Category Archives: C.diff. in the news

Clostridium difficile in Scotland Have Increased Significantly

Cases of the potentially deadly hospital infection Clostridium difficile in Scotland have increased significantly, figures show. Between April and June, 322 cases of the bug were diagnosed in patients over 65, compared to 270 the previous quarter, Health Protection Scotland (HPS) said the increasing rate was “statistically significant” and in the case of NHS Lothian, specialist support was being given to bring infections down. But the HPS report also found that cases of MRSA had fallen to the lowest ever recorded, with just 27 cases between April and June.

On the issue of C difficile, cases were shown to rising in both older and younger patients. The figures revealed there were 100 new C difficile cases in patients aged 15 to 64 years, compared to 92 the previous quarter. How to Support the ‘Night Owl’ Remote Worker Sponsored by Microsoft 365 [Opt out of Adyoulike ad targeting] HPS said rates for over-65s in NHS Lothian were higher than expected and extra support was being given to tackle the issue. “During this period, NHS Lothian reported an increased incidence of C difficile infection (CDI) to HPS,” the agency said. “HPS are providing on-going support to NHS Lothian in order reduce CDI in the board.” It said no other boards had rates which meant they were a cause for concern in the last quarter. The increasing rate of C difficile in Scotland in the most recent release follow previous reports showing infections falling to record lows following greater efforts to combat bugs and improve hospital cleanliness.

Health Secretary Alex Neil said: “Tackling healthcare associated infections is one of this government’s key priorities and Scotland is widely recognised across the globe as having some of the safest hospitals in the world. “This co-ordinated effort across Scotland’s NHS has had a significant impact on infection rates, with cases of MRSA having reduced by 89.2 per cent and cases of C difficule by 81.9 per cent since national monitoring began. “This quarter we saw cases of MRSA at their lowest levels on record and similarly last quarter C difficile cases were also at their lowest level. “So while we’ve seen increases in the number of cases of                C difficile and MSSA between April and June this year, this should be seen in the context of the dramatic fall in infection rates that have been achieved over the last few years. “

But even these relatively small fluctuations should serve as a clear indication that we must not let up in our drive to tackle this issue. “That is why, working with our key partners, we will continue to monitor infection rates and hospital cleanliness and act immediately where necessary to minimise healthcare associated infections.” The figures comes just over five years since a public inquiry into a deadly outbreak of C difficile at the Vale of Leven Hospital in Dunbartonshire first started, but which has yet to report its findings following a series of delays. Fiona Cameron, Head of Service Infection Prevention & Control, NHS Lothian, said: “NHS Lothian has experienced an increase in the number of cases of Clostridium difficile and we have drafted a robust action plan to identify and eradicate the cause. “As part of that action plan we recently recruited additional infection and prevention control nurses, increased education and ward rounds and began reviewing policies and guidance in relation to the prescription of antibiotic medicine, which is known to be related to Clostridium difficile.

“We have also asked Health Protection Scotland (HPS) to support our work and review our actions to provide any additional input and review actions so far.”

 

Read more at: http://www.scotsman.com/news/cases-of-fatal-hospital-infection-c-difficile-up-1-3561251

Researchers From Loyola Medicine Retrospectively Studied 100 Vancomycin Taper and Pulse Treatment Patients Treated For Recurrent C. difficile Infection

A tapered and pulsed regimen with vancomycin — with diligent follow-up — can achieve significant cure rates in recurrent Clostridium difficile (C. difficile) infected patients, according to a new study.

Researchers from Loyola Medicine retrospectively studied 100 vancomycin taper and pulse treatment patients treated for recurrent C. difficile infection between January 1, 2009 and December 31, 2014. Their clinic, the study authors wrote, has been a referral center for the infection for the past decade.

To read the article in its entirety please click on the following link:

http://www.mdmag.com/medical-news/pulsed-and-tapered-vancomycin-likely-route-to-recurrent-clostridium-difficile-cure

However, despite the guidelines for treatment of recurrent C. difficile infection being not too different than recurrent episodes – except for the use of vancomycin when the case is severe – there have not been many studies on this vancomycin taper and pulsed dosing. 

The researchers observed that after a referral, the confirmed recurrent C. difficile patients were treated with a vancomycin taper and pulse regimen: a taper of vancomycin to once-daily, followed by alternate day dosing; or once-daily followed by alternate day dosing; followed by every third day, for at least 2 weeks. After this regimen, all patients had 90-day follow-up documentation.

