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1.
JAMA Dermatol ; 160(5): 564, 2024 May 01.
Artículo en Inglés | MEDLINE | ID: mdl-38568680

RESUMEN

This case report describes Osler nodes and Janeway lesions on a man in his 70s.


Asunto(s)
Endocarditis Bacteriana , Humanos , Endocarditis Bacteriana/diagnóstico , Endocarditis Bacteriana/microbiología
2.
Transplant Cell Ther ; 30(4): 455.e1-455.e7, 2024 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-38346643

RESUMEN

Antibody titers and the potential need for immunization have not been formally studied in recipients of chimeric antigen receptor T cell therapy (CAR-T). Prior studies have shown that CD19-targeted CAR-T can induce persistent B cell aplasia but preserve plasma cells for humoral response. Aiming to assess the immune repertoire and antibody titer status of CAR-T recipients, we conducted a retrospective study of immune cell recovery and antibody titers to vaccines in anti-CD19 CAR-T recipients at Mayo Clinic, Rochester. In our cohort of 95 CAR-T recipients, almost one-half had low CD4 T and B cell counts prior to CAR-T that remained persistently low post-CAR-T. Prior to CAR-T, the seronegative rate was lowest for tetanus and highest for pneumococcus irrespective of prior transplantation status (within 2 years of CAR-T). At 3 months post-CAR-T, overall seronegativity rates were similar to pre-CAR-T rates for the prior transplantation and no prior transplantation groups. For patients who received IVIG, loss of seropositivity was seen for hepatitis A (1 of 7; 14%). No seroconversion was noted for pneumococcus. For patients who did not receive IVIG, loss of seropositivity was seen for pneumococcus (2 of 5; 40%) and hepatitis A (1 of 4; 25%). CAR-T recipients commonly experience T cell and B cell lymphopenia and might not have adequate antibody titers against vaccine-preventable diseases despite IVIG supplementation. Loss of antibody titers post-CAR-T is possible, highlighting the need for revaccination. Additional studies with long-term follow-up are needed to inform the optimal timing of immunization post-CAR-T.


Asunto(s)
Hepatitis A , Linfoma , Receptores Quiméricos de Antígenos , Humanos , Estudios Retrospectivos , Inmunoglobulinas Intravenosas , Antígenos CD19 , Tratamiento Basado en Trasplante de Células y Tejidos
4.
Eur J Clin Microbiol Infect Dis ; 42(8): 1037-1041, 2023 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-37351724

RESUMEN

We performed an updated study to investigate the rates of urinary tract infections (UTIs) in patients with recurrent Clostridioides difficile infection (CDI) who received fecal microbiota transplantation (FMT) for CDI. We found a significant reduction in number of UTIs after FMT compared to patients who received antibiotics for CDI treatment. After FMT, we also observed a trend towards reduction of antibiotic resistance in organisms causing UTI.


Asunto(s)
Clostridioides difficile , Infecciones por Clostridium , Infecciones Urinarias , Humanos , Trasplante de Microbiota Fecal/efectos adversos , Resultado del Tratamiento , Recurrencia , Infecciones por Clostridium/microbiología , Infecciones Urinarias/terapia , Infecciones Urinarias/etiología
6.
Chest ; 164(1): 124-136, 2023 07.
Artículo en Inglés | MEDLINE | ID: mdl-36907373

RESUMEN

BACKGROUND: The COVID-19 pandemic has led to unprecedented mental health disturbances, burnout, and moral distress among health care workers, affecting their ability to care for themselves and their patients. RESEARCH QUESTION: In health care workers, what are key systemic factors and interventions impacting mental health and burnout? STUDY DESIGN AND METHODS: The Workforce Sustainment subcommittee of the Task Force for Mass Critical Care (TFMCC) utilized a consensus development process, incorporating evidence from literature review with expert opinion through a modified Delphi approach to determine factors affecting mental health, burnout, and moral distress in health care workers, to propose necessary actions to help prevent these issues and enhance workforce resilience, sustainment, and retention. RESULTS: Consolidation of evidence gathered from literature review and expert opinion resulted in 197 total statements that were synthesized into 14 major suggestions. These suggestions were organized into three categories: (1) mental health and well-being for staff in medical settings; (2) system-level support and leadership; and (3) research priorities and gaps. Suggestions include both general and specific occupational interventions to support health care worker basic physical needs, lower psychological distress, reduce moral distress and burnout, and foster mental health and resilience. INTERPRETATION: The Workforce Sustainment subcommittee of the TFMCC offers evidence-informed operational strategies to assist health care workers and hospitals plan, prevent, and treat the factors affecting health care worker mental health, burnout, and moral distress to improve resilience and retention following the COVID-19 pandemic.


