Clostridioides (Clostridium) difficile (including epidemiology)Clinical epidemiology of Clostridium difficile infection among hospitalized patients with antibiotic-associated diarrhea in a university hospital of Brazil
Introduction
Antibiotic-associated diarrhea (AAD) is defined as an otherwise unexplained diarrhea that occurs in conjunction with the administration of antibiotics. Clostridium difficile infection (CDI) accounts for 10–33% of the cases of AAD and for the vast majority of cases of severe colitis associated with antibiotic therapy [1]. It is not only one of the most commonly diagnosed causes of nosocomial diarrhea in the developed world, but also closely related to increased morbidity, prolonged hospitalization, and rising health costs [2].
The risk factors for CDI include antimicrobial exposure, advanced age, prior hospitalization, use of feeding tubes, severe underlying disease, immunocompromising conditions, chemotherapeutic drugs, gastrointestinal surgery, and gastric acid suppression. Nearly all antimicrobials have been implicated in the development of CDI, particularly third-generation cephalosporins, clindamycin and fluoroquinolones [3]. It is believed that the disruption of the autochthonous intestinal microbiome by antibiotic use leads to the proliferation of C. difficile and potentially to the development of C. difficile–associated diarrhea [4].
Since the early 2000s, the incidence and severity of CDI have increased dramatically in North America and Europe, finding that has been attributed in part to the emergence of hypervirulent strains, such as ribotypes 027, 078 and 244 [5]. In contrast, little is known about the epidemiology of CDI in Latin American countries, where the majority of the hospitals lack personnel or structures for healthcare control of infection [6]. The potential worldwide spread of this infection calls for epidemiological studies to characterize currently circulating strains and also highlights the need for increased and permanent vigilance among public health professionals [7]. Furthermore, although previous studies found evidences that enterotoxin-producing Clostridium perfringens, methicillin-resistant Staphylococcus aureus (MRSA) and Klebisiella oxytoca could also be responsible for AAD, few studies have addressed these pathogens in patients with nosocomial diarrhea [8].
The aim of the current study is to compare clinical characteristics of hospitalized patients who received antibiotic therapy and developed CDI with those who received antibiotic therapy and developed diarrhea unrelated to C. difficile, as well as to identify other pathogens less frequently related to AAD. Furthermore, we assessed C. difficile ribotypes isolated from fecal samples of inpatients from a university hospital of Brazil, further contributing to clarify the epidemiology of CDI in Latin America.
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Subjects and inclusion criteria
The study was carried out at the Clinical Hospital of the Federal University of Minas Gerais, a 500-bed quaternary care hospital of Belo Horizonte, Minas Gerais state, southeast Brazil. From January 2011, to December 2015, patients (18 years of age or older) who have received systemic antibiotics anytime in the last 3 months, presenting with acute diarrhea after 72 h or more of hospitalization, were invited to participate in the study. All patients were followed from the time of admission until
Clostridium difficile infection
A total of 154 stool samples provided by patients with AAD were submitted to the microbiologic laboratory for C. difficile diagnostics during the study period from 2011 to 2015 (Fig. 1). Since complete data sets were available for only 110 patients, 44 individuals were excluded from the final analysis. Among those 110 patients, thirty-five (31.8%) were diagnosed with CDI, 21 (60%) of whom were positive for A/B toxins by EIA. Seven subjects were colonized by non-toxigenic C. difficile strains
Discussion
Antibiotic-associated diarrhea is a significant cause of morbidity and mortality, particularly in the elderly. The most common known infective cause of AAD is C. difficile, which accounts for 10–33% of the cases, 50%–75% of antibiotic-associated colitis, and more than 90% of antibiotic-associated pseudomembranous colitis in hospitalized patients [1,18,19]. This is the first study to address different aspects of C. difficile clinical epidemiology in Brazil. A high prevalence of CDI among
Acknowledgements
The authors are grateful for the financial support from PRPQ-UFMG, Fapemig, Capes/Proex and CNPq.
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Assessing risk factors, mortality, and healthcare utilization associated with Clostridioides difficile infection in four Latin American countries
2021, Brazilian Journal of Infectious DiseasesCitation Excerpt :Additionally, multivariate analyses found substantially increased odds of developing CDI in patients with comorbid dementia or moderate/severe renal disease compared with patients who did not have these pre-existing conditions. Consistent with these findings, a hospital-based study in Brazil found that comorbidity severity, as measured by CCI at the time of hospital admission, was a strong independent predictor of CDI-associated diarrhea.36 Similarly, a US retrospective cohort study of healthcare-associated CDI found that patients with a greater number of comorbidities had a greater risk of CDI, even after controlling for potentially confounding variables, including antibiotic therapy and age.39
Genetic relatedness, Virulence factors and Antimicrobial Resistance of C. difficile strains from hospitalized patients in a multicentric study in Brazil
2020, Journal of Global Antimicrobial ResistanceCitation Excerpt :Studies concerning epidemiology of C. difficile are scarce in Brazil. The methodologies applied are heterogeneous, i.e., ribotyping [13] and MLST [12; 14], the latter present greater inter-laboratory reproducibility. We determined the genetic relatedness of isolates from stool samples of patients from different hospitals in different states of Brazil by MLST and found a population of C. difficile distributed in 14 STs.