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1.
BMC Infect Dis ; 20(1): 277, 2020 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-32293302

RESUMO

BACKGROUND: Clostridium difficile infection (CDI), especially hospital-acquired Clostridium difficile infection (HA-CDI), continues to be a public health problem and has aroused great concern worldwide for years. This study aimed to elucidate the clinical and epidemiological features of HA-CDI and the characteristics of C.difficile isolates in Chongqing, Southwest China. METHODS: A case-control study was performed to identify the clinical incidence and risk factors of HA-CDI. C. difficile isolates were characterised by polymerase chain reaction (PCR) ribotyping, multilocus sequence typing (MLST), toxin gene detection and antimicrobial susceptibility testing. RESULTS: Of the 175 suspicious patients, a total of 122 patients with antibiotic-associated diarrhea (AAD) were included in the study; among them, 38 had HA-CDI. The incidence of AAD and HA-CDI was 0.58 and 0.18 per 1000 patient admissions, respectively. Chronic renal disease and cephalosporin use were independent risk factors for HA-CDI. Fifty-five strains were assigned into 16 sequence types (STs) and 15 ribotypes (RTs). ST2/RT449 (8, 14.5%) was the predominant genotype. Of the 38 toxigenic isolates, A + B + CDT- isolates accounted for most (34, 89.5%) and 1 A + B + CDT+ isolate emerged. No isolate was resistant to vancomycin, metronidazole or tigecycline, with A-B-CDT- being more resistant than A + B + CDT-. CONCLUSIONS: Different genotypes of C. difficile strains were witnessed in Chongqing, which hinted at the necessary surveillance of HA-CDI. Adequate awareness of patients at high risk of HA-CDI acquisition is advocated and cautious adoption of cephalosporins should be highlighted.


Assuntos
Infecções por Clostridium/epidemiologia , Clostridium difficile/genética , Infecção Hospitalar/epidemiologia , Hospitais de Ensino , Centros de Atenção Terciária , Adulto , Idoso , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Estudos de Casos e Controles , China/epidemiologia , Infecções por Clostridium/dietoterapia , Clostridium difficile/efeitos dos fármacos , Clostridium difficile/isolamento & purificação , Infecção Hospitalar/microbiologia , Diarreia/induzido quimicamente , Diarreia/epidemiologia , Diarreia/microbiologia , Feminino , Humanos , Incidência , Masculino , Metronidazol/uso terapêutico , Pessoa de Meia-Idade , Tipagem de Sequências Multilocus , Reação em Cadeia da Polimerase , Ribotipagem , Fatores de Risco , Vancomicina/uso terapêutico
2.
R I Med J (2013) ; 103(2): 21-23, 2020 Mar 02.
Artigo em Inglês | MEDLINE | ID: mdl-32122095

RESUMO

The rate of nosocomial C. difficile in the state of Rhode Island is among the highest in the country. Multiple factors impact the occurrence of nosocomial C. difficile. Improvement in a single factor may not lead to a decrease in the rate. We report the results of a multidisciplinary team that implemented multiple interventions, which led to a 42% reduction of nosocomial C. difficile at The Miriam Hospital.


Assuntos
Infecções por Clostridium/prevenção & controle , Clostridium difficile/isolamento & purificação , Infecção Hospitalar/prevenção & controle , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Transmissão de Doença Infecciosa do Profissional para o Paciente/prevenção & controle , Segurança do Paciente , Infecções por Clostridium/diagnóstico , Infecções por Clostridium/epidemiologia , Infecção Hospitalar/epidemiologia , Hospitais , Humanos , Rhode Island/epidemiologia
3.
R I Med J (2013) ; 103(2): 24-27, 2020 Mar 02.
Artigo em Inglês | MEDLINE | ID: mdl-32122096

RESUMO

C. difficile is a complication of antibiotic therapy. Certain antibiotics are associated with a higher rate of developing C. difficile. The charts of 54 patients with nosocomial C. difficile were reviewed and very few had received a high-risk antibiotic. Seven (13%) of 54 patients had not received any antibiotics in the hospital prior to the positive stool test for C. difficile. Moreover, 6 of the 7 had no documentation of receiving an antibiotic in the 56 days prior to admission suggesting that they might be colonized with C. difficile.