Asunto(s)
Agotamiento Profesional , COVID-19 , Desastres , Humanos , COVID-19/epidemiología , Pandemias , Consenso , Personal de Salud/psicología , Cuidados Críticos , Recursos Humanos , Agotamiento Profesional/epidemiología , Agotamiento Profesional/prevención & control , Agotamiento Profesional/psicología , Atención a la Salud
7.
Am J Infect Control ; 51(4): 454-460, 2023 04.
Artículo en Inglés | MEDLINE | ID: mdl-35732255

RESUMEN

BACKGROUND: We describe the investigation of a nosocomial outbreak of rapidly growing mycobacteria (RGM) infections and the results of mitigation efforts after 8 years. METHODS: A cluster of RGM cases in a Kentucky hospital in 2013 prompted an investigation into RGM surgical site infections following joint replacement surgery. A case-control study was conducted to identify risk factors. RESULTS: Eight cases were identified, 5 caused by M. wolinskyi and 3 by M. goodii. The case-control study showed the presence of a particular nurse in the operating room was significantly associated with infection. Environmental sampling at the nurse's home identified an outdoor hot tub as the likely source of M. wolinskyi, confirmed by pulsed-field gel electrophoresis and whole genome sequencing. The hot tub reservoir was eliminated, and hospital policies were revised to correct infection control lapses. No new cases of RGM infections have been identified as of 2021. DISCUSSION: Breaches in infection control practices at multiple levels may have led to a chain of infection from a nurse's hot tub to surgical sites via indirect person-to-person transmission from a colonized health care worker (HCW). CONCLUSIONS: The multifactorial nature of the outbreak's cause highlights the importance of overlapping or redundant layers of protection preventing patient harm. Future investigations of RGM outbreaks should consider the potential role of colonized HCWs as a transmission vector.


Asunto(s)
Artroplastia de Reemplazo , Infecciones por Mycobacterium no Tuberculosas , Humanos , Infecciones por Mycobacterium no Tuberculosas/epidemiología , Infecciones por Mycobacterium no Tuberculosas/microbiología , Micobacterias no Tuberculosas , Estudios de Casos y Controles , Estudios de Seguimiento , Kentucky/epidemiología , Hospitales , Brotes de Enfermedades
8.
Lancet Infect Dis ; 22(12): e349-e358, 2022 12.
Artículo en Inglés | MEDLINE | ID: mdl-36116460

RESUMEN

The largest outbreak of monkeypox in history began in May, 2022, and has rapidly spread across the globe ever since. The purpose of this Review is to briefly describe human immune responses to orthopoxviruses; provide an overview of the vaccines available to combat this outbreak; and discuss the various clinical data and animal studies evaluating protective immunity to monkeypox elicited by vaccinia virus-based smallpox vaccines, address ongoing concerns regarding the outbreak, and provide suggestions for the appropriate use of vaccines as an outbreak control measure. Data showing clinical effectiveness (~85%) of smallpox vaccines against monkeypox come from surveillance studies conducted in central Africa in the 1980s and later during outbreaks in the same area. These data are supported by a large number of animal studies (primarily in non-human primates) with live virus challenge by various inoculation routes. These studies uniformly showed a high degree of protection and immunity against monkeypox virus following vaccination with various smallpox vaccines. Smallpox vaccines represent an effective countermeasure that can be used to control monkeypox outbreaks. However, smallpox vaccines do cause side-effects and the replication-competent, second-generation vaccines have contraindications. Third-generation vaccines, although safer for use in immunocompromised populations, require two doses, which is an impediment to rapid outbreak response. Lessons learned from the COVID-19 pandemic should be used to inform our collective response to this monkeypox outbreak and to future outbreaks.


Asunto(s)
COVID-19 , Mpox , Vacuna contra Viruela , Viruela , Animales , Humanos , Mpox/epidemiología , Mpox/prevención & control , Viruela/prevención & control , Pandemias
9.
Mayo Clin Proc ; 97(9): 1694-1699, 2022 09.
Artículo en Inglés | MEDLINE | ID: mdl-35985857

RESUMEN

Monkeypox virus, a member of the Orthopoxvirus genus, was first identified as the etiology of monkeypox in 1970 in the Democratic Republic of Congo and remains endemic in regions of Central and West Africa. Following the most recent outbreak of monkeypox in multiple countries throughout Europe and North America, the infection has been declared a public health emergency by the Centers for Disease Control and Prevention. Within this report, we aim to provide clinicians with a focused overview of the epidemiology, clinical manifestation, diagnosis, and approaches to treat and prevent monkeypox infection amidst the global outbreak.


