•Many strategies to reduce microorganism spread were adopted during the COVID-19 pandemic.
•We have retrospectively analyzed the period of the pandemic and previous years.
•Such strategies reduce healthcare-associated (HA) C difficile infection (HA-CDI) incidence.
•Maintaining these measures over time could reduce HA-CDI and related expenses.
•This study helps to understand effective hygiene interventions to prevent CDI.
Clostridium difficile is the most common pathogen between healthcare-associated infections and its incidence has increased during the last years. lack of enough evidence about effective hygiene interventions to prevent this disease. Due to the coronavirus disease 2019 (COVID‑19) pandemic, several strategies to reduce microorganism spread were adopted in a hospital setting. The objective of this study was to establish whether such strategies can reduce healthcare-associated C difficile infection (HA-CDI) incidence. We found that during the pandemic (2020) HA-CDI incidence was significantly lower with respect to the previous years. This work demonstrates that maintaining this level of attention regarding control activities related to the prevention of microorganism transmission significantly reduces HA-CDI and related expenses in terms of health costs and human lives.
Clostridium difficile (CD) is the most common pathogen among healthcare-associated (HA) infections.
An important obstacle in the prevention of C difficile infection (CDI) is the lack of enough evidence about effective hygiene interventions to prevent this disease. Although preventive contact precautions are recommended, there is no sufficient data on their effectiveness for its prevention.
The objective of this study was to establish whether such strategies can reduce HA-CDI incidence. The primary task was to identify differences in HA-CDI incidence in medical wards before and during the COVID-19 pandemic. The secondary task was to evaluate if severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection could influence the incidence of CDI.
We conducted a retrospective analysis on medical wards’ discharges (n. 1617) in S. Andrea Hospital (Rome) from March 1 to June 30, 2020, comparing data before (2017, 2018, and 2019) and during (2020) the COVID-19 pandemic. Intensive care units and paediatric wards were excluded. CDI diagnosis was confirmed by clinical suspicious (presence of diarrhea defined as ≥3 unformed stools in 24 hours) plus stool tests positive for CD. HA-CDI incidence was depicted as CDI diagnosed ≥72 hours after admission per 100 total discharges. Data was collected using Excel Office, and χ² test was performed to detect differences in HA-CDI incidence between different groups. Value of P< .05 was considered significant.
The number of discharges and HA-CDI diagnosis for each medical ward is reported in Table 1. No statistically significant difference of HA-CDI incidence between the years 2017, 2018, and 2019 was observed. Conversely, during the pandemic (2020) HA-CDI incidence was significantly lower with respect to 2017 (odds ratio [OR] = 2.98; P = .002), 2018 (OR = 2.27; P = .023) and 2019 (OR = 2.07; P = .047) (see Table 1 and Fig. 1). Interestingly, during 2020, COVID-19 departments showed higher HA-CDI incidence respect to Covid-19 free wards (not significative). This data suggests SARS-Cov2 infection as a possible risk factor for CDI in agreement with recent evidences that report altered gut microbiota in COVID-19 patients.
MSD has launched Zinplava in the UK, offering patients a novel therapeutic option for the prevention of Clostridium difficilerecurrence.
Zinplava (bezlotoxumab) is not an antibacterial and is not indicated to actually treat the infection, but is a monoclonal antibody designed to neutralise C. difficile toxin B, which can damage the gut wall and cause inflammation, leading to diarrhoea.
It is the first and only EC licensed non-antibiotic option indicated to prevent recurrence of Clostridium difficile infection (CDI) in high-risk adults.
Around one-in-four patients experience a recurrence after the initial episode, and more than 40 percent of these have further recurrence, highlighting the need for new options able to break the infection cycle.
Pivotal Phase III clinical studies showed the rate of infection recurrence through week 12 to be significantly lower in patients given Zinplava (17.4 percent and 15.7 percent) or Zinplava and actoxumab (15.9 percent and 14.9 percent) than those taking a placebo (27.6 percent) and (25.7 percent), respectively.
“Notably, bezlotoxumab reduces the risk of the recurrence of CDI for at least 3 months, compared with standard of care antibiotic therapy. This is welcome addition to our limited options to reduce the considerable morbidity and mortality associated with CDI,” commented Mark Wilcox, Professor of Medical Microbiology at the University of Leeds.
