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Study Shows the Burden of CDI During the COVID-19 Pandemic: A Retrospective Case-Control Study in Italian Hospitals (CloVid)

Clovid

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Article
The Burden of Clostridioides Difficile Infection
during the COVID-19 Pandemic: A Retrospective
Case-Control Study in Italian Hospitals (CloVid)

Guido Granata 1,* , Alessandro Bartoloni 2, , Mauro Codeluppi 3, , Ilaria Contadini 4, Francesco Criistini 4, , Massimo Fantoni 5, , Alice Ferraresi 6, , Chiara Fornabaio 6, , Sara Grasselli 3,
Filippo Lagi 2, , Luca Masucci 5,, Massimo Puoti 7, , Alessandro Raimondi 7, , Eleonora Taddei 8
,Filippo Fabio Trapani 9, , Pierluigi Viale 9, , Stuart Johnson 10, Nicola Petrosillo 1, and on behalf of the CloVid Study Group †

1 Clinical and Research Department for Infectious Diseases, Severe and Immunedepression-Associated
Infections Unit, National Institute for Infectious Diseases L. Spallanzani IRCCS, 00149 Rome, Italy;  nicola.petrosillo@inmi.it
2 Department of Infectious Diseases, Careggi Hospital, University of Florence, 50121 Florence, Italy;alessandro.bartoloni@unifi.it (A.B.); filippo.lagi@unifi.it (F.L.)
3Infectious Diseases Unit, Guglielmo da Saliceto Hospital, 29121 Piacenza, Italy;
m.codeluppi@ausl.pc.it (M.C.); s.grasselli@ausl.pc.it (S.G.)
4Infectious Diseases Unit, Rimini-Forlì-Cesena Hospitals, 48121 Rimini, Italy;
ilaria.contadini@auslromagna.it (I.C.); francesco.cristini@auslromagna.it (F.C.)
5 Dipartimento di Scienze di Laboratorio e Infettivologiche —Fondazione Policlinico A. Gemelli IRCCS,Via della Pineta Sacchetti, 00168 Rome, Italy; massimo.fantoni@policlinicogemelli.it (M.F.);
luca.masucci@policlinicogemelli.it (L.M.)
6Infectious Diseases Unit, ASST Cremona, 26100 Cremona, Italy; alice.ferraresi@asst-cremona.it (A.F.);c.fornabaio@asst-cremona.it (C.F.)
7Infectious Diseases Unit, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy;
massimo.puoti@ospedaleniguarda.it (M.P.); alessandro.raimondi@ospedaleniguarda.it (A.R.)
8 Dipartimento di Sicurezza e Bioetica—Sezione di Malattie Infettive—Fondazione Policlinico A.
Gemelli IRCCS, Via della Pineta Sacchetti, 00168 Rome, Italy; eleonora.taddei@policlinicogemelli.it
9 Department of Medical and Surgical Sciences, Infectious Diseases Unit,
Alma Mater Studiorum–University of Bologna, 40126 Bologna, Italy; filippofabio.trapani@aosp.bo.it (F.F.T.);
pierluigi.viale@unibo.it (P.V.)
10 Research Service, Hines VA Hospital and Infectious Disease Section, Loyola University Medical Center,
Maywood, IL 60153, USA; stuart.johnson2@va.gov
* Correspondence: guido.granata@inmi.it; Tel.: +39-065-517-0241
† CloVid (Clostridioides difficile infection during the COVID-19) Study Group.
Received: 28 October 2020; Accepted: 25 November 2020; Published: 27 November 2020

Abstract: Data on the burden of Clostridioides difficile infection (CDI) in Coronavirus Disease
2019 (COVID-19) patients are scant. We conducted an observational, retrospective, multicenter,
1:3 case (COVID-19 patients with CDI)-control (COVID-19 patients without CDI) study in Italy
to assess incidence and outcomes, and to identify risk factors for CDI in COVID-19 patients.
From February through July 2020, 8402 COVID-19 patients were admitted to eight Italian hospitals;