On average, the patients in the clinic were on their third C. difficile diarrhea episode. Half of the patients had also received a standard course of vancomycin, while another third had received some type of vancomycin taper regimen, the researchers said.

Despite the fact that many of these patients were a “treatment experienced” population, 75% of the patients who received a supervised vancomycin taper and pulsed regimen achieved a cure,  study author Stuart Johnson  MD, . He added that the results were further improved for patients who received the expended pulse phase: 81% achieved a cure.

“The findings were not unexpected to us, but I think that many clinicians will be surprised how well a deliberate, prolonged vancomycin taper and pulse regimen – with careful follow up – works,” Johnson said.

There were no significant differences among the patients in terms of gender, age, concomitant antibiotics, proton pump inhibitor use, histamine receptor-2 blocker use, or patients with a regimen greater than 10 weeks in length, the researchers continued.

The researchers added that their finding of improved cure rates with alternate-day dosing plus every third day dosing over strictly alternate-day dosing is consistent with the hypothesis that pulsed dosing can promote a cyclical decrease in spore burden, they wrote. This can also permit the resetting of normal microbiota in the gut.

Johnson concluded that the clinical implications of the study show most recurrent C. difficile patients do not need fecal microbiota transplant (FMT).

“FMT has received an enormous amount of press and this procedure is now widely available throughout the US,” Johnson said. “FMT is attractive because it addresses one of the primary mechanisms involved with recurrent C. difficile infection, a marked disruption of the resident bacteria that populate the intestine and provide an important host defense against C. difficile.

Although physicians screen donor feces for “known pathogens,” not all is known of the potential complications to come from FMT, Johnson said.

“In addition, it appears that efficacy with a carefully supervised vancomycin taper and pulse regimen compare to that achieved with FMT,” Johnson said.

The study, “Vancomycin Taper and Pulsed Regimen with careful Follow up for Patients with Recurrent Clostridium difficile Infection,” was published in the journal Clinical Infectious Diseases.

C. diff. May Carry Risks in Preoperative and Postoperative Patients

 

There are risks for acquiring a C. difficile infection (CDI).

The risks range from the overuse of Antibiotics, Immunosuppressed patients, prolonged hospital stays, being a patient in a long-term care facility, and for the senior population.

There may also be a risk for the surgical patients and the following study explains the study and the results:

To read the article in its entirety please click on the following link: https://cdifffoundation.wordpress.com/wp-admin/post-new.php

A lengthy study of four surgical specialties has determined that Clostridium difficile infection (CDI) is a major risk factor for postoperative patients, although incidences varied.

Although it has been shown that CDI is associated with increased cost, morbidity and mortality in patients after surgery, this is the first to examine C. difficile rates across multiple surgical specialties (Infect Control Hosp Epidemiol 2017:1-4. doi: 10.1017/ice.2017.158).

“This study has great importance as the landscape of repayment for elective surgical procedures changes,” said the study’s lead author, James Bernatz, MD, a surgeon with the Department of Orthopedics and Rehabilitative Medicine at University of Wisconsin Hospital and Clinics, in Madison. “With more surgeries being reimbursed as bundled payments, hospitals are pressured to limit costs. As C. diff infection has been found to increase length of stay by one week and double the cost of care, it is clearly a postoperative complication to be avoided.”

Dr. Bernatz and his colleagues conducted the study at a 592-bed tertiary care academic center. They used the hospital’s quality improvement database to review admissions to the orthopedic surgery, neurosurgery, trauma surgery and general surgery units from January 2014 through July 2016. Those patients who underwent an inpatient surgical procedure, and did not meet the exclusion criteria, were surveyed.

Case patients were defined as those who underwent an inpatient procedure and subsequently developed a health care–associated CDI, which was defined as a positive polymerase chain reaction (PCR) test result for C. difficile toxin gene recorded more than 72 hours after admission and within 12 weeks of discharge.

They found 52 cases of CDI among 11,310 surgical admissions to four hospital units: general surgery, neurology, orthopedics and trauma. In all 52 cases, patients had a PCR-positive test result more than 72 hours after admission and within 12 weeks of discharge, making the incidence rate 0.80 cases per 1,000 patient-days. The trauma unit had the highest rate at 9.5 CDI cases per 1,000 admissions (11 cases over 1.160 admissions during the study period). General surgery had 30 cases among 3,447 admissions for a rate of 8.7; orthopedics had six cases among 4,339 admissions for a rate of 1.4; and neurology had five cases among 2,364 admissions for a rate of 2.1.

A number of risk factors were surveyed, including the use of antibiotics.

