Real-time polymerase chain reaction (PCR) cycle threshold and Clostridioides difficile infection outcomes.

OBJECTIVE: Clostridioides difficile infection (CDI) causes significant morbidity and mortality; however, the diagnosis of CDI remains controversial. The primary aim of our study was to evaluate the association of polymerase chain reaction (PCR) cycle threshold (Ct) values with CDI disease severity, recurrence, and mortality among adult patients with CDI. DESIGN: Retrospective cohort study. SETTING: Single tertiary-care hospital. PATIENTS: Adult patients diagnosed with hospital-onset, healthcare facility-associated CDI from June 2014 to September 2015. METHODS: We performed a retrospective chart review of included patients. Univariate and multivariable logistic regression methods were used to evaluate the association between Ct values and CDI severity, 8-week recurrence, and 30-day mortality. RESULTS: Among 318 included patients, 51% were male and the mean age was 62 years; ~32% of the patients developed severe CDI and 11% developed severe-complicated CDI. The 30-day all-cause mortality rate was 11% and the 8-week recurrence rate was 9.5%. The overall mean Ct value was 32.9 (range, 23-40). Multivariable analyses showed that lower values of PCR Ct were associated with increased odds of 30-day morality (odds ratio [OR] 0.83; 95% confidence interval [CI], 0.72-0.96) but were not independently associated with CDI severity (OR, 0.99; 95% CI, 0.90-1.09) or recurrence (OR, 0.88; 95% CI, 0.77-1.00). CONCLUSIONS: Our findings suggest that PCR Ct values at the time of diagnosis may have a limited predictive value and utility in clinical decision making for inpatients with CDI. Larger, prospective studies across different patient populations are needed to confirm our findings.

Comparative Antimicrobial Efficacy of Two Hand Sanitizers in Intensive Care Units Common Areas: A Randomized, Controlled Trial.

OBJECTIVE Contaminated hands of healthcare workers (HCWs) are an important source of transmission of healthcare-associated infections. Alcohol-based hand sanitizers, while effective, do not provide sustained antimicrobial activity. The objective of this study was to compare the immediate and persistent activity of 2 hand hygiene products (ethanol [61% w/v] plus chlorhexidine gluconate [CHG; 1.0% solution] and ethanol only [70% v/v]) when used in an intensive care unit (ICU). DESIGN Prospective, randomized, double-blinded, crossover study SETTING Three ICUs at a large teaching hospital PARTICIPANTS In total, 51 HCWs involved in direct patient care were enrolled in and completed the study. METHODS All HCWs were randomized 1:1 to either product. Hand prints were obtained immediately after the product was applied and again after spending 4-7 minutes in the ICU common areas prior to entering a patient room or leaving the area. The numbers of aerobic colony-forming units (CFU) were compared for the 2 groups after log transformation. Each participant tested the alternative product after a 3-day washout period. RESULTS On bare hands, use of ethanol plus CHG was associated with significantly lower recovery of aerobic CFU, both immediately after use (0.27 ± 0.05 and 0.88 ± 0.08 log10 CFU; P = .035) and after spending time in ICU common areas (1.81 ± 0.07 and 2.17 ± 0.05 log10 CFU; P<.0001). Both the antiseptics were well tolerated by HCWs. CONCLUSIONS In comparison to the ethanol-only product, the ethanol plus CHG sanitizer was associated with significantly lower aerobic bacterial counts on hands of HCWs, both immediately after use and after spending time in ICU common areas. CLINICAL TRIAL IDENTIFIER Clinicaltrials.gov identifier NCT02258412 Infect Control Hosp Epidemiol 2018;39:267-271.

Diagnostic testing methods for Clostridium difficile infection: A statewide survey of Ohio acute care hospitals.

We surveyed Ohio acute care hospitals on laboratory testing used for diagnosis of Clostridium difficile infection (CDI). Of 146 hospitals surveyed, 109 (84%) used nucleic acid amplification tests (NAATs) as stand-alone diagnostic assays. Only 53 (42.4%) hospitals using NAATs had a mechanism in place to prevent repeat CDI testing.

Prolonged Clostridium difficile Infection May Be Associated With Vitamin D Deficiency.

BACKGROUND: Clostridium difficile infection (CDI) is one of the leading causes of hospital-acquired infections, creating a financial burden for the U.S. healthcare system. Reports suggest that vitamin D-deficient CDI patients incur higher healthcare-associated expenses and longer lengths of stay compared to nondeficient counterparts. The objective here was to evaluate the relationship between vitamin D level and CDI recurrence. MATERIALS AND METHODS: A retrospective chart review was conducted for 112 patients with vitamin D level drawn within 3 months of CDI diagnosis. Recurrence, severity of disease, 30-day mortality, and course of CDI were assessed. RESULTS: The vitamin D-deficient group included 56 patients, and the normal group included 56 patients. The mean age of vitamin D-deficient and -sufficient groups was 68 ± 15.7 and 71 ± 14.4 years, respectively. The mean 25(OH) D level in the deficient group was 11.7 ± 4.6 ng/mL, and it was 36.2 ± 16.2 ng/mL in the normal group. A longer course of diarrhea was apparent in the vitamin D-deficient group compared to the normal group: 6.1 days (95% confidence interval [CI], 4.9-7.2) vs 4.2 days (95% CI, 3.5-4.9; P = .01). Sepsis rate was 24% in vitamin D-deficient group and 13% in normal group (P = .03). There were no differences in CDI recurrence, length of stay, severity of illness, and mortality with respect to vitamin D status. CONCLUSION: There may be an association between course of diarrhea and increased rate of sepsis in vitamin D-deficient CDI patients.

Community-acquired pneumonia caused by Yersinia enterocolitica in an immunocompetent patient.

Most cases of Yersinia enterocolitica manifest with symptoms of enterocolitis, such as diarrhoea, fever and abdominal pain. Y. enterocolitica is a very rare cause of pneumonia, and usually occurs in immunocompromised patients. We report a case of community-acquired pneumonia (CAP) caused by Y. enterocolitica in an elderly patient who did not develop symptoms of enterocolitis. This aetiology should be considered in patients with CAP who do not respond to initial empirical therapy.