38 CDI cases were identified, including 32 hospital-onset-CDI (HO-CDI) and 6 community-onset,
healthcare-associated-CDI (CO-HCA-CDI). HO-CDI incidence was 4.4 × 10,000 patient-days.
The percentage of cases recovering without complications at discharge (i.e., pressure ulcers, chronic heart decompensation) was lower than among controls (p = 0.01); in-hospital stays were longer among cases, 35.0 versus 19.4 days (p = 0.0007). The presence of a previous hospitalization (p = 0.001), previous
steroid administration (p = 0.008) and the administration of antibiotics during the stay (p = 0.004) were risk factors associated with CDI. In conclusions, CDI complicates COVID-19, mainly in patients with J. Clin. Med. 2020, 9, 3855; doi:10.3390/jcm9123855 http://www.mdpi.com/journal/jcm J. Clin. Med. 2020, 9, 3855 2 of 11 co-morbidities and previous healthcare exposures. Its association with antibiotic usage and hospital-acquired bacterial infections should lead to strengthen antimicrobial stewardship programmes and infection prevention and control activities

1. Introduction
Since 31 December 2019, when the World Health Organization (WHO) was informed of an
outbreak of a respiratory disease affecting the city of Wuhan, the world has been shaken by the
most profound health crisis of the last several decades [1,2]. Coronavirus Disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has spread rapidly worldwide with the consequence of causing a serious health threat to humans on every continent.  At present, more than thirty million people are known to have been infected, which has placed a great burden on health care systems and heightened anxiety and psychological stress of medical staff [3].

The lack of high-level evidence, inherent to the novelty and rapid spread of COVID-19, has led to
the adoption of heterogeneous therapeutic management approaches, often without a clear distinction between evidence-based data and expert opinion in informing treatment choices. The high number shortage of beds, especially in critical areas, and the need for healthcare worker protection have challenged compliance with infection control and antibiotic stewardship programs in most health-care facilities facing this emergent threat of COVID-19 [4]. During the pandemic many health-care facilities gave priority to the protection of their healthcare workers from COVID-19, reducing attention to the prevention of other bacterial infections transmitted by interpersonal contact. Moreover, most of the early recommendations for the management of COVID-19 patients considered the use of empirical antibiotic treatment, resulting in large usage of antimicrobials in COVID-19 patients. Up to 94% of COVID-19 patients have been reported to receive empirical antibiotic therapy during their hospital stay [4–9]. Bacterial superinfections have been described in the course of COVID-19 disease
and early reports of Clostridioides difficile infection (CDI) co-infection have been published [10,11]. CDI is commonly associated with the use of broad-spectrum antibiotics, absence of antimicrobial stewardship, inadequate infection control, and hospital overcrowding [12]. Currently, we do not have a clear picture of the burden of CDI in COVID-19 patients and there is a lack of data on the prevalence and clinical manifestations of CDI in COVID-19 patients.
The aim of this study was to assess the incidence of CDI in hospitalized COVID-19 patients,
to describe the clinical characteristics and outcomes of COVID-19 patients with CDI and to identify risk factors for the onset of CDI in COVID-19 patients.

2. Materials and Methods
We conducted an observational, retrospective, national multicenter, case-control study with 1:3
matching to assess the incidence, clinical characteristics, and outcomes of COVID-19 patients with CDI. In addition, we evaluated risk factors associated with the occurrence of CDI in COVID-19 patients. The study was performed in 8 acute-care Italian hospitals admitting COVID-19 patients, between February 2020 and July 2020 (Figure 1 and Table S1). All the hospitals have an Infectious Disease Unit. The study was approved by the Ethics Committees of the participant hospitals.J. Clin. Med. 2020, 9, 3855 3 of 11 J. Clin. Med. 2020, 9, x FOR PEER REVIEW 3 of 11

Figure 1. Geographical distribution of participating centers. The detailed list of the eight participating centers is available as supplementary material (Table S1).
2.1. Study Design Hospitalized adult (>18 years old) patients with COVID-19 and CDI were identified from the databases of the participant centers. Cases were defined as COVID-19 patients with CDI; controls were COVID-19 patients without CDI. Cases were matched 1:3 with controls. Demographic, epidemiological, and clinical data (COVID-19 onset and clinical characteristics, medications given for COVID-19, antimicrobial treatments before and after the diagnosis of COVID-19, laboratory data, CDI onset and characteristic, and patient’s outcome) were collected in clinical record forms (CRF)