Assuntos
Antibacterianos/uso terapêutico , Infecções por Clostridium/tratamento farmacológico , Clostridium difficile/efeitos dos fármacos , Infecção Hospitalar/tratamento farmacológico , Prescrição Inadequada/efeitos adversos , Pacientes Internados , Adulto , Idoso , Idoso de 80 Anos ou mais , Infecções por Clostridium/diagnóstico , Infecções por Clostridium/epidemiologia , Clostridium difficile/isolamento & purificação , Infecção Hospitalar/microbiologia , Feminino , Hospitais , Humanos , Incidência , Pacientes Internados/estatística & dados numéricos , Tempo de Internação , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Rhode Island/epidemiologia
4.
R I Med J (2013) ; 103(2): 28-30, 2020 Mar 02.
Artigo em Inglês | MEDLINE | ID: mdl-32122097

RESUMO

The rate of nosocomial C. difficile in Rhode Island is among the highest in the country. Colonization with C. difficile is uncommon but can lead to falsely identifying a patient as having C. difficile infection. Additionally, unrecognized C. difficile colonization may act as a reservoir in the hospital. During a 19-day period, rectal swabs obtained for routine VRE surveillance were cultured for C. difficile. Overall, 51 (7.9%) of 649 patients had C. difficile by culture. The majority (n=36, 71%) of patients from whom a rectal swab grew C. difficile did not have a sample sent to the clinical laboratory. Hence, at least 5.5% of the 649 patients were colonized. One patient was classified as having hospital-acquired C. difficile since the clinical specimen was sent to the clinical laboratory on hospital day 4. This patient was culture positive on admission and hence misclassified as having hospital- acquired C. difficile.


Assuntos
Infecções por Clostridium/epidemiologia , Clostridium difficile/isolamento & purificação , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/microbiologia , Pacientes Internados/estatística & dados numéricos , Adulto , Infecções por Clostridium/diagnóstico , Infecções por Clostridium/tratamento farmacológico , Hospitais , Humanos , Tempo de Internação , Reto/microbiologia , Rhode Island
5.
Int J Infect Dis ; 90: 111-115, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31707136

RESUMO

AIM: To obtain standardized epidemiological data for Clostridium difficile infection (CDI) in Slovakia. METHODS: Between October and December 2016, 36 hospitals in Slovakia used the European Centre for Disease Prevention and Control (ECDC) Clostridium difficile infection (CDI) surveillance protocol. RESULTS: The overall mean CDI incidence density was 2.8 (95% confidence interval 1.9-3.9) cases per 10 000 patient-days. Of 332 CDI cases, 273 (84.9%) were healthcare-associated, 45 (15.1%) were community-associated, and 14 (4.2%) were cases of recurrent CDI. A complicated course of CDI was reported in 14.8% of cases (n=51). CDI outcome data were available for 95.5% of cases (n=317). Of the 35 patients (11.1%) who died, 34 did so within 30 days after their CDI diagnosis. Of the 78 isolates obtained from 12 hospitals, 46 belonged to PCR ribotype 001 (59.0%; 11 hospitals) and 23 belonged to ribotype 176 (29.5%; six hospitals). A total of 73 isolates (93.6%) showed reduced susceptibility to moxifloxacin (ribotypes 001 and 176; p< 0.01). A reduced susceptibility to metronidazole was observed in 13 isolates that subsequently proved to be metronidazole-susceptible when, after thawing, they were retested using the agar dilution method. No reduced susceptibility to vancomycin was found. CONCLUSIONS: These results show the emergence of C. difficile ribotypes 027 and 176 with a predominance of ribotype 001 in Slovakia in 2016. Given that an almost homogeneous reduced susceptibility to moxifloxacin was detected in C. difficile isolates, this stresses the importance of reducing fluoroquinolone prescriptions in Slovak healthcare settings.


