Clostridium Difficile Infection In Long Term Care Facilities
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Clostridium Difficile Infection In Long Term Care Facilities
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Author : Teena Chopra
language : en
Publisher: Springer Nature
Release Date : 2019-11-14
Clostridium Difficile Infection In Long Term Care Facilities written by Teena Chopra and has been published by Springer Nature this book supported file pdf, txt, epub, kindle and other format this book has been release on 2019-11-14 with Medical categories.
This book aims to fill knowledge gap among healthcare workers about Clostridium difficile (also known as C.difficile and CDI) among aging patients, especially those in long-term care facilities (LTCFs). Written by experts in infectious diseases and geriatric medicine, this book provides comprehensive information on all aspects of CDI pertaining to LTCF settings, including epidemiology, diagnosis, prevention, management and the unique challenges faced by LTCFs with regards to the CDI problem. The book begins by introducing the topic as it relates to aging patients before delving into the various aspects of CDI management. Topics include infection control and prevention, treatment of CDI, and the establishment of antibiotic stewardship programs to reduce inappropriate antibiotic use and reduce CDI rates. The book also features a chapter on probiotics for the prevention of CDI and new strategies to monitor environmental cleaning practices of CDI patient rooms that do not appear in any other resource. Clostridium Difficile Infection in Long-Term Care Facilities is an excellent resource for geriatricians, infectious diseases specialists, long-term care administrators, nurses, pharmacists, researchers, and all clinicians working with infections in long-term care settings.
Clostridium Difficile Infection Infection Prevention And Control Guidance For Management In Long Term Care Facilities
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Author :
language : en
Publisher:
Release Date : 2012
Clostridium Difficile Infection Infection Prevention And Control Guidance For Management In Long Term Care Facilities written by and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on 2012 with Clostridium difficile categories.
Effectiveness Of Early Diagnosis Prevention And Treatment Of Clostridium Difficile Infection
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Author : U. S. Department of Health and Human Services
language : en
Publisher: CreateSpace
Release Date : 2013-04-06
Effectiveness Of Early Diagnosis Prevention And Treatment Of Clostridium Difficile Infection written by U. S. Department of Health and Human Services and has been published by CreateSpace this book supported file pdf, txt, epub, kindle and other format this book has been release on 2013-04-06 with Medical categories.
Clostridium difficile infection (CDI) is a serious healthcare-associated infection and a growing health care problem. C. difficile is a Gram-positive, spore-forming, anaerobic bacterium that, when ingested, can cause CDI if it is a toxigenic strain. CDI symptoms include varying levels of diarrhea severity, as well as pseudomembranous colitis and toxic megacolon. CDI incidence is estimated at 6.5 cases per 10,000 patient days in hospital. About 250,000 hospitalizations were associated with CDI in 2005. Direct attributable mortality from CDI has been reported to be as high as 6.9 % of cases. Elderly people in hospitals account for the vast majority of severe morbidity and mortality. Residents of long-term care facilities are also at higher risk. Incidence rates may increase by fourfold or fivefold during outbreaks. In addition to institutional care environments, C. difficile is also common in the community, being easily isolated from soil and water samples. Community-associated CDI rates are generally much lower, accounting for 27 % of all CDI cases in a recent prevalence study, but are also on the rise. However, the source of the C. difficile organisms responsible for cases of CDI in the community is not well understood. In order for CDI to develop, a person must be infected with a strain of C. difficile capable of making toxin in the person's colon. Approximately 1–2 % of healthy individuals are colonized with C. difficile. If these people have usual, healthy colonic flora, the risk of CDI is very low. There is a small risk of CDI if the colon flora becomes disturbed, commonly through antibiotic use, while the person is colonized with a toxigenic strain. Antibiotics that disturb colon flora enough to allow CDI to develop must get into the colon, and they are associated with alterations in relative amounts of colon bacterial constituents. The immune status of the patient also contributes to the risk of developing CDI and the experienced severity. Other risk factors include increasing age, female gender, comorbidities, gastrointestinal procedures, and use of gastric acid suppression medications. Risk profiles for recurrent CDI are similar. One study, which statistically modeled CDI within the hospital setting, suggested that reducing patient susceptibility to infection is more effective in reducing CDI cases than lowering transmission rates. The purpose of this systematic review was to provide an overarching assessment of the evidence for comparing the accuracy of diagnostic tests and the effectiveness of prevention and treatment interventions on initial and recurrent CDI-related patient outcomes in adult patients. The major impetus of this review is the presence of clinical disease, not asymptomatic carriage of the C. difficile organism. The review focuses on adult patients because adults, and particularly elderly adults, carry the large majority of the morbidity and mortality burden. The following Key Questions (KQs) form the basis for this review: KQ 1. How do different methods for detection of toxigenic C. difficile to assist with diagnosis of CDI compare in their sensitivity and specificity? Do the differences in performance measures vary with sample characteristics? KQ 2. What are effective prevention strategies? What is the effectiveness of current prevention strategies? What are the harms associated with prevention strategies? How sustainable are prevention practices in health care (outpatient, hospital inpatient, extended care) and community settings? KQ 3. What are the comparative effectiveness and harms of different antibiotic treatments? Does effectiveness vary by disease severity or strain? Does effectiveness vary by patient characteristics: age, gender, comorbidity, hospital- versus community-acquired setting? How do prevention and treatment of CDI affect resistance of other pathogens? KQ 4. What are the effectiveness and harms of nonstandard adjunctive interventions? In patients with relapse/recurrent CDI?