(Table S2).
Controls were matched to cases according to the following criteria:
1. Same gender
2. Hospitalization in the same hospital and in the same unit
3. Same date of hospital admission ± 7 days
4. Same age ± 3 years
All cases and controls were followed up to 30 days from their hospital discharge to assess for
new onset of diarrhea, recurrence of CDI, and mortality at 30 days from the hospital discharge.
The definitions of CDI, microbiological evidence of C. difficile, CDI recurrence, mild CDI, severe
CDI and complicated CDI and the definitions of the clinical syndromes associated with COVID-19
adopted in the study are described in Table S3.

2.2. Data Analysis
The incidence of CDI among all COVID-19 patients admitted to the participating hospitals was
calculated using as the numerator the number of CDI cases and as the denominator the number of days of hospitalization of the COVID-19 patients (× 10,000). The characteristics of the study population and Figure 1. Geographical distribution of participating centers. The detailed list of the eight participating centers is available as supplementary material (Table S1).

2.1. Study Design
Hospitalized adult (>18 years old) patients with COVID-19 and CDI were identified from the
databases of the participant centers. Cases were defined as COVID-19 patients with CDI; controls were COVID-19 patients without CDI. Cases were matched 1:3 with controls. Demographic, epidemiological, and clinical data (COVID-19 onset and clinical characteristics, medications given for COVID-19, antimicrobial treatments before and after the diagnosis of COVID-19, laboratory data, CDI onset and characteristic, and patient’s outcome) were collected in clinical record forms (CRF) (Table S2).

Controls were matched to cases according to the following criteria:
1. Same gender
2. Hospitalization in the same hospital and in the same unit
3. Same date of hospital admission ±7 days
4. Same age ±3 years
All cases and controls were followed up to 30 days from their hospital discharge to assess for new onset of diarrhea, recurrence of CDI, and mortality at 30 days from the hospital discharge.
The definitions of CDI, microbiological evidence of C. difficile, CDI recurrence, mild CDI, severe
CDI and complicated CDI and the definitions of the clinical syndromes associated with COVID-19
adopted in the study are described in Table S3.

2.2. Data Analysis
The incidence of CDI among all COVID-19 patients admitted to the participating hospitals was
calculated using as the numerator the number of CDI cases and as the denominator the number of days of hospitalization of the COVID-19 patients (× 10,000). The characteristics of the study population and the patient outcome were evaluated by means of descriptive statistics. The potential correlations J. Clin. Med. 2020, 9, 3855 4 of 11
between CDI and clinical variables of COVID-19 (infection onset, severity) and laboratory findings were analyzed by univariate and multivariate analysis. To identify risk factors for onset of CDI in COVID-19 patients and any determinants of delayed diagnosis of CDI, the characteristics of the CDI group were compared to the control group by means of univariate and multivariate analysis.

2.3. Statistical Analysis
Quantitative variables were tested for normal distribution and compared by means of a paired
t-test. Qualitative differences between groups were assessed by use of Fisher’s exact test. The precision of odd ratio (OR) was determined by calculating a 95% confidence interval (CI). A p value less than 0.05 was considered statistically significant. Variables from the univariate analysis were considered for inclusion in multivariate logistic regression analysis if p-value was less than 0.05. Backward stepwise logistic regression was performed, and the model that was considered biologically plausible and had the lowest −2 log-likelihood ratio was chosen as the final model. Statistical analysis was performed using the software program IBM SPSS version 24.