“Antimicrobial resistance is a key national issue and we hope with bezlotoxumab to not only help achieve a reduction in the number of recurrent episodes of CDI but also a reduction in the amount of antibiotic prescriptions that would otherwise be needed to treat these recurrent episodes,” added Dr Mike England, MSD’s Interim Medical Director.
Zinplava is administered as a single, one-off, one-hour intravenous infusion alongside standard-of-care antibiotic therapy for the treatment of CDI.
Greetings from the main office of the C Diff Foundation and the C diff Survivors Alliance Network located in New Port Richey, Florida. As we close 2017 we mark the 5th anniversary of the two organizations. We want to share with you a summary and reflection on this year’s events and campaigns moving our mission forward and message delivered worldwide. The mission and promoting C.diff. Awareness has been shared this year with listeners in over 25 Counties during Season III on C. diff. Spores and More Global Broadcasting Network (www.cdiffradio.com), 5,000+ visitors during global events, 9,600+ residents and business owners throughout villages and communities by our dedicated volunteer patient advocates, to over 1,000 clinicians who received up-to-date data expanding their knowledge during workshops and local symposiums offered worldwide, 3,000+ incoming calls received through the Nationwide Hot-Line 1-844-FOR-CDIF with the thousands of e-mails received seeking assistance.
After each event, workshop, meeting, introduction we thank the individuals for sharing in five years of opportunity to provide life-saving data educating and advocating for C. difficile infection prevention, treatments, environmental safety and support worldwide. The mission of the C Diff Foundation is the momentum of charity that has proven effective and grown over the past five years. A single act of charity grows into more and greater charity worldwide. The work each member of the C Diff Foundation, with hundreds of Volunteer Patient Advocates, promote the Foundation’s mission which never stops with a single act. Instead, it builds, it grows, and it expands into an exponential impact of good in the world helping to save lives. We thank you for your continued support and encourage you to continue your journey, proposing three verbs important to the C Diff Foundation and the C diff Survivors Alliance Network in general.
The first of these verbs is “to promote” C.diff. Awareness. It is the first step that opens doors in educating individuals, clinicians, communities in learning more about this life-threatening infection which causes a great amount of pain and suffering around the globe. It is essential and it is the compass in reaching shared goals.
The second verb is “to heighten awareness” across the nation to continue proclaiming November Clostridium difficile infection awareness month. The Governors proclaimed November C. difficile (C.diff) infection awareness month in 2017 and we encourage them “to welcome” this proclamation in 2018 with more than a yearly executive order of greeting or inviting their residents to take notice. We look forward to working with delegates, with your support, to make this proclamation statement nationwide and welcome the importance of the time, education, programs, and agenda in place addressing this life-threatening infection. The C Diff Foundation advocates and supports the individuals and families suffering during and after being treated for a C. diff. infection.
Finally, the third verb that the C Diff Foundation and C diff Survivors Alliance Network propose is “to go.” Here we are all challenged to do something big or small — with what we are able to do. With the unity of members with volunteers with patients, families, and clinicians we can make a difference with enthusiasm and simplicity to get up and go. We can do for others today what we could not do for ourselves during our time of illnesses, during the long periods of isolation, during the losses, and during the pain and suffering.
As members of the C Diff Foundation we know that our enthusiasm for our mission is the desire to bring awareness and promote C. difficile infection prevention, treatments, environmental safety and support worldwide. We witness changes by the data and information being delivered within villages, through major cities and in small communities — it is only by taking this path that we gain satisfaction knowing that the news delivered with enthusiasm “to promote, to heighten awareness and to go” with the members and volunteers in the C Diff Foundation and C diff Survivors Alliance Network creates positive results.
We are truly grateful for your continued dedication, efforts and support and thank you again for making this year’s November anniversary such a special occasion through the growth and advances made worldwide. Let’s carry the mission into the New Year, carving new paths to witness the decline of newly diagnosed cases of Clostridium difficile (C.diff., C. difficile) infections and saving lives worldwide.
“None of us can do this alone ~ All of us can do this together.”
Welcome to the 5th Annual International C.diff. Awareness Conference & Health EXPO second update. The Conference & Health EXPO begins on November 9th at 8:00 a.m. and concludes on November 10th at 3:00 p.m. There are over twenty guest speakers, leading topic experts, sharing up-to-date data with an audience of health care professionals from a variety of management levels and specialties, medical educators, medical students, and professionals with shared interests. The venue is the University of Nevada Las Vegas (UNLV) Thomas and Mack Center in conjunction with the Embassy Suites Convention Center where staff and event coordinators are working together to create this amazing event. Embassy Suite Convention Center hotel accommodations are now at a “limited availability.” Please utilize the hotel reservation portal available on the conference page
Volunteer Patient Advocates, with the
C Diff Foundation Members, were busy in the kitchens baking across the globe to support our mission and provide education at each event.