Future Research Needs For Prevention And Treatment Of Clostridium Difficile Infection
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Author : U. S. Department of Health and Human Services
language : en
Publisher: CreateSpace
Release Date : 2013-04-04
Future Research Needs For Prevention And Treatment Of Clostridium Difficile Infection written by U. S. Department of Health and Human Services and has been published by CreateSpace this book supported file pdf, txt, epub, kindle and other format this book has been release on 2013-04-04 with Medical categories.
Clostridium difficile infection (CDI) is a serious healthcare-associated infection and a growing health care problem, especially with the emergence of more virulent strains in the early 2000s. Clostridium difficile was first recognized as having the ability to cause pseudomembranous colitis in the late 1970s. CDI is now the most common cause of nosocomial infectious diarrhea. Asymptomatic colonization in healthy adults has been observed in only 3 percent of persons, while the prevalence of such colonization among residents in long-term-care facilities approaches 50 percent. Individuals colonized with Clostridium difficile serve as a reservoir for infection by contaminating the environment with Clostridium difficile spores, thus leading to the spread of the organism on the hands of health care workers or via use of medical equipment. CDI is increasing in incidence and, in all likelihood, severity. The number of cases diagnosed among patients discharged from hospitals increased from 31 per 100,000 persons in 1996 to 84 per 100,000 persons in 2005. Infection due to a relatively new strain of Clostridium difficile, termed “North American pulsed-field gel electrophoresis type 1” (NAP1), is felt to be at least partially responsible for this increased incidence of CDI as well as for the increased severity of clinical illness. The NAP1 strain is capable of producing more than 15 times the quantity of both toxins A and B, which are directly responsible for the damage to the intestinal tract of infected patients. Hence, CDI is not only now more common, but also more severe, leading to an attributable mortality of up to 16 percent of all deaths. A comparative effectiveness review (CER) was prepared by the Minnesota Evidence-based Practice Center (EPC) on Comparative Effectiveness of Early Diagnosis, Prevention, and Treatment of Clostridium difficile Infection (December 2011). The purpose of the CER was to provide an overarching assessment of the evidence for comparing the accuracy of diagnostic tests and the effectiveness of prevention and treatment interventions on initial and recurrent CDI related patient outcomes in adults. Key informants, provided input to the EPC on the scope of the CER, agreed that its greatest contribution to the field could be to have an independent organization provide a comprehensive review of the major concerns of the field for both clinicians and researchers. The major impetus underlying the SR was a concern about the presence of clinical disease, not asymptomatic carriage of the Clostridium difficile organism.1 Molecular epidemiological studies whose main purpose was to identify the strains of Clostridium difficile present in the population were outside the scope of the CER. The CER focused on adult patients as they, particularly elderly adults, carry the most of the morbidity and mortality burden.The CER addressed the following Key Questions (KQs): 1. How do different methods for detection of toxigenic Clostridium difficile to assist with diagnosis of CDI compare in their sensitivity and specificity? a. Do the differences in performance measures vary with sample characteristics? 2. What are effective prevention strategies? a. What is the effectiveness of current prevention strategies? b. What are the harms associated with prevention strategies? c. How sustainable are prevention practices in health care (outpatient, hospital inpatient, extended care) and community settings? 3. What are the comparative effectiveness and harms of different antibiotic treatments? a. Does effectiveness vary by disease severity or strain? b. Does effectiveness vary by patient characteristics: age, gender, comorbidity, hospital versus community-acquired setting? c. How do prevention and treatment of CDI affect resistance of other pathogens? 4. What are the effectiveness and harms of nonstandard adjunctive interventions? a. In patients with relapse/recurrent CDI?
The Epidemiology And Microbiology Of Clostridium Difficile In Long Term Care And Acute Care And Characterization Of The Fecal Microbiota In Elderly Individuals In Ontario Canada
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Author : Gabriella Mallia
language : en
Publisher:
Release Date : 2018
The Epidemiology And Microbiology Of Clostridium Difficile In Long Term Care And Acute Care And Characterization Of The Fecal Microbiota In Elderly Individuals In Ontario Canada written by Gabriella Mallia and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on 2018 with categories.