3. Results
3.1. CDI Incidence among COVID-19 Patients
Overall, during the study period, a total of 40,315 patients were admitted to the eight participant hospitals; of these, 8402 were COVID-19 patients. The mean hospital stay for COVID-19 patients was 13.8 days (range 1–59 days). Thirty-eight CDI cases were identified, including 32 hospital-onset CDI (HO-CDI) and 6 community-onset, healthcare-associated CDI (CO-HCA-CDI) cases. Therefore, during the study period, 32 COVID-19 patients developed HO-CDI, corresponding to an HO-CDI prevalence of 0.38%, and an HO-CDI incidence of 4.4 × 10,000 patient days ranging in the hospitals from 0.7 to 12.3 × 10,000 patient days (Table S4).
3.2. Clinical Features of Clostridioides Difficile Infection in COVID-19 Patients
The demographic and epidemiological data, the comorbidities, the clinical characteristics, and
the outcome of the 38 COVID-19 patients with CDI and of the 114 controls included in the study are described in Table 1. The mean laboratory findings at the admission of the 38 COVID-19 patients with CDI and of the 114 controls are shown in Table 2. The CDI characteristics, severity, management, and follow-up of the 38 COVID-19 patients with CDI included in the study are shown in Table 3.

Table 1. Demographic and epidemiological data, comorbidities, clinical characteristics of the Coronavirus Disease 2019 (COVID-19), and outcome of the 38 COVID-19 patients with CDI and of the 114 COVID-19 controls included in the study. CCI: Charlson Co-morbidity Index. LTHCF: long-term health care facility. ARDS: Acute Respiratory Distress Syndrome. LMWH: Low Molecular Weight

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What Is SARS-CoV-2 and the Disease It Causes Named coronavirus disease 2019 or Better Known As COVID-19

 

 

 

What is Coronavirus?

The virus has been named “SARS-CoV-2” and the disease it causes has been named “COVID-19.”

Coronaviruses are a large family of viruses that may cause respiratory illnesses in humans ranging from common colds to more severe conditions such as Severe Acute Respiratory Syndrome (SARS) and Middle Eastern Respiratory Syndrome (MERS).

‘Novel coronavirus’ is a new, previously unidentified strain of coronavirus. The novel coronavirus involved in the current outbreak has been named SARS-CoV-2 by the World Health Organization (WHO). The disease it causes has been named “coronavirus disease 2019” (or “COVID-19”).

 

LISTEN AT YOUR LEISURE

Special Episode with Dr. Teena Chopra, MD, MPH

and Jennifer Wood, C. diff. Survivor – discussing the COVID-19 and C. difficile infection information

 

How does the virus spread?

COVID-19 can spread from person to person usually through close contact with an infected person or through respiratory droplets that are dispersed into the air when an infected person coughs or sneezes.  It may also be possible to get the virus by touching a surface or object contaminated with the virus and then touching your mouth, nose or eyes, but it is not thought to be the main way the virus spreads.

 

 

Where has COVID-19 spread to?

As of the March 6, 2020, there are over 95,000 confirmed cases of infection by the virus—and 3,381 of that number have resulted in death. While most cases of COVID-19 infection are in China, the virus has spread to 88 other countries.

What are the symptoms?

Similar to other respiratory illnesses, the symptoms of COVID-19 may include fever, cough, and shortness of breath.

People infected with COVID-19 may experience any range of these symptoms along with aches and pains, nasal congestion, runny nose, sore throat and diarrhea. Symptoms can start to show up anywhere from two to 14 days after exposure to the virus3. It may be possible for an infected person who is not yet showing any symptoms to spread the virus. Older persons, and those with pre-existing medical illnesses like heart disease and diabetes, however, seem to be more likely to experience severe respiratory symptoms and complications.

How to protect yourself from coronavirus

The best preventative action is to avoid being exposed to the virus. You can do this by taking a few cautionary steps—the same as you would if you were trying to avoid getting any respiratory illness.

  1. Wash your hands with soap and water frequently. If soap and water are not readily accessible, use alcohol-based sanitizers.
  2. Avoid contact with sick people.
  3. Avoid touching your eyes, nose, and mouth with your hands if they are unwashed.
  4. Cover your mouth and nose with a tissue or your bent elbow when you sneeze or cough. Make sure to dispose of the tissue immediately.
  5. If you are feeling unwell, stay home.
  6. If you have no respiratory symptoms such cough, a medical mask is not necessary.  Only use the mask if you have symptoms such as coughing or sneezing or suspect a COVID-19 infection. A mask is recommended for those caring for anyone with COVID-19.

What to do if you suspect you are infected?