Asunto(s)
Mpox , África Occidental/epidemiología , Brotes de Enfermedades/prevención & control , Humanos , Mpox/diagnóstico , Mpox/epidemiología , Monkeypox virus/genética , Salud Pública
10.
Respir Med ; 199: 106882, 2022 08.
Artículo en Inglés | MEDLINE | ID: mdl-35633606

RESUMEN

Invasive aspergillosis (IA) is a serious complication in immunocompromised and critically ill patients but is difficult to diagnose. We sought to examine how often cases go undiagnosed and to understand the presenting clinical and radiologic features associated with fatal IA. We reviewed cases of fatal IA confirmed at autopsy (N = 67) between 1999 and 2019 at a tertiary academic hospital. At autopsy, pulmonary involvement was present in 97% of cases--46% were limited to the lungs and 51% had concomitant extrapulmonary involvement. Immunosuppression with either glucocorticoids and/or other immunosuppressive agents was present in 85%. Among those not immunocompromised (15%), chronic lung disease was present in 70%, and a respiratory coinfection was found in 50%. Chest imaging abnormalities including consolidation, ground glass opacities, halo sign, cavitation, and air crescent sign were present in 49%, 49%, 37%, 22%, and 7% of cases, respectively. Diagnostic bronchoscopy was performed in 61% of cases and yielded aspergillus in 63% of those cases by either bronchoalveolar lavage (galactomannan and/or culture), bronchial washings, or transbronchial biopsy cultures. Either a respiratory coinfection or other systemic coinfection was diagnosed in 64%. The performance of diagnostic bronchoscopy was associated with accurate pre-mortem identification of IA (p = 0.001). Clinicians correctly identified IA as the cause of death in only 27% of fatal IA cases identified at autopsy. Complex presenting features, high rates of co-infections, and low rates of invasive diagnostic procedures may have led to missed diagnoses of IA.


Asunto(s)
Aspergilosis Pulmonar Invasiva , Enfermedades no Diagnosticadas , Autopsia , Líquido del Lavado Bronquioalveolar/microbiología , Coinfección/epidemiología , Humanos , Aspergilosis Pulmonar Invasiva/diagnóstico , Aspergilosis Pulmonar Invasiva/mortalidad
11.
Chest ; 161(2): 429-447, 2022 02.
Artículo en Inglés | MEDLINE | ID: mdl-34499878

RESUMEN

BACKGROUND: After the publication of a 2014 consensus statement regarding mass critical care during public health emergencies, much has been learned about surge responses and the care of overwhelming numbers of patients during the COVID-19 pandemic. Gaps in prior pandemic planning were identified and require modification in the midst of severe ongoing surges throughout the world. RESEARCH QUESTION: A subcommittee from The Task Force for Mass Critical Care (TFMCC) investigated the most recent COVID-19 publications coupled with TFMCC members anecdotal experience in order to formulate operational strategies to optimize contingency level care, and prevent crisis care circumstances associated with increased mortality. STUDY DESIGN AND METHODS: TFMCC adopted a modified version of established rapid guideline methodologies from the World Health Organization and the Guidelines International Network-McMaster Guideline Development Checklist. With a consensus development process incorporating expert opinion to define important questions and extract evidence, the TFMCC developed relevant pandemic surge suggestions in a structured manner, incorporating peer-reviewed literature, "gray" evidence from lay media sources, and anecdotal experiential evidence. RESULTS: Ten suggestions were identified regarding staffing, load-balancing, communication, and technology. Staffing models are suggested with resilience strategies to support critical care staff. ICU surge strategies and strain indicators are suggested to enhance ICU prioritization tactics to maintain contingency level care and to avoid crisis triage, with early transfer strategies to further load-balance care. We suggest that intensivists and hospitalists be engaged with the incident command structure to ensure two-way communication, situational awareness, and the use of technology to support critical care delivery and families of patients in ICUs. INTERPRETATION: A subcommittee from the TFMCC offers interim evidence-informed operational strategies to assist hospitals and communities to plan for and respond to surge capacity demands resulting from COVID-19.