Regarding antibiotic use, the researchers found that the odds of CDI increased 3.34-fold when the perioperative antibiotic is continued more than 24 hours after surgery, outside of the perioperative window. Antibiotic use, other than the perioperative antibiotic, while in the hospital also was associated with 2.2 times greater odds of CDI. And exposure to antibiotics as long as six months before surgery increases the odds of CDI more than threefold.

“Although the surgeon cannot necessarily control the antibiotics prescribed to their patients in the year leading up to surgery, they can control antibiotic administration in the perioperative and postoperative period,” Dr. Bernatz said. “Antibiotics should be limited to one prophylactic preoperative dose, unless 24 hours of antibiotics are indicated. In the immediate postoperative period, antibiotics should be used judiciously.”

Other significant risk factors included number of hospital admissions in the past year and proton pump inhibitor or histamine type 2 receptor blocker use in the previous six months. “Previous studies have shown a correlation between CDI and hospital admission in the previous 3 months,” the researchers wrote. “Our study reports that this association extends to 12 months. We found that the number of hospital admissions in the past year increases the odds of CDI by 133% for each admission.”

A higher American Society of Anesthesiologists (ASA) physical status classification also was a significant risk factor for CDI; ASA IV or V patients were 15 times more likely to develop CDI than those with ASA class I or II disease, according to the researchers.

Dr. Bernatz said additional research is needed to further reveal these links. “Other studies could examine the rate of C. diff infection between operations within one subspecialty to determine if certain operative variables or patient characteristics affect the postoperative risk of C. diff infection,” he said.

Clifford McDonald, MD and Alison Laufer-Halpin, Ph.D., of the CDC Discuss the Human Microbiome on C. diff. Spores and More

C Diff Foundation’s “C. diff. Spores and More Global Broadcasting Network” is honored to announce Doctors McDonald and Laufer-Halpin as our guest speakers on

Tuesday, July 25, 2017 at 10 a.m. PT / 1 p.m. ET

(www.cdiffradio.com)

These two leading topic experts will be discussing significant ways to unlock the mysteries of the human microbiome; how it affects our health, the immune system, and why it is so important to protect it.

As part of the Centers for Disease Control and Prevention (CDC) efforts to protect patients and slow antibiotic-resistance, the CDC is investing in research to discover and develop new ways to prevent antibiotic-resistant infections.

To Listen To the Podcast – click on the following link:

https://www.voiceamerica.com/episode/100322/the-human-microbiome-how-it-works-how-it-affects-your-health-your-immune-system-and-why-it-is

 

Learn more about C Diff Radio at: http://www.cdiffradio.com/.

C Diff Foundation Welcomes Denise Graham, Assistant Public Relations

We are pleased to welcome Denise Graham
to the C Diff Foundation.

Denise Graham, Founder and President of DDG Associates, formerly the Executive Vice President to the Association for Professionals in Infection Control (APIC) and Epidemiology, led the nation’s public reporting initiative thereby enabling her to work closely with all agencies falling under the U.S. Department of Health and Human Services.  Her expertise in this arena continues by assisting clients with ongoing changes such as value-based purchasing and guidelines coming from the Centers for Disease Control and Prevention (CDC).

With greater than twenty years of experience in the healthcare industry, Denise has formed key working relationships with numerous leading experts.

Denise comes to the C Diff Foundation as Assistant Public Relations Coordinator  to introduce the organization with greater visibility and continued growth in educating and advocating for C.difficile Infection prevention, treatments, environmental safety and support worldwide.

To contact Denise:, please e-mail her at:    denise@cdifffoundation.org

Early Results From the CDC Prevention’s Emerging Infections Program shows a decline in Clostridium difficile Infections from 2011 to 2014

The early results from the CDC’s Prevention’s Emerging Infections Program show prevalence steadily increased from 2000 to 2010 but decreased from 2011 to 2014, which is around the time antimicrobial stewardship programs were being introduced because of increased awareness of the disease. For example, the VA introduced their program in 2012.

 

Clostridium difficile rates are dropping for the first time in a decade in healthcare settings, and it’s likely due to better cleaning and antibiotic prescribing policies, authorities say.

The rates for national healthcare incidence of the disease may be decreasing anywhere from 9% to 15%, a Centers for Disease Control and Prevention expert said in an NPR report.

Clostridium difficile rates are dropping for the first time in a decade in healthcare settings, and it’s likely due to better cleaning and antibiotic prescribing policies, authorities say.

The rates for national healthcare incidence of the disease may be decreasing anywhere from 9% to 15%, a Centers for Disease Control and Prevention expert said  in an NPR report.

