Tag Archives: Clostridium difficile study

New Study Shows that Identifying Patients At Risk For Poor Outcomes Caused by CDI Using Serum Eosinophil Count Information Collected Upon Admission

 

 

 

When it comes to addressing health care-associated infections, Clostridium difficile, remains, well, difficult.

Research suggests that illness due to C difficile is the most common nosocomial infection in the United States, with mortality rates as high as 22%.

Yet, a new study published on September 12 in JAMA Surgery suggests there may be a—relatively—simple and cost-effective solution:

by identifying patients at risk for poor outcomes caused by C difficile infection using serum eosinophil count information collected at hospital admission.

“There’s a frequently obtained, but often underutilized, marker that can predict not only mortality but adverse outcomes in disease,” study co-author David B. Stewart, MD, FACS, FASCRS, associate professor and section chief, colorectal surgery, University of Arizona, told Contagion®.

“Eosinophil count is a marker we often ignore because, in general, it’s relatively unimportant for the bacterial infections we deal with.

However, what our research shows that undetectable levels of eosinophils at the time of admission can be an accurate predictor of disease severity.”

SOURCE:  https://www.contagionlive.com/news/potential-new-marker-for-mortality-due-to-clostridium-difficile-infection

For their research, Dr. Stewart and his colleagues performed a cohort study 2065 adult patients admitted for C difficile infection through the emergency departments of 2 tertiary referral centers over a 10-year period. The study population was then stratified based on eosinophil count (0.0 cells/μL or >0.0 cells/μL) at the time of admission, and divided into a training and validation cohort. The authors used multivariable logistic regression to construct a predictive model for inpatient mortality as well as other disease-related outcomes.

What they found is that of the 2065 patients in the study (52.9% of whom were women; participants had a mean age of 63.4 years), those with an undetectable eosinophil count at admission had increased in-hospital mortality in both the training and validation cohorts. In addition, undetectable eosinophil counts were associated with indicators of severe sepsis “such as admission to monitored care settings, the need for vasopressors, and emergency total colectomy,” according to the authors.

Other significant predictors of C difficile infection mortality at admission included other readily obtainable and easily available markers such as comorbidity burden and lower systolic blood pressures. A subgroup analysis of patients presenting with no initial tachycardia or hypotension revealed that only those with undetectable admission eosinophil counts, but not those with elevated white blood cell counts, “had significantly increased odds of inpatient mortality” due to C difficile infection. In fact, the multivariable logistic analysis revealed that undetectable eosinophil levels (eosinopenia) had greater than 90% accuracy among patients with a predicted probability of mortality of more than 20%.

According to Dr. Stewart, the JAMA Surgery paper is the first human study to follow up on the work of co-author William A. Petri, MD, PhD, Wade Hampton Frost Professor of Medicine and chief, division of infectious disease, University of Virginia, who had explored the relationship between eosinophil levels and C difficile infection mortality in mice.

Given that most emergency departments call for complete blood counts and differentials for every new patient that’s admitted, obtaining eosinophil counts for patients shouldn’t be a costly or inefficient step to take; it would merely entail accessing data that has already been collected, in most cases.

“What we demonstrate in our present study is that eosinophil counts at the time admission are strongly predictive of outcomes with relation to C difficile infection,” Dr. Stewart explained. “Now, we need to look determine, if we were to change the management of patients based on that information, would that change outcomes? [As such,] we are in the planning stages of a prospective clinical trial to see if we can lower the incidence of adverse events like the need for vasopressors and emergency total colectomy by responding to that information.”

In a related commentary published with the study, authors from the department of surgery at McGovern Medical School at the University of Texas Health Science Center in Houston wrote that “admission eosinopenia may be a novel and inexpensive prognosticator for guiding the management of [C difficile infections].

Moreover, there are data to suggest that the resolution of eosinopenia may be a marker for a response to antimicrobial therapy in infections.

Ultimately, interventions to block the TLR2-dependent pathway or to restore eosinophil cell counts may have therapeutic potential in [C difficile infections]

The StoP CDI Study

The StoP CDI study will test this idea in a randomized, double-blinded, placebo-controlled trial.

If successful in demonstrating that vancomycin can prevent the disease, the research could save thousands of lives, stop tens of thousands of infections, and save millions of health care dollars.

The Agency for Healthcare Research and Quality recently awarded Dr. Sims with a $2.4 million grant to study a theory that could prevent thousands of C. difficile infections and deaths all over the world. This is one of the largest grants Beaumont Health has ever received.

Ms Post was diagnosed with a Clostridium difficile infection and was treated for it with vancomycin and got better. However, a few days after she stopped the vancomycin, the diarrhea would come back as the infection relapsed. After talking with several doctors she was directed to Matthew Sims, M.D., PhD, director of infectious disease research at Beaumont Hospital, Royal Oak, who enrolled her in a research study and broke the cycle of relapses.

Dr. Sims believes oral vancomycin can keep the C. diff in check when the good bacteria is killed by other antibiotics and should prevent the patient from becoming sick. Participants in the study will be given vancomycin or a placebo along with the antibiotics treating the original infection.

