified 68 patients with CDAD. For each patient, we randomly selected one control subjects with stool analysis negative for C. difficile. Comorbid illnesses, previous hospitalizations, antibiotics, corticosteroids, immunosuppressants and gastric acid suppressing exposures were recorded. Results, The use of PPI was significantly higher in C. difficile positive group compared with C. difficile negative group [odds ratio (OR): = 4.5; 95% confidence interval (CI) = 1.4,14.4]. We also found a trend for the use of H2RAs in patients infected by C. difficile compared with C. difficile negative comparison group (OR: = 3.8; 95% CI = 0.7,18.9). Conclusions, Children exposed to PPIs therapy seem to be at higher risk for the development of Clostridium difficile -associated disease. [source] Proton pump inhibitors increase significantly the risk of Clostridium difficile infection in a low-endemicity, non-outbreak hospital settingALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 6 2009B. R. DALTON Summary Background, Proton pump inhibitors (PPI) have been linked to higher risk of Clostridium difficile infection (CDI). The relevance of this association in hospitals with low disease activity, where an outbreak strain is nondominant, has been assessed in relatively few studies. Aim, To assess the association of PPI and CDI in a setting of low disease activity. Methods, A retrospective cohort study was conducted at two hospitals. Patients admitted for ,7 days receiving antibiotics were included. Demographics, exposure to PPI, antibiotics and other drugs in relation to diagnosis of CDI were assessed by univariate and multivariate analyses. Results, Of 14 719 patients, 149 (1%) first episode CDI were documented; PPI co-exposure increased CDI [1.44 cases/100 patients vs. 0.74 cases/100 non-exposed (OR: 1.96, 95% CI: 1.42,2.72)]. By logistic regression, PPI days (adjusted OR: 1.01 per day, 95% CI: 1.00,1.02), histamine-2 blockers, antidepressants, antibiotic days, exposure to medications, age, admission service and length of admission were significant predictors. Conclusions, A statistically significant increase in CDI was observed in antibiotic recipients who received PPI, but the absolute risk increase is modest. In settings of with low rates of CDI, the benefit of PPI therapy outweighs the risk of developing CDI. These data support programmes to decrease inappropriate use of PPI in hospitalized patients. [source] Predictors of serious complications due to Clostridium difficile infectionALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 6 2009D. GUJJA Summary Background, Identifying individuals with severe Clostridium difficile infection (CDI) at risk for major complications has become an important objective. Presence of clinical variables that predict complications from CDI would have the potential to strongly influence management. Aim, To determine which clinical variables predict complications from CDI. Methods, Cross-sectional study of all individuals admitted to Temple University Hospital between 12/1/03 and 7/1/08 with the primary discharge diagnosis of CDI were eligible. Only patients experiencing their first episode of CDI were included. Abstracted data included demographic, physiological, laboratory, radiological, endoscopic, pharmacy and outcome data. Response was categorized as none, partial or complete. Complications attributed to CDI were defined as colon resection or death. Results, Overall 32 of 200 patients (16%) experienced a complication due to CDI including death (n = 20) and colectomy (n = 12). White blood cell count above 30,000 cells/mm3 (OR = 4.06; 95% CI, 1.28,12.87) and a rise in the creatinine to over 50% above baseline (OR = 7.13; 95% CI, 3.05,16.68) predicted a complication. AROC for percent rise in serum creatinine was 0.73 (95% CI: 0.64,0.85) and 0.62 (95% CI: 0.58,0.80) for white blood cell count. Conclusions, Severe white blood cell count elevation and a rise in the creatinine to over 50% above baseline are important independent predictors of serious adverse events due to CDI. These patients likely would benefit from more intensive care and early surgical consultation. [source] Failure of dietary oligofructose to prevent antibiotic-associated diarrhoeaALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 4 2005S. Lewis Summary Background :,Oligofructose is metabolized by bifidobacteria, increasing their numbers in the colon. High bifidobacteria concentrations are important in providing ,colonization resistance' against pathogenic bacteria. Aim :,To reduce the incidence of antibiotic-associated diarrhoea in elderly patients. Methods :,Patients over the age of 65 taking broad-spectrum antibiotics received either oligofructose or placebo. A baseline stool sample was cultured for Clostridium difficile and tested for C. difficile toxin. A further stool sample was analysed for C. difficile if diarrhoea developed. Results :,No difference was seen in the baseline characteristics, incidence of diarrhoea, C. difficile infection or hospital stay between the two groups (n = 435). Oligofructose increased bifidobacterial concentrations (P < 0.001, 95% CI: 0.69,1.72). A total of 116 (27%) patients developed diarrhoea of which 49 (11%) were C. difficile -positive and were more likely to be taking a cephalosporin (P = 0.006), be female (P < 0.001), to have lost more weight (P < 0.001, 95% CI: 0.99,2.00) and stayed longer in hospital (P < 0.001, 95% CI: 0.10,1.40). Amoxicillin (amoxycillin) and clavulanic acid increased diarrhoea not caused by C. difficile (P = 0.006). Conclusion :,Oligofructose does not protect elderly patients receiving broad-spectrum antibiotics from antibiotic-associated diarrhoea whether caused by C. difficile or not. Oligofructose was well-tolerated and increased faecal