Asunto(s)
Comités Consultivos , COVID-19 , Cuidados Críticos , Atención a la Salud/organización & administración , Capacidad de Reacción , Triaje , COVID-19/epidemiología , COVID-19/terapia , Cuidados Críticos/métodos , Cuidados Críticos/organización & administración , Práctica Clínica Basada en la Evidencia/métodos , Práctica Clínica Basada en la Evidencia/organización & administración , Humanos , SARS-CoV-2 , Capacidad de Reacción/organización & administración , Capacidad de Reacción/normas , Triaje/métodos , Triaje/normas , Estados Unidos/epidemiología
12.
Cancer Med ; 10(15): 5120-5130, 2021 08.
Artículo en Inglés | MEDLINE | ID: mdl-34155819

RESUMEN

BACKGROUND: Pneumocystis jirovecii pneumonia (PJP) is a life-threatening infection occurring in patients receiving bendamustine. The poorly defined incidence, particularly when utilizing polymerase chain reaction (PCR)-based diagnostic techniques, precipitates unclear prophylaxis recommendations. Our objective was to determine the cumulative incidence of PJP diagnosed by single copy target, non-nested PCR in patients receiving bendamustine. METHODS: Patients were evaluated for PJP from initiation of bendamustine through 9 months after the last administration. The cumulative incidence of PJP was estimated using the Aalen-Johansen method. Cox proportional hazard models were used to demonstrate the strength of association between the independent variables and PJP risk. RESULTS: This single-center, retrospective cohort included 486 adult patients receiving bendamustine from 1 January 2006 through 1 August 2019. Most patients received bendamustine-based combination therapy (n = 461, 94.9%), and 225 (46.3%) patients completed six cycles. Rituximab was the most common concurrent agent (n = 431, 88.7%). The cumulative incidence of PJP was 1.7% (95% CI 0.8%-3.3%, at maximum follow-up of 2.5 years), after the start of bendamustine (n = 8 PJP events overall). Prior stem cell transplant, prior chemotherapy within 1 year of bendamustine, and lack of concurrent chemotherapy were associated with the development of PJP in univariate analyses. Anti-Pneumocystis prophylaxis was not significantly associated with a reduction in PJP compared to no prophylaxis (HR 0.37, 95% CI (0.05, 3.04), p = 0.36). CONCLUSIONS: Our incidence of PJP below 3.5%, the conventional threshold for prophylaxis implementation, indicates routine anti-Pneumocystis prophylaxis may not be necessary in this population. Factors indicating a high-risk population for targeted prophylaxis require further investigation.


Asunto(s)
Antineoplásicos Alquilantes/uso terapéutico , Clorhidrato de Bendamustina/uso terapéutico , Pneumocystis carinii , Neumonía por Pneumocystis/epidemiología , Adulto , Anciano , Anciano de 80 o más Años , Antifúngicos/administración & dosificación , Antineoplásicos Inmunológicos/uso terapéutico , Femenino , Humanos , Incidencia , Linfoma Folicular/tratamiento farmacológico , Masculino , Persona de Mediana Edad , Neumonía por Pneumocystis/diagnóstico , Neumonía por Pneumocystis/microbiología , Neumonía por Pneumocystis/prevención & control , Reacción en Cadena de la Polimerasa , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Rituximab/uso terapéutico , Factores de Tiempo , Adulto Joven
13.
IDCases ; 25: e01196, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34189041

RESUMEN

An 18-year-old man presented with 5-days of a lower extremity rash, sore throat, rapidly progressive bilateral facial numbness and paresthesias in his distal extremities. His neurological examination acutely deteriorated to include moderate bilateral facial weakness in a lower motor neuron pattern, mild flaccid dysarthria, mild bilateral interossei weakness, and diffuse hyporeflexia. In addition to neurological examination, EMG results of acute demyelinating polyradiculoneuropathy were suggestive of Guillain-Barre Syndrome (GBS). Infectious laboratory testing demonstrated acute infection of Epstein-Barr Virus (EBV) with relatively low EBV DNA quantitative values. The patient subsequently developed fever and cervical lymphadenopathy during his hospital course. Contrasting typical GBS, which presents weeks after an acute infection, the patient's presenting symptom of EBV infection was GBS. GBS as a presenting symptom of EBV has not previously been described. This case may represent a unique mechanism for the pathogenesis of GBS in acute infections as opposed to the traditional post-infectious antibody-mediated process.