We kicked off the month long chain of events with a successful recipe to educate and advocate for
C. difficile infection awareness worldwide. More than 700 brochures were shared at the bake sales meeting the goal – promoting C. diff. infection prevention, treatments, environmental safety and support across the globe during the month long campaign. Thank You to everyone involved making this campaign a global success.
Save the Date
On September 14th a day to Honor the Professionals Dedicated to Clostridium difficile Research and Development. Their Efforts Bring Forth New Concepts, New Theories, and the Progress Towards A Better Understanding – Pursuing Future Developments In Clostridium difficile (a.k.a., C.diffiicle, C.diff.).
September 14th, 8:00 a.m. – 12:00 p.,m. ET
This free, live webinar by C.diff. Science, is to honor Professionals in the Science community, leading the way advancing C. difficile Infection Prevention, Treatments, and Environmental Safety Products worldwide – hosted by the C Diff Foundation – a slate of industry leaders and medical researchers — from highly regarded health systems — share their journeys and efforts focused on Clostridium difficile research and development that will be appreciated by colleagues, fellow-researchers, and the scientific teams within organizations.
It was a pleasure joining the local residents of Treasure Island, Florida on May 18th. Educating and Advocating for C. difficile infection prevention, treatments, and environmental safety, a shared goal to witness a decline in newly diagnosed
C. diff Study Provides Insight Into Antibiotic Resistance and Risks for Infection
Exposure to specific antibiotics is linked to the development of certain strains of antibiotic-resistant C. difficile, one of the fastest growing bacteria superbugs, according to a new study published by Stuart Johnson, MD, of Loyola University Health System (LUHS),Loyola University Chicago Stritch School of Medicine (SSOM) and the Hines VA Medical Hospital.
“This discovery takes us one step closer to preventing C. diffand supports targeting specific antibiotics for antibiotic stewardship monitoring programs in the setting of high infection rates due to specific strains of C. diff,” said Dr. Johnson, the lead author, who reported the findings of the retrospective C. diff case control study in Antimicrobial Agents and Chemotherapy.
C. diff has been associated with multiple healthcare facility outbreaks and high national rates of C. difficile infection (CDI) since 2001 and now rivals Methicillin-resistant staphylococcus aureus (MRSA) in both frequency and severity.
Several infectious diseases, including MRSA and C. diff,have become resistant to antibiotics.
As a result, the medical community has deliberately reduced the routine practice of prescribing antibiotics for infectious diseases.
There currently is not a highly effective prevention method for C. diff.
“Antibiotic exposure is arguably the most important risk factor for C. difficile infection (CDI),” Johnson wrote.
“We know that antibiotics wipe out beneficial flora in the gut, making patients susceptible to a C. diff infection.
The other role of antibiotics highlighted in our study is that overuse of specific antibiotics may facilitate infection due to C. diff strains that are highly resistant to those antibiotics.”
Dr. Johnson and a team that included his longtime research partner, foremost C. diff expertDale Gerding, MD, LUHS, SSOM, identified 143 patients with first episode CDI between 2005 and 2007 in one U.S. hospital at a time when increased CDI rates and severity were noted nation-wide.
Of those 103 patients, or 72 percent, were infected with the BI/NAP1/027 C. diff strain, which is highly resistant to fluoroquinolones and macrolides.
Most patients received multiple antibiotics within six weeks of being diagnosed with CDI. Fluoroquinolone and macrolide exposure was more frequent in patients with B1 strains, and the C. difficile bacteria recovered from the stool specimens of these BI-infected patients also showed high-level resistance to these antibiotics.
The article, “Fluoroquinolone and Macrolide Exposure Predict Clostridium difficile Infection with the Highly Fluoroquinolone-and Macrolide-Resistant Epidemic C. difficile Strain Bi/NAP1/027,” can be read online. Authors are Jeffrey T. Wieczorkiewicz, Bert K. Lopansri, Adam Cheknis, James R. Osmolski, David W. Hecht, Dale N. Gerding and Stuart Johnson.
Source: Loyola University Health System
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