Assuntos
Infecções por Clostridium/epidemiologia , Infecções por Clostridium/microbiologia , Clostridium difficile/classificação , Adolescente , Idoso , Antibacterianos/farmacologia , Clostridium difficile/efeitos dos fármacos , Clostridium difficile/genética , Clostridium difficile/isolamento & purificação , Feminino , Humanos , Incidência , Lactente , Masculino , Moxifloxacina/farmacologia , Ribotipagem , Eslováquia/epidemiologia
6.
Diagn Microbiol Infect Dis ; 96(1): 114920, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31699545

RESUMO

We evaluated the performance of the Luminex ARIES® C. difficile Assay on 984 stool specimens prospectively collected from patients being tested for CDI at 4 clinical laboratories in the United States. Results were compared to direct and enriched toxigenic culture. Positive percent agreement (PPA) of the ARIES® C. difficile Assay was 98.1% versus direct toxigenic culture, and sensitivity versus direct plus enriched toxigenic culture was 90.5%. Negative percent agreement (NPA) of the ARIES® C. difficile Assay against direct culture was 92.6%, and specificity versus direct plus enriched toxigenic culture was 95.8%. The ARIES® C. difficile Assay was also compared to the results of routine (molecular, antigen, and/or toxin) methods for C. difficile testing used at each institution. The PPA of the ARIES® C. difficile Assay ranged from 82.9% to 100%. NPA values against these commercial assays ranged from 94.5% to 100%.


Assuntos
Infecções por Clostridium/diagnóstico , Clostridium difficile/isolamento & purificação , Reação em Cadeia da Polimerase em Tempo Real , Adolescente , Adulto , Proteínas de Bactérias/genética , Toxinas Bacterianas/genética , Criança , Pré-Escolar , Infecções por Clostridium/microbiologia , Fezes/microbiologia , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Técnicas de Diagnóstico Molecular , Estudos Prospectivos , Sensibilidade e Especificidade , Adulto Jovem
7.
Lett Appl Microbiol ; 70(1): 29-35, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31631350

RESUMO

The objective of this study was to undertake a microbiological survey of foods, animal faeces and wastewater samples for Clostridium difficile, and determine the genotypes and antimicrobial susceptibilities of isolates. A total of 211 samples were tested for C. difficile using culture methods. Thirteen toxigenic C. difficile isolates were obtained; ten from wastewater samples, one each from pig and duck faeces and another from a raw meat product. Eight PCR-ribotypes (RTs) were identified, including two novel RTs (878 and 879). Single-nucleotide polymorphism analysis using WGS data for all isolates provided greater discrimination between C. difficile isolates within the same RT and multilocus sequence typing (MLST) profiles. All C. difficile isolates were found to be susceptible to the first-line human antimicrobials used to treat C. difficile infection. SIGNIFICANCE AND IMPACT OF THE STUDY: This is the first study to report the isolation of Clostridium difficile from animals, food and wastewater in New Zealand (NZ) and provides important data with respect to ribotypes and multilocus sequence typing profiles, whole genome sequence and antimicrobial susceptibilities. The results highlight the need for further investigations into the epidemiology of C. difficile in NZ and to elucidate the role of the environmental and food sources as transmission routes of human infection.


Assuntos
Clostridium difficile/isolamento & purificação , Fezes/microbiologia , Carne/microbiologia , Águas Residuárias/microbiologia , Animais , Antibacterianos/farmacologia , Clostridium difficile/classificação , Clostridium difficile/efeitos dos fármacos , Clostridium difficile/genética , Patos , Contaminação de Alimentos/análise , Genótipo , Humanos , Testes de Sensibilidade Microbiana , Tipagem de Sequências Multilocus , Nova Zelândia , Suínos
8.
Emerg Microbes Infect ; 9(1): 42-52, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31873046

RESUMO

Clostridioides difficile causes healthcare-related diarrhoea in high-income countries. Highly resistant spores persist in healthcare facilities, primarily infecting patients who have recently received antimicrobials. C. difficile infection (CDI) has been studied in detail in North America and Europe; however, the epidemiology of CDI elsewhere, including the Asia-Pacific region, is largely unknown. A survey of CDI was performed in 13 Asia-Pacific countries. Epidemiological data on 600 cases were collected and molecular typing undertaken on 414 C. difficile isolates. Healthcare facility-associated CDI comprised 53.6% of cases, while community-associated CDI was 16.5%. The median age of cases was 63.0 years and 45.3% were female, 77.5% had used antibiotics in the previous 8 weeks, most frequently third-generation cephalosporins (31.7%), and 47.3% had used proton pump inhibitors. Recurrence (9.1%) and mortality (5.2%) rates were low, while complications including colitis or pseudomembranous colitis (13.8%), colectomy (0.4%), and toxic megacolon (0.2%) were uncommon. Common C. difficile strains were ribotypes 017 (16.7%), 014/020 (11.1%) and 018 (9.9%), with wide variation between countries. Binary toxin-positive strains of C. difficile were detected rarely. Overall, disease severity appeared mild, and mortality and recurrence were low. Continued education about, and surveillance of, CDI in Asia are required to reduce the burden of disease.