14.
Infect Control Hosp Epidemiol ; 42(4): 388-391, 2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-33100247

RESUMEN

OBJECTIVE: Presenteeism is an expensive and challenging problem in the healthcare industry. In anticipation of the staffing challenges expected with the COVID-19 pandemic, we examined a decade of payroll data for a healthcare workforce. We aimed to determine the effect of seasonal influenza-like illness (ILI) on absences to support COVID-19 staffing plans. DESIGN: Retrospective cohort study. SETTING: Large academic medical center in the United States. PARTICIPANTS: Employees of the academic medical center who were on payroll between the years of 2009 and 2019. METHODS: Biweekly institutional payroll data was evaluated for unscheduled absences as a marker for acute illness-related work absences. Linear regression models, stratified by payroll status (salaried vs hourly employees) were developed for unscheduled absences as a function of local ILI. RESULTS: Both hours worked and unscheduled absences were significantly related to the community prevalence of influenza-like illness in our cohort. These effects were stronger in hourly employees. CONCLUSIONS: Organizations should target their messaging at encouraging salaried staff to stay home when ill.


Asunto(s)
Absentismo , COVID-19/epidemiología , Personal de Salud/estadística & datos numéricos , Presentismo/estadística & datos numéricos , Recursos Humanos , Centros Médicos Académicos/organización & administración , Centros Médicos Académicos/estadística & datos numéricos , Epidemias , Personal de Salud/psicología , Humanos , Minnesota/epidemiología , Estudios Retrospectivos
16.
Leuk Lymphoma ; 61(11): 2622-2629, 2020 11.
Artículo en Inglés | MEDLINE | ID: mdl-32623928

RESUMEN

A Polymerase Chain Reaction-based diagnosis of Pneumocystis Pneumonia (PCP) and the need for anti-Pneumocystis prophylaxis in Hodgkin lymphoma patients receiving chemotherapy requires further investigation. This retrospective, single-center, study evaluated 506 consecutive adult patients diagnosed with Hodgkin lymphoma receiving chemotherapy between January 2006 and August 2018. The cumulative incidence of PCP 1 year after start of chemotherapy was 6.2% (95% CI 3.8-8.5%). Mortality 30 days from PCP diagnosis was 8% (n = 2) with one death attributable to PCP. Bleomycin-containing combination chemotherapy regimen was not significantly associated with a higher risk for PCP when compared to other regimens (HR = 1.59, 95% CI 0.55-4.62 p = 0.40). Anti-Pneumocystis prophylaxis was not significantly associated with a decreased incidence of PCP (HR = 0.51, 95% CI 0.15-1.71, p = 0.28). As the overall incidence is above the commonly accepted 3.5% threshold, clinicians should consider the potential value of prophylaxis. The utility of universal vs. targeted anti-Pneumocystis prophylaxis requires prospective, randomized investigation.


Asunto(s)
Enfermedad de Hodgkin , Pneumocystis carinii , Neumonía por Pneumocystis , Adulto , Enfermedad de Hodgkin/tratamiento farmacológico , Humanos , Incidencia , Pneumocystis carinii/genética , Neumonía por Pneumocystis/diagnóstico , Neumonía por Pneumocystis/tratamiento farmacológico , Neumonía por Pneumocystis/epidemiología , Reacción en Cadena de la Polimerasa , Estudios Prospectivos , Estudios Retrospectivos , Combinación Trimetoprim y Sulfametoxazol
18.
J Intensive Care Med ; 35(12): 1465-1470, 2020 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-30813829

RESUMEN

BACKGROUND: Corticosteroid therapy is a well-recognized risk factor for Pneumocystis pneumonia (PCP); however, it has also been proposed as an adjunct to decrease inflammation and respiratory failure. OBJECTIVE: To determine the association between preadmission corticosteroid use and risk of moderate-to-severe respiratory failure at the time of PCP presentation. METHODS: This retrospective cohort study evaluated HIV-negative immunosuppressed adults diagnosed with PCP at Mayo Clinic from 2006 to 2016. Multivariable regression models were used to evaluate the association between preadmission corticosteroid exposure and moderate-to-severe respiratory failure at presentation. RESULTS: Of the 323 patients included, 174 (54%) used preadmission corticosteroids with a median daily dosage of 20 (interquartile range: 10-40) mg of prednisone or equivalent. After adjustment for baseline demographics, preadmission corticosteroid therapy did not decrease respiratory failure at the time of PCP presentation (odds ratio: 1.23, 95% confidence interval: 0.73-2.09, P = .38). Additionally, after adjusting for inpatient corticosteroid administration, preadmission corticosteroid use did not impact the need for intensive care unit admission (P = .98), mechanical ventilation (P = .92), or 30-day mortality (P = .11). CONCLUSIONS: Corticosteroid exposure before PCP presentation in immunosuppressed HIV-negative adults was not associated with a reduced risk of moderate-to-severe respiratory failure.