bifidobacterial concentrations. [source] Clostridium difficile infection and surgeryBRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 1 2009D. Gourevitch Prudence with antibiotics [source] Human mucosa/submucosa interactions during intestinal inflammation: involvement of the enteric nervous system in interleukin-8 secretionCELLULAR MICROBIOLOGY, Issue 12 2005Emmanuelle Tixier Summary Interleukin-8 (IL-8) is a key chemokine upregulated in various forms of intestinal inflammation, especially those induced by bacteria such as Clostridium difficile (C. difficile). Although interactions between different mucosal and submucosal cellular components have been reported, whether such interactions are involved in the regulation of IL-8 secretion during C. difficile infection is unknown. Moreover, whether the enteric nervous system, a major component of the submucosa, is involved in IL-8 secretion during an inflammatory challenge remains to be determined. In order to investigate mucosa/submucosa interactions that regulate IL-8 secretion, we co-cultured human intestinal mucosa and submucosa. In control condition, IL-8 secretion in co-culture was lower than the sum of the IL-8 secretion of both tissue layers cultured alone. Contrastingly, IL-8 secretion increased in co-culture after mucosal challenge with toxin B of C. difficile through an IL-1,-dependent pathway. Moreover, we observed that toxin B of C. difficile increased IL-8 immunoreactivity in submucosal enteric neurones in co-culture and in intact preparations of mucosa/submucosa, through an IL-1,-dependent pathway. IL-1, also increased IL-8 secretion and IL-8 mRNA expression in human neuronal cell lines (NT2-N and SH-SY5Y), through p38 and ERK1/2 MAP kinase-dependent pathways. Our results demonstrate that mucosa/submucosa interactions regulate IL-8 secretion during inflammatory processes in human through IL-1,-dependent pathways. Finally we observed that human submucosal neurones synthesize IL-8, whose production in neurones is induced by IL-1, via MAPK-dependent pathways. [source] No evidence for a clear link between active intestinal inflammation and autism based on analyses of faecal calprotectin and rectal nitric oxideACTA PAEDIATRICA, Issue 7 2007Elisabeth Fernell Abstract Aim: Due to parental concern regarding the child's bowel habits and the ongoing discussion whether there might be an association between autism and intestinal inflammation, two inflammatory markers were analysed in a group of children with autism. Methods: Twenty-four consecutive children with autism (3,13 years) of unknown aetiology were investigated with respect to faecal calprotectin and rectal nitric oxide (NO). Results: One child who previously had a severe Clostridium difficile infection displayed raised levels of both these inflammatory markers and one child with extreme constipation for whom only calprotectin was possible to measure had raised levels. The remaining children displayed results that did not indicate an active inflammatory status in the intestine when the two inflammatory markers were combined. Conclusion: By the use of two independent markers of inflammatory reactions in the gut, i.e. rectal NO and faecal calprotectin we were not able to disclose evidence of a link between the autistic disorder and active intestinal inflammation. [source] Clostridium difficile in food,innocent bystander or serious threat?CLINICAL MICROBIOLOGY AND INFECTION, Issue 1 2010J. S. Weese Abstract Clostridium difficile is a critically important cause of disease in humans, particularly in hospitalized individuals. Three major factors have raised concern about the potential for this pathogen to be a cause of foodborne disease: the increasing recognition of community-associated C. difficile infection, recent studies identifying C. difficile in food animals and food, and similarities in C. difficile isolates from animals, food and humans. It is clear that C. difficile can be commonly found in food animals and food in many regions, and that strains important in human infections, such as ribotype 027/NAP1/toxinotype III and ribotype 078/toxinotype V, are often present. However, it is currently unclear whether ingestion of contaminated food can result in colonization or infection. Many questions remain unanswered regarding the role of C. difficile in community-associated diarrhoea: its source when it is a food contaminant, the infective dose, and the association between ingestion of contaminated food and disease. The significant role of this pathogen in human disease and its potential emergence as an important community-associated pathogen indicate that careful evaluation of different sources of exposure, including food, is required, but determination of the potential role of food in C. difficile infection may be difficult. [source] Still difficult; clinical practice guidelines for Clostridium difficile infectionCLINICAL MICROBIOLOGY AND INFECTION, Issue 12 2009R. C. Read No abstract is available for this article. [source] Evidence for low risk of Clostridium difficile infection associated with tigecyclineCLINICAL MICROBIOLOGY AND INFECTION, Issue 10 2007M. H. Wilcox Abstract Broad-spectrum antibiotics are often associated with a relatively high risk of Clostridium difficile infection (CDI). However, exceptions to this rule, e.g., piperacillin,tazobactam, show that marked inhibition of gut flora is not synonymous with CDI risk. Tigecycline has marked broad-spectrum activity that includes Gram-positive and Gram-negative facultative and obligate anaerobes. Antibiotic susceptibility, gut model and clinical trial data suggest that tigecycline is associated with a relatively low risk of CDI. Further clinical data should be obtained to confirm the results of these initial studies. [source] | ||||||||||