This thesis is an investigation of Clostridium difficile in elderly patients in an acute care facility (ACF) and residents in a long-term care facility (LTCF) in southern Ontario, Canada. The first part of this thesis presents the findings of a cross-sectional study that describes the epidemiology and microbiology of C. difficile in elderly individuals. C. difficile was isolated from 92/410 (22.4%) ACF and 89/474 (18.8%) LTCF samples. Ribotypes 027 (35%) and 020 (10.4%) predominated the LTCF while ribotypes AI-82/1 (20.7%) and ribotype O (14.1%) predominated the ACF (P=0.031). In the LTCF, C. difficile colonization was associated with a history of Proton Pump Inhibitor (PPI) use (OR=2.05, P=0.003, 95% CI=1.20-3.49), and the interaction terms of male residents with prior medical leave of absence (OR=11.28, P=0.011. 95% CI=1.70-74.87), and a prior history of C. difficile infection (CDI) combined with fluoroquinolone use (OR=39.30, P=0.032, 95% CI=0.032). In the ACF, C. difficile colonization was associated with length of stay (OR=1.00, P=0.037, 95% CI=0.10-1.00), feeding through a tube (OR=4.83, P=0.001, 95% CI=1.95-11.97), antibiotic use (OR=4.36, P=0.050, 95% CI=1.00-18.95), immunosuppressive therapy (OR=8.09, P=0.001, 95% CI=2.24-29.22), and VRE colonization (OR=19.64, P=0.016, 95% CI=1.73-222.61), and the interaction terms for cephalosporin and fluoroquinolone use (OR=31.13, P=0.022 95% CI=1.51-1077.61), and prior CDI and cephalosporin use (OR=59.59, P=0.044, 95% CI=1.12-2854.07). The second part of this thesis describes the fecal microbiota of elderly individuals from ACF and LTCF, and evaluates the impact of PPIs, antibiotics, facility, and C. difficile colonization on microbial diversity, richness, evenness, community, and structure. Evenness and diversity were not affected by other risk factors. Facility and C. difficile colonization were associated with changes in relative abundance of key taxa. Community membership and structure were affected by facility. The changes identified in this study group, might better shape healthcare approaches in elderly, serving as indicators of health as well as aid in development of novel bacterial therapies. C. difficile colonization remains a complex and challenging issue, with the implications in its development of CDI still unclear. Given the potential for transmission by individuals colonized with C. difficile colonized, this area warrants further study.
Clostridium Difficile In An Urban University Affiliated Long Term Acute Care Hospital
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Author : Jerry Jacob
language : en
Publisher:
Release Date : 2016
Clostridium Difficile In An Urban University Affiliated Long Term Acute Care Hospital written by Jerry Jacob and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on 2016 with categories.
Background: Clostridium difficile is the most common cause of healthcare-associated infections in the United States, and has been associated with adverse outcomes in the acute care setting. However, little is known regarding the burden or impact of C. difficile infection (CDI) in long-term acute care hospitals (LTACHs). Methods: A retrospective matched cohort study was performed among patients at an urban, university-affiliated LTACH between July 2008 and October 2015. The incidence rate of LTACH-onset CDI was assessed and patient characteristics associated with adverse outcomes examined. Patients with CDI were matched to concurrently hospitalized LTACH patients without a diagnosis of CDI. A multivariable model using logistic regression was developed to determine characteristics associated with a composite primary outcome of either 30-day readmission to an acute care hospital or mortality. Subgroup analyses were performed for patients with a diagnosis of severe CDI. Results: The overall incidence of CDI was 21.4 cases per 10,000 patient-days. Patients with CDI had a mean age (±SD) of 70 ±14 years and a mean admission Charlson Comorbidity Index (CCI) of 4 ±2. Median (IQR) time between admission and diagnosis of CDI was 16 days (range: 9-23 days). In the final multivariable model, CDI was not a significant risk factor for the primary outcome (OR, 1.06 [95% confidence interval {CI}, 0.53-2.10]). Congestive heart failure (OR, 2.27 [95% CI, 1.15-4.57]), albumin level (OR, 0.44 [95% CI, 0.22-0.79]), and immunosuppression (OR, 2.94 [95% CI, 1.06-8.39]) were independent risk factors for the primary outcome. On subgroup analysis, severe CDI and CCI were significant risk factors for the primary outcome in bivariable analysis (OR, 2.91 [95% CI 1.03-8.20] and OR, 1.36 [95% CI 1.06-1.80], respectively). Only CCI remained significant in the multivariable model (OR, 1.32 [95% CI 1.02-1.75]). Conclusions: LTACH-onset CDI was found to have a relatively high incidence in an urban, university affiliated LTACH. CDI was not a significant risk factor for the composite outcome of 30-day readmission or mortality. Future research should focus on infection prevention and antibiotic stewardship measures to decrease CDI specifically in the LTACH setting.