Asunto(s)
Corticoesteroides , Infecciones por VIH , Neumonía por Pneumocystis , Insuficiencia Respiratoria , Corticoesteroides/administración & dosificación , Corticoesteroides/efectos adversos , Adulto , Estudios de Cohortes , Humanos , Neumonía por Pneumocystis/inducido químicamente , Neumonía por Pneumocystis/fisiopatología , Insuficiencia Respiratoria/etiología , Estudios Retrospectivos
19.
J Bone Jt Infect ; 4(5): 209-215, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31700768

RESUMEN

Background: Hematopoietic stem cell transplantation (HSCT) recipients are at increased risk for infection. This study describes bone and joint infections (BJI) among HSCT recipients. Methods: We reviewed 5861 patients who underwent HSCT at Mayo Clinic, Rochester, MN from January 1, 2005 through January 1, 2015 for study inclusion. BJI was defined as native septic arthritis, prosthetic joint infection, osteomyelitis, and orthopedic implant infection. All adults with BJI after HSCT were included in the analysis. Results: Of 5861 patients, 33 (0.6%) developed BJI. Native joint septic arthritis was the most common BJI occurring in 15/33 (45.4%) patients. Patients were predominantly male (24/33, 72.7%), with median age of 58 (range 20-72) years. BJI was diagnosed a median of 39 (range 1-114) months after allogeneic (14/33, 42.4%) or autologous (19/33, 57.6%) HSCT. Organisms were recovered via tissue (24/27, 88.9%), synovial fluid (13/17, 76.5%), and/or blood cultures (16/25, 64%). Most underwent surgical debridement (23/33, 69.7%). Patients were followed a median of 78.3 months (range 74-119). Therapy was unsuccessful in 4/33 (12.1%), with death related to the underlying BJI in two (50%). Failure occurred a median of 3.4 (0.1-48.5) months from diagnosis. At last follow up, 7/33 (21.2%) patients were alive. Median overall survival was 13 months (0.07-70.6). Conclusion: BJI among HSCT recipients is infrequent. The most common infection is native joint septic arthritis. Pathogens appear similar to patients without HSCT. Treatment involving surgical-medical modalities is successful, with most patients surviving >1 year after BJI.

20.
Anaerobe ; 58: 35-46, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-31330183

RESUMEN

BACKGROUND: Decreases in clinical response of Clostridioides difficile to antibiotics used for its treatment have raised concerns regarding antibiotic resistance. We conducted a systematic review and meta-analysis to study the resistance rates of C. difficile to various antibiotics over time. METHODS: We systematically searched MEDLINE, Embase, and Web of Science from inception through 03/31/2017 for observational studies assessing antibiotic resistance rates in C. difficile. Weighted summary estimates were calculated using inverse variance heterogeneity models [MetaXL software (v. 5.3)]. A priori subgroup analyses were done (by study year, continent, susceptibility testing method, origin of isolates); ribotype 027 strains were analyzed separately. RESULTS: From 1982 to 2017, 60 studies (8336 isolates) were analyzed. Fifty-three studies reported vancomycin resistance; weighted pooled resistance (WPR), 2.1% (95% CI, 0%-5.1%; I2 = 95%). Fifty-five studies reported metronidazole resistance; WPR, 1.9% (95% CI, 0.5%-3.6%; I2 = 89%). Compared to the period before 2012, vancomycin resistance increased by 3.6% (95% CI, 2.9%-4.2%; P < 0.001) after 2012, and metronidazole resistance decreased by 0.8% (95% CI, 0.1%-1.5%; P = 0.02). No isolates were resistant to fidaxomicin. CONCLUSION: Resistance of C. difficile to vancomycin is increasing, with a smaller, declining resistance to metronidazole; there is significant heterogeneity between studies. Ongoing monitoring of resistance to commonly used antibiotics is required.


Asunto(s)
Clostridioides difficile/efectos de los fármacos , Infecciones por Clostridium/epidemiología , Infecciones por Clostridium/microbiología , Farmacorresistencia Bacteriana , Animales , Clostridioides difficile/aislamiento & purificación , Infecciones por Clostridium/veterinaria , Salud Global , Humanos , Prevalencia
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