Source:

Beaumont Hospital, Royal Oak

To read the article in its entirety click on the following link to be redirected:

http://www.news-medical.net/news/20161207/Preventing-C-difficile-infections-could-save-thousands-of-lives-and-millions-of-health-care-dollars.aspx?platform=hootsuite

Study Finds Community – acquired Clostridium difficile (Cdiff) Infection (CDI) Greater Than Hospital-acquired CDI

GRAPHCdiff2016

 

 

 

 

 

 

ASM Microbe 2016 (Poster 290)

Community-onset CDI cases increased at a higher rate than hospital-acquired cases—accounting for almost half of the cases—in an examination of clinical data from 154 U.S. hospitals over eight years, according to research presented at the ASM Microbe 2016 (Poster 290)

Researchers from Merck and Becton Dickinson wanted to examine this trend, and looked at where CDI began by analyzing clinical data from 154 hospitals from 2008 to 2015.

>> Thank You Merck and Becton Dickinson For Conducting This Study <<

A CDI case was defined as a positive C. difficile toxin or molecular assay of a stool specimen obtained from a patient without a positive assay in the previous eight weeks.

First, they looked at the overall CDI rate in those facilities in that eight-year period and found 154,629 total CDI cases.

Then the teased out whether the case was acquired in the community or hospital. They also dived a little deeper to understand which community cases really were “community” that is there was no hospital stay within a certain time before the onset of disease, explained Andy DeRyke, PharmD, director scientific strategy lead at Merck, and one of the researchers.

They used these three definitions:
Community-onset-community-associated: CDI occurred in an outpatient setting or within three calendar days after hospital admission and the patient had not had an overnight hospital stay in the prior 12 weeks before onset of infection;
Community-onset-hospital-associated: CDI occurred in an outpatient setting or within three days after hospital admission, but the patient had spent at least one night in the hospital in the prior 12 weeks to the onset of infection; and
Hospital-onset: CDI occurred after spending three days in the hospital.

Although not knew information—other studies as well as the Centers for Disease Control and Prevention (CDC) have reported community-acquired infection—they were surprised by how many cases were community acquired.

From 2008 to 2015, the total number of CDI cases increased from 14,686 to 25,273 (72% increase, P<0.01).

Those that were Community-onset-community-associated rose from 6,586 to 13,975 (112%, P<0.01).

While the cases that probably stemmed from a hospital exposure also increased, the rate was much lower, according to Dr. DeRyke.

Those that were community-onset-hospital-associated rose from from 4,545 to 6,524 (44%, P<0.01); while hospital-onset rose from from 3,555 to 4,775 (34%, P<0.01).

The community-onset-community-associated cases accounted for half of overall cases and proportionately increased from 45% in 2008 to 55% in 2015 (P<0.01).

They also looked at cases geographically and found that the Midwest had the highest CDI rate in the country.

“The rates of C. diff are increasing over time,” he said. “Despite all these efforts to eliminate C. diff, it continues to increase.”

Ambulatory patients and caregivers will find the same problems that hospitals have in trying to rid the environment of C. difficile, he said. “The problem is, it’s everywhere,” he said and recommended that any person caring for a patient with CDI make sure that they wash their hands frequently and disinfect with bleach.

https://cdifffoundation.org/hand-washing-updates/

 

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

http://www.idse.net/Hospital-acquired-infection/Article/06-16/C-diff-Not-Just-a-Hospital-Problem-Anymore/36793

Hospital C. diff. Study; CDI Rates and Prediction of Length of Stay in Patients Without C. diff. Infection

Clostridium-difficile_456px

Hospital Clostridium difficile Infection Rates and Prediction of Length of Stay in Patients Without  C. difficile Infection (CDI)

> C Diff Foundation > C. diff. Research Community April 2016

Abstract

BACKGROUND Inpatient length of stay (LOS) has been used as a measure of hospital quality and efficiency. Patients with Clostridium difficile infections (CDI) have longer LOS.

OBJECTIVE To describe the relationship between hospital CDI incidence and the LOS of patients without CDI.

DESIGN Retrospective cohort analysis.

METHODS We predicted average LOS for patients without CDI at both the hospital and patient level using hospital CDI incidence. We also controlled for hospital characteristics (eg, bed size) and patient characteristics (eg, comorbidities, age).

SETTING Healthcare Cost and Utilization Project Nationwide Inpatient Sample, 2009–2011.

PATIENTS The Nationwide Inpatient Sample includes patients from a 20% sample of all nonfederal US hospitals.

RESULTS Inpatient LOS was significantly longer (P<.001) at hospitals with greater CDI incidence at both the hospital and individual level.

At a hospital level, a percentage point increase in the CDI incidence rate was associated with more than an additional day’s stay (between 1.19 and 1.61 days).

At the individual level, controlling for all observable variables, a percentage point increase in the CDI incidence rate at their hospital was also associated with longer LOS (between 0.6 and 1.05 additional days).

Hospital CDI incidence had a larger impact on LOS than many other commonly used predictors of LOS.

CONCLUSION CDI rates are a predictor of LOS in patients without CDI at an individual and institutional level. CDI rates are easy to measure and report and thus may provide an important marker for hospital efficiency and/or quality.

Infect. Control Hosp. Epidemiol. 2016;37(4):404–410

Aaron C. Millera1, Linnea A. Polgreena2, Joseph E. Cavanaugha2 and Philip M. Polgreena2 c1

a1 Cornell College, Mount Vernon, Iowa

a2 University of Iowa, Iowa City, Iowa