The Ascrs Manual Of Colon And Rectal Surgery
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Author : David E. Beck
language : en
Publisher: Springer Science & Business Media
Release Date : 2009-06-12
The Ascrs Manual Of Colon And Rectal Surgery written by David E. Beck and has been published by Springer Science & Business Media this book supported file pdf, txt, epub, kindle and other format this book has been release on 2009-06-12 with Medical categories.
The ASCRS Textbook of Surgery of the Colon and Rectum offers a comprehensive textbook designed to provide state of the art information to residents in training and fully trained surgeons seeking recertification. The textbook also supports the mission of the ASCRS to be the world’s authority on colon and rectal disease. The combination of junior and senior authors selected from the membership of the ASCRS for each chapter will provide a comprehensive summary of each topic and allow the touch of experience to focus and temper the material. This approach should provide the reader with a very open minded, evidence based approach to all aspects of colorectal disease. Derived from the textbook, The ASCRS Manual of Surgery of the Colon and Rectum offers a “hands on” version of the textbook, written with the same comprehensive, evidence-based approach but distilled to the clinical essentials. In a handy pocket format, readers will find the bread and butter information for the broad spectrum of practice. In a consistent style, each chapter outlines the condition or procedure being discussed in a concise outline format – easy to read, appropriately illustrated and referenced.
Effectiveness Of Probiotics In Preventing Antibiotic Associated Diarrhea And Clostridium Difficile In Long Term Care
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Author : Marva Edwards-Marshall
language : en
Publisher:
Release Date : 2010
Effectiveness Of Probiotics In Preventing Antibiotic Associated Diarrhea And Clostridium Difficile In Long Term Care written by Marva Edwards-Marshall and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on 2010 with Clostridium difficile categories.
Problem/Purpose: Antibiotic associated diarrhea (AAD) and clostridium-difficile diarrhea (CDAD) are the most common forms of infectious diarrhea in long-term care facilities. The purpose of this study was to determine the effectiveness of probiotics in preventing AAD and CDAD in the long term care geriatric population, and to identify interventions that can be used to improve clinical practice. Background/Significance: Prophylactic use of probiotics have been purported to decrease the incidences of AAD and CDAD. Previous studies have yielded contradictory results on the efficacy of probiotics. The objective of this study was to evaluate the impact of administration of probiotics on the rate of infectious diarrhea in the Long Term Care (LTC) population. Method: This was a retrospective cohort study. The charts of residents of a LTC facility who were 65 years of age and older, and were administered antibiotic therapies, with or without co-administration of probiotics were reviewed. A data collection instrument was created for this study and piloted prior to its utilization. A chi-square test of independence was calculated to obtain the results. Results: Forty-four residents received probiotics with antibiotics, five cases of diarrhea were reported; no cases of CDAD were reported. In 39 residents who received antibiotics without probiotics, two cases of diarrhea and one case of CDAD were reported. Conclusion: The study showed no statistically significant evidence to support the effectiveness of probiotic use in the prevention of AAD and CDAD in a long term care facility. The incidence of AAD was higher in the group with probiotics.
Evidence Based Gastroenterology And Hepatology
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Author : John W. D. McDonald
language : en
Publisher: John Wiley & Sons
Release Date : 2019-02-13
Evidence Based Gastroenterology And Hepatology written by John W. D. McDonald and has been published by John Wiley & Sons this book supported file pdf, txt, epub, kindle and other format this book has been release on 2019-02-13 with Medical categories.
The revised fourth edition of Evidence-Based Gastroenterology and Hepatology continues to provide the most current, evidence-based information for determining the appropriate medical and surgical options for screening for, diagnosing, and treating gastrointestinal conditions. With contributions from an international team of leading experts in the field, the 4th edition includes practical recommendations for the care of individual patients based on the latest scientific evidence.
Oecd Health Policy Studies Embracing A One Health Framework To Fight Antimicrobial Resistance
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Author : OECD
language : en
Publisher: OECD Publishing
Release Date : 2023-09-14
Oecd Health Policy Studies Embracing A One Health Framework To Fight Antimicrobial Resistance written by OECD and has been published by OECD Publishing this book supported file pdf, txt, epub, kindle and other format this book has been release on 2023-09-14 with categories.
Antimicrobial resistance (AMR) – the ability of microbes to resist antimicrobials – remains an alarming global health threat. This report identifies 11 One Health “best buys” that, if implemented systematically, would improve population health, reduce health expenditure and generate positive returns for the economy.