The symptoms of COVID-19 are very similar to those of a cold or the flu, making it challenging to identify the specific cause of any respiratory symptoms. If you suspect you have been infected by COVID-19, you should seek medical care as soon as possible.

Until you can access medical care, you should follow these guidelines to reduce your likelihood of infecting others:

  • Restrict your outdoor activities and stay at home as much as you can. If it is feasible, stay in a separate room, and use a different bathroom from others in your household.
  • Clean and/or disinfect objects and surfaces that you touch regularly.
  • Track your symptoms as accurately as possible, so you can provide medical personnel with useful information.

Are there any treatments or vaccines?

There are currently no treatments, drugs, or vaccines available to treat or prevent COVID-19. People infected with the virus should receive medical treatment to relieve and alleviate the symptoms they are experiencing.

For Additional Information Please Visit the CDC Website:

https://www.cdc.gov/coronavirus/2019-ncov/about/index.html

 

Resource:  https://www.gethealthystayhealthy.com/articles/what-know-about-coronavirus-covid-19-explained

What Is SARS-CoV-2 and the Disease It Causes Named coronavirus disease 2019 or Better Known As COVID-19

 

 

 

What is Coronavirus?

The virus has been named “SARS-CoV-2” and the disease it causes has been named “COVID-19.”

Coronaviruses are a large family of viruses that may cause respiratory illnesses in humans ranging from common colds to more severe conditions such as Severe Acute Respiratory Syndrome (SARS) and Middle Eastern Respiratory Syndrome (MERS).

‘Novel coronavirus’ is a new, previously unidentified strain of coronavirus. The novel coronavirus involved in the current outbreak has been named SARS-CoV-2 by the World Health Organization (WHO). The disease it causes has been named “coronavirus disease 2019” (or “COVID-19”).

 

LISTEN AT YOUR LEISURE

Special Episode with Dr. Teena Chopra, MD, MPH

and Jennifer Wood, C. diff. Survivor – discussing the COVID-19 and C. difficile infection information

 

How does the virus spread?

COVID-19 can spread from person to person usually through close contact with an infected person or through respiratory droplets that are dispersed into the air when an infected person coughs or sneezes.  It may also be possible to get the virus by touching a surface or object contaminated with the virus and then touching your mouth, nose or eyes, but it is not thought to be the main way the virus spreads.

 

 

Where has COVID-19 spread to?

As of the March 6, 2020, there are over 95,000 confirmed cases of infection by the virus—and 3,381 of that number have resulted in death. While most cases of COVID-19 infection are in China, the virus has spread to 88 other countries.

What are the symptoms?

Similar to other respiratory illnesses, the symptoms of COVID-19 may include fever, cough, and shortness of breath.

People infected with COVID-19 may experience any range of these symptoms along with aches and pains, nasal congestion, runny nose, sore throat and diarrhea. Symptoms can start to show up anywhere from two to 14 days after exposure to the virus3. It may be possible for an infected person who is not yet showing any symptoms to spread the virus. Older persons, and those with pre-existing medical illnesses like heart disease and diabetes, however, seem to be more likely to experience severe respiratory symptoms and complications.

How to protect yourself from coronavirus

The best preventative action is to avoid being exposed to the virus. You can do this by taking a few cautionary steps—the same as you would if you were trying to avoid getting any respiratory illness.

  1. Wash your hands with soap and water frequently. If soap and water are not readily accessible, use alcohol-based sanitizers.
  2. Avoid contact with sick people.
  3. Avoid touching your eyes, nose, and mouth with your hands if they are unwashed.
  4. Cover your mouth and nose with a tissue or your bent elbow when you sneeze or cough. Make sure to dispose of the tissue immediately.
  5. If you are feeling unwell, stay home.
  6. If you have no respiratory symptoms such cough, a medical mask is not necessary.  Only use the mask if you have symptoms such as coughing or sneezing or suspect a COVID-19 infection. A mask is recommended for those caring for anyone with COVID-19.

What to do if you suspect you are infected?

The symptoms of COVID-19 are very similar to those of a cold or the flu, making it challenging to identify the specific cause of any respiratory symptoms. If you suspect you have been infected by COVID-19, you should seek medical care as soon as possible.