Assuntos
Infecções por Clostridium/epidemiologia , Infecções por Clostridium/microbiologia , Clostridium difficile/isolamento & purificação , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Ásia/epidemiologia , Austrália/epidemiologia , Infecções por Clostridium/tratamento farmacológico , Infecções por Clostridium/etiologia , Clostridium difficile/classificação , Clostridium difficile/genética , Clostridium difficile/fisiologia , Diarreia/microbiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Adulto Jovem
10.
BMC Genomics ; 20(1): 796, 2019 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-31666016

RESUMO

BACKGROUND: Clade 5 Clostridioides difficile diverges significantly from the other clades and is therefore, attracting increasing attention due its great heterogeneity. In this study, we used third-generation sequencing techniques to sequence the complete whole genomes of three ST11 C. difficile isolates, RT078 and another two new ribotypes (RTs), obtained from three independent hospitalized elderly patients undergoing antibiotics treatment. Mobile genetic elements (MGEs), antibiotic-resistance, drug resistance genes, and virulent-related genes were analyzed and compared within these three isolates. RESULTS: Isolates 10,010 and 12,038 carried a distinct deletion in tcdA compared with isolate 21,062. Furthermore, all three isolates had identical deletions and point-mutations in tcdC, which was once thought to be a unique characteristic of RT078. Isolate 21,062 (RT078) had a unique plasmid, different numbers of transposons and genetic organization, and harboring special CRISPR spacers. All three isolates retained high-level sensitivity to 11 drugs and isolate 21,062 (RT078) carried distinct drug-resistance genes and loss of numerous flagellum-related genes. CONCLUSIONS: We concluded that capillary electrophoresis based PCR-ribotyping is important for confirming RT078. Furthermore, RT078 isolates displayed specific MGEs, indicating an independent evolutionary process. In the further study, we could testify these findings with more RT078 isolates of divergent origins.


Assuntos
Clostridium difficile/genética , Elementos de DNA Transponíveis , Evolução Molecular , Genoma Bacteriano , Clostridium difficile/isolamento & purificação , Repetições Palindrômicas Curtas Agrupadas e Regularmente Espaçadas , Farmacorresistência Bacteriana/genética , Sequenciamento Completo do Genoma
11.
BMC Infect Dis ; 19(1): 961, 2019 Nov 11.
Artigo em Inglês | MEDLINE | ID: mdl-31711425

RESUMO

BACKGROUND: Clostridioides difficile is considered the main pathogen responsible for hospital-acquired infections. This prospective study determined the prevalence, molecular epidemiological characteristics, and risk factors for C. difficile infection (CDI) and C. difficile colonization (CDC) among patients in the intensive care unit (ICU) of a large-scale tertiary hospital in China, with the aim of providing strategies for efficient CDI and CDC prevention and control. METHODS: Stool samples were collected and anaerobically cultured for C. difficile detection. The identified isolates were examined for toxin genes and subjected to multilocus sequence typing. Patients were classified into CDI, CDC, and control groups, and their medical records were analyzed to determine the risk factors for CDI and CDC. RESULTS: Of the 800 patients included in the study, 33 (4.12%) and 25 (3.12%) were identified to have CDI and CDC, respectively. Associations with CDI were found for fever (OR = 13.993), metabolic disorder (OR = 7.972), and treatment with fluoroquinolone (OR = 42.696) or combined antibiotics (OR = 2.856). CDC patients were characterized by prolonged hospital stay (OR = 1.137), increased number of comorbidities (OR = 36.509), respiratory diseases (OR = 0.043), and treatment with vancomycin (OR = 18.168). Notably, treatment with metronidazole was found to be a protective factor in both groups (CDI: OR = 0.042; CDC: OR = 0.013). Eighteen sequence types (STs) were identified. In the CDI group, the isolated strains were predominantly toxin A and toxin B positive (A + B+) and the epidemic clone was genotype ST2. In the CDC group, the dominant strains were A + B+ and the epidemic clone was ST81. CONCLUSIONS: The prevalences of CDC and CDI in our ICU were relatively high, suggesting the importance of routine screening for acquisition of C. difficile. Future prevention and treatment strategies for CDC and CDI should consider hospital stay, enteral nutrition, underlying comorbidities, and use of combined antibiotics. Moreover, metronidazole may be a protective factor for both CDI and CDC, and could be used empirically.