The decreased rates may be credited to an increase in antimicrobial stewardship programs.

The programs restrict unnecessary antibiotic prescriptions, in addition to implementing stricter cleaning and infection control protocols. C. diff does not respond to conventional cleaning methods.

“It was estimated that C. diff infection was the most commonly reported infection [acquired in healthcare settings] nationally,” said Alice Guh, M.D., medical officer at the CDC. “That generated a lot of awareness.”

That’s three times what it was in 2000.

In nursing homes, 20% to 50% of residents can be colonized with the disease at a time, medical experts note.

To read article in its entirety click on the following link

http://www.mcknights.com/news/c-diff-rates-in-healthcare-settings-drop-for-first-time-in-a-decade/article/672543/

Multiple Recurring Clostridium difficile infections (mrCDI) Data From 2001-2012 Study

Article from the Lancashire Post, July 4, 2017

To read the article in its entirety, please click on the following link:

http://www.lep.co.uk/news/offbeat/cases-of-clostridium-difficile-soaring-1-8630398

 

mrCDI (multiple recurring C. difficile infections), they are the most difficult to treat and are rapidly becoming more common, say scientists.

* also referred to  as rCDI, recurring CDI

In the US between 2001 and 2012 the annual rate rose by almost 200 per cent more than four times the increase in ‘ordinary’ C. diff.

The bug, which can kill elderly patients, most commonly affects those who have recently been treated with antibiotics.

The precise reasons for the sharp rise in mrCDI’s incidence is so far unknown but adds strain to healthcare systems with an urgent need for new treatments.

FMT has shown good results in small studies in the war on C. diff but hasn’t yet been thoroughly evaluated.

Professor James Lewis, of Pennsylvania University, said: “The increasing incidence of C. difficile being treated with multiple courses of antibiotics signals rising demand for faecal microbiota transplantation in the United States.

 

“While we know faecal microbiota transplantation is generally safe and effective in the short term, we need to establish the long term safety of this procedure.”

C.diff is a bacterium that causes inflammation of the colon, a condition called colitis. Symptoms include diarrhoea, fever, loss of appetite, nausea and abdominal pain.

Recurrent C.diff, a bout within 90 days of the last, is a major problem with the risk of contracting it again at 50-60 per cent after three or more infections.

 

The bacteria are found in faeces, and people can become infected if they touch items or surfaces that are contaminated and then touch their mouths or mucous membranes.

Burden On Healthcare Systems

C. diff afflicts half a million Americans a year causing tens of thousands of deaths and costing the nation’s healthcare system an estimated $5 billion.

The study published in the Annals of Internal Medicine identified the alarming trend by analysing a nationwide health insurance database with the records of more than 40 million US patients.

Cases of C. diff were considered to have multiple recurrences when doctors treated them with at least three closely spaced courses of antibiotics.

According to the analysis, the incidence of C diff rose by about 43 percent over the study period, compared to 189 percent for mrCDI.

Older females more susceptible

The latter group were more likely to be older with an average age of 56, seven years more than the former’s 49 and were more likely to be female (64 per cent vs. 59 percent.

They were also more likely to have been exposed previously to medications such as corticosteroids, heartburn drugs known as PPIs (proton-pump inhibitors) and antibiotics.

The rapid rise in the incidence of mrCDI may be due in part to Americans’ increasing use of such drugs. But Prof Lewis said other causes are also likely.

He said: “An additional driver of this rise in incidence could be the recent emergence of new strains of C. difficile, such as NAP1, which has been shown to be a risk factor for recurrent CDI.”

C.diff is notorious for spreading among vulnerable patients within hospitals and can lead to fatal blood infections (sepsis) – especially among the elderly.

The antibiotics metronidazole, vancomycin, and fidoxamicin are commonly used to treat CDI……….

Long used in veterinary medicine, FMT is an alternative to antibiotics and involves infusions of foecal matter from healthy intestines.

The aim is to help restore a normal gut bacteria population in the patient and thereby discourage C. diff growth.

But Prof Lewis said despite such promising results more needs to be known about FMT’s long-term safety – and the fast-rising incidence of mrCDI underscores this need.

The American Gastroenterological Association recently set up a formal registry for doctors to report their results with FMT procedures.

Prof Lewis said: “It’s a way in which practitioners who are performing faecal microbiota transplantation can contribute data to help answer these critical questions.”

A small study in 2013 found a single FMT infusion cleared up diarrhoea in 81 percent of the recurrent-CDI patients who received it. On the other hand the standard antibiotic vancomycin worked for just 31 percent.