New insights into transmission of Clostridium difficile infection-narrative review.

BACKGROUND: Traditionally, Clostridium difficile has been considered a typical healthcare-associated pathogen-that is, one transmitted within healthcare facilities and thus prevented by implementation of standard infection control measures. Recently this concept has been challenged by studies suggesting a relevant role for community acquisition of C. difficile. AIMS: To discusses the current literature, compiled during the last decade, reporting on sources of acquisition of C. difficile and subsequent transmission. SOURCES: The databases PubMed, Medline, Embase and the Cochrane Database were searched for articles published from 1 January 2007 to 30 June 2017 reporting on possible transmission pathways of C. difficile and/or suggesting a source of acquisition of C. difficile. All study types reporting on adult populations were considered; case reports and series were excluded. The PRISMA guidelines for the reporting of systematic reviews were followed. CONTENT: Among 24 original articles included, 63% report on transmission of C. difficile in healthcare settings and 37% investigate sources and transmission of C. difficile in the community. Contact with symptomatic carriers (53.3%), the hospital environment (40.0%) and asymptomatic carriers (20%) were the most commonly reported transmission pathways within healthcare settings. The leading sources for acquisition of C. difficile in the community include direct contact with symptomatic and asymptomatic carriers in the community, including infants (30%) and residents of long-term non-acute care facilities (30%), followed by contact with contaminated environments in outpatient care settings (20%) and exposure to livestock or livestock farms (20%). IMPLICATIONS: In healthcare settings, future control efforts may need to focus on extending cleaning and disinfection procedures beyond the immediate surroundings of symptomatic carriers. Potential targets to prevent acquisition of C. difficile in the community include household settings, long-term care facilities and outpatient settings, while the role of livestock in entertaining transmission requires further investigation.

Guidance document for prevention of Clostridium difficile infection in acute healthcare settings.

SCOPE: Clostridium difficile infection (CDI) is the most important infective cause of healthcare-associated diarrhoea in high income countries and one of the most important healthcare-associated pathogens in both Europe and the United States. It is associated with high morbidity and mortality resulting in both societal and financial burden. A significant proportion of this burden is potentially preventable by a combination of targeted infection prevention and control measures and antimicrobial stewardship. The aim of this guidance document is to provide an update on recommendations for prevention of CDI in acute care settings to provide guidance to those responsible for institutional infection prevention and control programmes. METHODS: An expert group was set up by the European society of clinical microbiology and infectious diseases (ESCMID) Study Group for C. difficile (ESGCD), which performed a systematic review of the literature on prevention of CDI in adults hospitalized in acute care settings and derived respective recommendations according to the GRADE approach. Recommendations are stratified for both outbreak and endemic settings. QUESTIONS ADDRESSED BY THE GUIDELINE AND RECOMMENDATIONS: This guidance document provides thirty-six statements on strategies to prevent CDI in acute care settings, including 18 strong recommendations. No recommendation was provided for three questions.

[Effect of various types of thermotherapy in the rehabilitation of persons with war injuries of the extremities]. / Efekti razlicitih vrsta termoterapije u rehabilitaciji osoba sa ratnim povredama ekstremiteta.

The aim of this study was to check thermotherapy influence on the outcome of the rehabilitation program in patients who suffered contractures of joints following the war injuries of extremities and to compare the three different thermotherapy effects: peloid, hidrocolator and paraffin. The research included 36 examinees divided into 4 parallel groups: three experimental and a control one. The observation features were: movement range, skin temperature and hyperemic halo diameter around the joint. Rehabilitation program lasted ten therapeutic days. Experimental group examinees were treated by kinesiotherapy and various types of thermotherapy. Control group examinees were treated only by kinesiotherapy. The results demonstrated that thermotherapy did not influence significantly the functional recovery. Characteristically the best thermotherapeutical effect to the skin was reached by the use of paraffin.

[Physical therapy in the rehabilitation of patients with aerobic infections of the extremities]. / Vrijednost fizikalne terapije za rehabilitaciju osoba sa aerobnim infekcijama ekstremiteta.

OBJECTIVE: To evaluate how infection of extremity after war wound influenced the possibilities and immediate effects of a physical therapy. METHODS: The retrospective clinical investigation comparing two groups: group A (n = 86) with infection, group B (n = 87) without infection. Main indicators for possibilities of the physical therapy were the numbers and types of physical procedures used. For the estimation of immediate effects of physical therapy the muscle power and the range of motion were used. RESULTS: The number of daily physical procedures in the group with infection, compared to the group without infection, was significantly lesser ((A: 2.87 +/- 1.73; B: 4.02 +/- 1.73; p < 0.001). The patients with infection were significantly less frequently submitted to thermotherapy, hydrotherapy, interferent current and electrostimulation. Patients with infection, compared to patients without infection, had significantly poorer improvement of amplitude of analyzed movements at the end of treatment (A: 6.66 +/- 7.28 degrees; B: 16.66 +/- 14.79 degrees; p < 0.001). CONCLUSION: The infection of the extremities limited the possibilities and reduced the immediate effects of physical therapy.