Assuntos
Infecções por Clostridium/epidemiologia , Clostridium difficile/isolamento & purificação , Unidades de Terapia Intensiva , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Proteínas de Bactérias/metabolismo , Toxinas Bacterianas/metabolismo , China/epidemiologia , Infecções por Clostridium/tratamento farmacológico , Infecções por Clostridium/prevenção & controle , Clostridium difficile/genética , Comorbidade , Enterotoxinas/metabolismo , Feminino , Genótipo , Humanos , Tempo de Internação , Masculino , Programas de Rastreamento , Metronidazol/uso terapêutico , Pessoa de Meia-Idade , Epidemiologia Molecular , Tipagem de Sequências Multilocus , Prevalência , Estudos Prospectivos , Fatores de Risco
12.
Emerg Microbes Infect ; 8(1): 1553-1562, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31662120

RESUMO

Molecular epidemiology of Clostridium difficile infection (CDI) has been extensively studied in North America and Europe; however, limited data on CDI are available in the Asia-Pacific region. A multicentre retrospective study was conducted in this region. C. difficile isolates were subjected to multilocus sequence typing (ST) and antimicrobial susceptibility testing. Totally, 394 isolates were collected from Hangzhou, Hong Kong, China; Busan, South Korea; Fukuoka, Japan; Singapore; Perth, Sydney, Australia; New York, the United States. C. difficile isolates included 337 toxin A-positive/B-positive/binary toxin-negative (A+B+CDT-), 48 A-B+CDT-, and nine A+B+CDT+. Distribution of dominant STs varied geographically with ST17 in Fukuoka (18.6%), Busan (56.0%), ST2 in Sydney (20.4%), Perth (25.8%). The antimicrobial resistance patterns were significantly different among the eight sites (χ2 = 325.64, p < 0.001). Five major clonal complexes correlated with unique antimicrobial resistances. Healthcare-associated (HA) CDI was mainly from older patients with more frequent antimicrobial use and higher A-B+ positive rates. Higher resistance to gatifloxacin, tetracycline, and erythromycin were observed in HA-CDI patients (χ2 = 4.76-7.89, p = 0.005-0.029). In conclusion, multiple C. difficile genotypes with varied antimicrobial resistance patterns have been circulating in the Asia-Pacific region. A-B+ isolates from older patients with prior antimicrobial use were correlated with HA-CDI.


Assuntos
Antibacterianos/farmacologia , Infecções por Clostridium/microbiologia , Clostridium difficile/efeitos dos fármacos , Farmacorresistência Bacteriana , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Ásia , Criança , Pré-Escolar , Clostridium difficile/classificação , Clostridium difficile/genética , Clostridium difficile/isolamento & purificação , Infecção Hospitalar/microbiologia , Eritromicina/farmacologia , Feminino , Gatifloxacina/farmacologia , Humanos , Lactente , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Filogenia , Tetraciclina/farmacologia , Adulto Jovem
15.
Gut ; 68(12): 2111-2121, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31563878

RESUMO

Although faecal microbiota transplantation (FMT) has a well-established role in the treatment of recurrent Clostridioides difficile infection (CDI), its widespread dissemination is limited by several obstacles, including lack of dedicated centres, difficulties with donor recruitment and complexities related to regulation and safety monitoring. Given the considerable burden of CDI on global healthcare systems, FMT should be widely available to most centres.Stool banks may guarantee reliable, timely and equitable access to FMT for patients and a traceable workflow that ensures safety and quality of procedures. In this consensus project, FMT experts from Europe, North America and Australia gathered and released statements on the following issues related to the stool banking: general principles, objectives and organisation of the stool bank; selection and screening of donors; collection, preparation and storage of faeces; services and clients; registries, monitoring of outcomes and ethical issues; and the evolving role of FMT in clinical practice,Consensus on each statement was achieved through a Delphi process and then in a plenary face-to-face meeting. For each key issue, the best available evidence was assessed, with the aim of providing guidance for the development of stool banks in order to promote accessibility to FMT in clinical practice.