Until you can access medical care, you should follow these guidelines to reduce your likelihood of infecting others:

  • Restrict your outdoor activities and stay at home as much as you can. If it is feasible, stay in a separate room, and use a different bathroom from others in your household.
  • Clean and/or disinfect objects and surfaces that you touch regularly.
  • Track your symptoms as accurately as possible, so you can provide medical personnel with useful information.

Are there any treatments or vaccines?

There are currently no treatments, drugs, or vaccines available to treat or prevent COVID-19. People infected with the virus should receive medical treatment to relieve and alleviate the symptoms they are experiencing.

For Additional Information Please Visit the CDC Website:

https://www.cdc.gov/coronavirus/2019-ncov/about/index.html

 

Resource:  https://www.gethealthystayhealthy.com/articles/what-know-about-coronavirus-covid-19-explained

US Food and Drug Administration (FDA) Issued a Safety Alert About Potential Risks of Serious, Even Life-Threatening Infections Linked To Fecal Microbiota Transplantation (FMT)

The US Food and Drug Administration (FDA) yesterday issued a safety alert about the potential risk of serious, even life-threatening, infections linked to fecal microbiota transplantation (FMT) after six patients were infected with diarrhea-causing Escherichia coli following the procedure.  March 13, 2020

According to the alert, two patients developed enteropathogenic E coli (EPEC) infections, and four developed Shiga toxin–producing E coli (STEC), after receiving FMT for Clostridoides difficile infection. Four of the six patients required hospitalization.

“FDA is informing patients and healthcare providers of the potential risk of transmission of pathogenic bacteria by FMT products and the resultant serious adverse reactions that may occur,” the agency said. “Patients considering FMT for the treatment of C. difficile infection should speak to their health care provider to understand the associated risks.”

STEC is a pathogenic form of E coli that causes abdominal pain, bloody diarrhea, vomiting, and mild fever. EPEC generally doesn’t cause any symptoms, but some strains can cause diarrhea.

Change in screening protocols

The stool used in the procedures all came from Boston-based OpenBiome, the country’s largest stool bank. The company said in a press release yesterday that the cases are the first reports of likely transmission of pathogens by FMT involving stool that came from OpenBiome, which has shipped more than 50,000 FMT treatments to physicians since 2013.

The patients who developed the infections received FMT product prepared from three OpenBiome donors. The two patients who developed EPEC infections were treated with stool from two donors, and the six STEC patients received stool from one donor. OpenBiome says all unused material from the donors has been destroyed.

The FDA says bacterial isolates from the patients’ stools are not yet available to determine if the STEC or EPEC organisms are genetically identical to the organisms from the stool donors—a finding that would confirm that the donor stool was the source of the infection.

In response to the safety alert, OpenBiome says it is immediately implementing changes to its screening program in collaboration with the FDA.

While the company has previously screened donor samples for STEC via enzyme immunoassay, and says the donor involved in the STEC cases tested negative at all screens, OpenBiome will add polymerase chain reaction (PCR) testing for STEC to its screening process. PCR tests on retained donor samples conducted after Openbiome was notified of the infections were found to be positive for STEC.

The retained stool samples from the donors linked to the EPEC infections were found to be positive for EPEC upon further testing from OpenBiome. The company says it has not previously screened donors for EPEC, a position based on international and national guidelines, but will immediately implement EPEC screening by PCR into its donor screening protocol.

“In addition to updating and implementing STEC and EPEC screening into our quality and safety protocols, OpenBiome is also working with FDA to implement retrospective screening of units to ensure that available material meets these new standards,” the company said.

After reporting the infections to the FDA, OpenBiome received information that two additional FMT recipients who received stool from the donor linked to the STEC infections had died. The company said in an update today that the treating clinician for one of the patients determined that the patient had died from underlying cardiac causes, and testing for STEC was not performed. In the second case, testing of donor material was negative for STEC.

“Therefore, it was determined that the death was unrelated to STEC,” the company said.