Assuntos
Infecções por Clostridium/terapia , Clostridium difficile/isolamento & purificação , Consenso , Transplante de Microbiota Fecal/métodos , Microbioma Gastrointestinal , Infecções por Clostridium/microbiologia , Seleção do Doador , Humanos , Manejo de Espécimes/métodos
16.
Gac Med Mex ; 155(4): 343-349, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31486783

RESUMO

Introduction: Clostridium difficile infection (CDI) causes potentially lethal diarrhea. Objective: To identify the risk factors for mortality in hospitalized patients with CDI. Method: Cross-sectional, retrospective study. The analyzed risk factors were age, comorbidities, nutritional status, past and current use of antibiotics, proton pump inhibitors, steroids, immunosuppressive therapy and chemotherapy, as well as development of acute kidney injury (AKI). Results: Sixty-eight cases were assessed. Mean age was 51.4 ± 19.37 years. Mortality was 22.2 %. Moderate to severe undernutrition (Odds ratio [OR] = 20.15; 95% confidence interval [CI] = 1.13-35; p = 0.004), use of more than 2 antibiotics (OR = 1.61; 95% CI = 0.39-6.65; p = 0.01), AKI as determined by creatinine levels (OR = 1.34; 95% CI = 0.09-2.21; p = 0.02), hypotension with vasopressor use (OR = 1.28; 95% CI = 0.30-1.23; p = 0.001) and multiple organ failure (OR = 1.13; 95% CI = 0.31-4.92; p = 0.002) were associated with mortality. Conclusions: CDI represents an important problem in hospitalized patients and confers them an additional morbidity and mortality risk.


Assuntos
Infecções por Clostridium/epidemiologia , Clostridium difficile/isolamento & purificação , Diarreia/epidemiologia , Adulto , Fatores Etários , Idoso , Infecções por Clostridium/etiologia , Infecções por Clostridium/mortalidade , Estudos Transversais , Diarreia/microbiologia , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Estado Nutricional , Estudos Retrospectivos , Fatores de Risco
17.
Artigo em Inglês | MEDLINE | ID: mdl-31554297

RESUMO

Implementation of environmental cleaning and disinfection has been shown to reduce the incidences of healthcare-associated infections. The effect of an enhanced strategy for terminal room disinfection, applying the pulsed xenon-based ultraviolet light no-touch disinfection systems (PX-UVC) after the current standard operating protocol (SOP) was evaluated. In a teaching hospital, the effectiveness in reducing the total bacterial count (TBC) and in eliminating high-concern microorganisms was assessed on five high-touch surfaces in different critical areas, immediately pre- and post-cleaning and disinfection procedures (345 sampling sites). PX-UVC showed only 18% (15/85) of positive samples after treatment compared to 63% (72/115) after SOP. The effectiveness of PX-UVC was also observed in the absence of manual cleaning and application of a chemical disinfectant. According to the hygienic standards proposed by the Italian Workers Compensation Authority, 9 of 80 (11%) surfaces in operating rooms showed TBC ≥15 CFU/24 cm2 after the SOP, while all samples were compliant applying the SOP plus PX-UVC disinfection. Clostridium difficile (CD) spores and Klebsiella pneumoniae (KPC) were isolated only after the SOP. The implementation of the standard cleaning and disinfection procedure with the integration of the PX-UVC treatment had effective results in both the reduction of hygiene failures and in control environmental contamination by high-concern microorganisms.


Assuntos
Desinfecção/métodos , Raios Ultravioleta , Xenônio , Carga Bacteriana , Clostridium difficile/isolamento & purificação , Infecção Hospitalar/prevenção & controle , Hospitais de Ensino , Humanos , Itália , Klebsiella pneumoniae/isolamento & purificação , Salas Cirúrgicas
19.
Biomed Res Int ; 2019: 4278598, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31380423