FMT safety issues

FMT has been found in several studies to be a highly effective treatment for recurrent C difficile infections that aren’t responding to antibiotics, and at least 10,000 FMT procedures for recurrent C difficile are performed each year. FMT is also being investigated for treating other conditions in more than 300 trials.

The idea behind the procedure is to introduce healthy bacteria from a donor into the gut microbiome of a sick recipient and restore the balance between good and bad bacteria.

But this is the second safety alert issued by the FDA regarding FMT. In June 2019, the agency warned of the potential for dangerous infections after two FMT patients developed drug-resistant bloodstream infections and one died, and the agency halted a number of FMT trials until additional screening measures could be put in place. A subsequent paper in the New England Journal of Medicine revealed that the two patients, both of whom were enrolled in clinical trials at Massachusetts General Hospital in Boston, had extended-spectrum beta-lacatamase (ESBL)-producing E coli in their blood.

The two patients had both received stool from Mass General that came from the same donor. While the hospital had screened the stool for C difficile and the presence of drug-resistant pathogens by the hospital, it had not screened it for ESBL-producing E coli. The authors of the paper could not conclusively attribute the infections to FMT, but suspected the patients likely acquired the pathogen from the procedure.

RESOURCE:  http://www.cidrap.umn.edu/news-perspective/2020/03/fda-warns-about-infections-linked-fecal-microbiota-transplants?utm_source=dlvr.it&utm_medium

 

 

First Isolation of C.diff. PCR Ribotype 027 and Epidemiological Research of CDI in Hospitalized Adults In Tongji Hospital, Central China

Abstract

Author Information: Zhou Y1, Mao L2, Yu J2, Lin Q2, Luo Y2, Zhu X3, Sun Z4.

BACKGROUND:

Clostridium difficile infection (CDI) is an emerging healthcare problem in the world. The purpose of this study was to perform a systematic epidemiological research of CDI in Tongji hospital, the central of China.

METHODS:

Stool samples from hospitalized adults suspected of CDI were enrolled. The diagnosis of CDI were based on the combination of clinical symptoms and laboratory results. Clinical features of CDI and non-CDI patients were compared by appropriate statistical tests to determine the risk factors of CDI. Multilocus sequence typing (MLST) was employed for molecular epidemiological analysis. Susceptibility testing and relevant antimicrobial agent resistance genes were performed as well.

RESULTS:

From June 2016 to September 2017, 839 hospitalized adults were enrolled. Among them, 107 (12.8%, 107/839) patients were C. difficile culture positive, and 73 (8.7%, 73/839) were infected with toxigenic C. difficile (TCD), with tcdA + tcdB+ strains accounting for 90.4% (66/73) and tcdA-tcdB+ for 9.6% (7/73). Meanwhile, two TCD strains were binary toxin positive and one of them was finally identified as CD027. Severe symptoms were observed in these two cases. Multivariate analysis indicated antibiotic exposure (p = 0.001, OR = 5.035) and kidney disease (p = 0.015, OR = 8.329) significantly increased the risk of CDI. Phylogenetic tree analysis demonstrated 21 different STs, including one new ST (ST467); and the most dominant type was ST54 (35.6%, 26/73). Multidrug-resistant (MDR) TCD were 53.4% (39/73); resistance to ciprofloxacin, erythromycin, and clindamycin were > 50%. Other antibiotics showed relative efficiency and all strains were susceptible to metronidazole and vancomycin. All moxifloxacin-resistant isolates carried a mutation in GyrA (Thr82 → Ile), with one both having mutation in GyrB (Ser366 → Ala).

CONCLUSIONS:

Knowledge of epidemiological information for CDI is limited in China. Our finding indicated tcdA + tcdB+ C. difficile strains were the dominant for CDI in our hospital. Significant risk factors for CDI in our setting appeared to be antibiotic exposure and kidney disease. Metronidazole and vancomycin were still effective for CDI. Although no outbreak was observed, the first isolation of CD027 in center China implied the potential spread of this hypervirulent clone. Further studies are needed to enhance our understanding of the epidemiology of CDI in China.

Source:  https://www.ncbi.nlm.nih.gov/pubmed/30845918?dopt=Abstract&utm_source=dlvr.it&utm_medium=twitter