RESUMO

Rhodococcus equi is responsible for infections in multiple-host animals. In humans, the prevalence of rhodococcus has increased worldwide and represents an emergent risk. R. equi is a soil-borne opportunistic bacterium isolated from feces of a wide variety of domestic species, except cats; thus, there is no known potential risk of its transmission from humans. Here, the mono- and cooccurrence of Rhodococcus equi and other bacteria and selected virulence markers were investigated in feces of nondiarrheic cats from urban (n=100) and rural (n=100) areas. Seven (7/200=3.5%) R. equi isolates were recovered in ceftazidime, novobiocin, and cycloheximide (CAZ-NB) selective media, exclusively of cats from three distinct farms (p=0.01), and these cats had a history of contact with horses and their environment (p=0.0002). None of the R. equi isolates harbored hosted-adapted plasmid types associated with virulence (pVAPA, pVAPB, and pVAPN). One hundred seventy-five E. coli isolates were identified, and 23 atypical enteropathogenic E. coli (aEPEC), 1 STEC (Shiga-toxin producing E. coli), and 1 EAEC (enteroaggregative E. coli) were detected. Eighty-six C. perfringens type A isolates were identified, and beta-2 and enterotoxin were detected in 21 and 1 isolates, respectively. Five C. difficile isolates were identified, one of which was toxigenic and ribotype 106. The main cooccurring isolates in cats from urban areas were E. coli and C. perfringens A (26/100=26%), E. coli and C. perfringens type A cpb2+ (8/100=8%), and aEPEC (eae+/escN+) and C. perfringens type A (5/100=5%). In cats from farms, the main cooccurring isolates were E. coli and C. perfringens type A (21/100=21%), E. coli and C. perfringens type A cpb 2 + 8/100=8%), and E. coli and R. equi (4/100=4%). We identified, for the first time, R. equi in nondiarrheic cats, a finding that represents a public health issue because rhodococcus has been reported in both immunosuppressed and immunocompetent humans, particularly people living with HIV/AIDS.


Assuntos
Gatos/microbiologia , Fezes/microbiologia , Rhodococcus equi/isolamento & purificação , Microbiologia do Solo , Animais , Clostridium difficile/genética , Clostridium difficile/isolamento & purificação , Escherichia coli/genética , Escherichia coli/isolamento & purificação , Cavalos/microbiologia , Humanos , Rhodococcus equi/genética , Rhodococcus equi/patogenicidade
20.
Am J Health Syst Pharm ; 76(Supplement_3): S85-S90, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31418771

RESUMO

PURPOSE: A novel automatic discontinuation policy implemented within an antimicrobial stewardship program (ASP) is described, and results of an evaluation of the policy's effects on antibiotic usage are reported. METHODS: A retrospective, before-and-after study was conducted at an 800-bed, tertiary care, academic teaching hospital to evaluate selected antibiotic usage outcomes in both intensive care unit (ICU) and non-ICU adult patients targeted for ASP interventions before and after implementation of an automatic discontinuation of antibiotics policy (ADAP) authorizing the ASP team to automatically halt antibiotic therapy in cases involving inappropriate duplicate antimicrobial coverage or excess duration of therapy. The primary outcome was total days of antibiotic therapy. Secondary outcomes included excess days of therapy and rates of 30-day readmission, Clostridioides difficile infection, and multidrug-resistant infection. RESULTS: There were no statistically significant differences in group demographics or clinical characteristics. The most common indication for antibiotics was hospital-acquired pneumonia, and the most common reason for ASP intervention was excess duration of therapy. The mean total number of antibiotic days per patient was reduced from 7.6 days in the pre-ADAP group to 6.6 days in the post-ADAP group (p < 0.05). The mean number of excess days of antibiotics was similarly reduced, from 2.3 days to 1.5 days, after implementation of the ADAP (p < 0.05). CONCLUSION: Adoption of an ADAP-a more active approach to ASP interventions-was effective in reducing overall antibiotic usage and improving the efficiency of the ASP.


Assuntos
Antibacterianos/uso terapêutico , Gestão de Antimicrobianos/organização & administração , Infecções por Clostridium/epidemiologia , Guias de Prática Clínica como Assunto , Antibacterianos/farmacologia , Gestão de Antimicrobianos/normas , Gestão de Antimicrobianos/estatística & dados numéricos , Infecções por Clostridium/microbiologia , Infecções por Clostridium/prevenção & controle , Clostridium difficile/efeitos dos fármacos , Clostridium difficile/isolamento & purificação , Farmacorresistência Bacteriana Múltipla , Feminino , Humanos , Prescrição Inadequada/prevenção & controle , Unidades de Terapia Intensiva/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Readmissão do Paciente/estatística & dados numéricos , Políticas , Avaliação de Programas e Projetos de Saúde , Estudos Retrospectivos , Centros de Atenção Terciária/organização & administração , Centros de Atenção Terciária/estatística & dados numéricos
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