Background: Systematic surveillance of Clostridioides difficile infection (CDI) in our institution showed a reduction in the incidence of healthcare associated CDI (HA-CDI) during COVID-19 pandemic. ...Aim: Our objective was to search for factors related to this reduction. Methods: We retrospectively studied the trend of the incidences of HA-CDI, Multidrug Resistant (MDR) organisms, total antibiotic and chlorine consumptions as well as the influence of the last two on the incidence of HA-CDI. Results: During COVID-19 pandemic, the HA-CDI incidence was reduced with respect to the previous years, although total antibiotic consumption was found to increase ( p < .01). MDR organisms’ incidence was found to increase ( p < .01), as well as the chlorine consumption ( p = .04) which was the only factor to be related to the decreased rates of HA-CDI (r = −0.786, p < .05). Discussion: In our institution, COVID-19 epidemic overlapped with the reduction in the HA-CDI’s incidence. This could be due to faithful compliance with the contact precaution measures but then, we would expect the incidence of MDR organisms to decrease as well. Chlorine usage for environmental cleaning was generalized during pandemic. It was the only factor to be related to the decreased rates of HA-CDI, highlighting the importance of environmental cleaning as a measure for HA-CDI prevention.
•Itraconazole is superior to other azoles against Candida parapsilosis in vitro.•Itraconazole has a lower fungicidal:inhibitory ratio for C. parapsilosis and Candida glabrata.•Empirical itraconazole ...was given to critically ill patients who were unresponsive to antimicrobials.•Itraconazole substantially decreased the rate of breakthrough candidemia.
In vitro and clinical data were analysed to evaluate the susceptibility profile of itraconazole in light of the new cut-off points. The in vitro activity of itraconazole was compared with that of eight comparators against 119 Candida bloodstream isolates from 2015 to 2018. Minimum inhibitory concentrations (MICs) were measured by the colorimetric MICRONAUT-S assay. The content of wells without any color change was sub-cultured to measure killing efficacy. No major differences were found against Candida albicans. Itraconazole, posaconazole and amphotericin B were the most active agents against Candida parapsilosis. Of the 32 isolates of C. parapsilosis that were resistant to fluconazole, 96.9%, 78.1% and 93.8% were susceptible to itraconazole, voriconazole and posaconazole, respectively. The ratio of the minimum fungicidal concentration (MFC) to the MIC of itraconazole was lower than for the other azoles against C. parapsilosis and C. glabrata. Itraconazole achieved greater inhibition over-time of the growth of C. parapsilosis than fluconazole. Seventy-three critically ill patients who were unresponsive to antibiotics received intravenous empirical treatment with itraconazole (n = 28) or comparators (n = 45). Case-control matching was conducted for severity, comorbidities, risk factors for candidemia, administered antibiotics and days of antifungal treatment. Breakthrough candidemia was found in 3.6% of patients treated with itraconazole and in 32.1% of patients treated with comparators (P: 0.020); breakthrough candidemia by C. parapsilosis was found in 3.6% and 28.6% of patients, respectively. Results indicate that itraconazole retains a valuable susceptibility profile against Candida isolates, particularly C. parapsilosis. This superior profile may explain the clinical efficacy in the occurrence of breakthrough candidemia and warrants further clinical investigation.
BACKGROUNDInflammatory bowel disease (IBD) is an independent risk factor for Clostridium difficile infection (CDI), which is associated significantly with disease severity. We aimed to determine the ...rates of CDI among hospitalized IBD patients in major tertiary referral hospitals in Greece.
PATIENTS AND METHODSA retrospective analysis was carried out of stool cultures from hospitalized patients investigated for diarrhea, during 2016, tested for CDI with glutamate dehydrogenase (GDH) and toxins A and B.
RESULTSIn total, 6932 patients were tested for CDI; 894 were positive for GDH (12.89%) and 339 were also positive for C. difficile toxin (4.89%). The prevalence of CDI among all hospitalized patients was 1.6/1000 patient-days. Among these, there were 401 IBD patients, and 62 were positive for GDH (15.46%) and 30 were also positive for C. difficile toxin (7.48%). The prevalence of CDI in IBD patients was 2.5/1000 patient-days, significantly higher than in non-IBD hospitalized patients (30/401 vs. 309/6531, P=0.013). Among the 30 IBD patients (ulcerative colitis=18, Crohn’s disease=12) with CDI, six were receiving biologics, three were on corticosteroids one combined with azathioprine (AZA) and one combined with 5-ASA, nine were on AZA monotherapy and 12 were on 5-ASA monotherapy. The prevalence of CDI among patients receiving AZA monotherapy was significantly higher than in patients receiving other medications (9/68 vs. 21/333, P=0.047). Mild CDI (n=28) was treated with metronidazole and/or vancomycin, whereas severe CDI (n=2) was treated with vancomycin.
CONCLUSIONThe prevalence of CDI is higher in hospitalized IBD patients than those without IBD and AZA monotherapy increases the risk of CDI.
The correlation of Clostridium difficile infection (CDI) with in-hospital morbidity is important in hospital settings where broad-spectrum antimicrobial agents are routinely used, such as in Greece. ...The C. DEFINE study aimed to assess point-prevalence of CDI in Greece during two study periods in 2013.
There were two study periods consisting of a single day in March and another in October 2013. Stool samples from all patients hospitalized outside the ICU aged ≥18 years old with diarrhea on each day in 21 and 25 hospitals, respectively, were tested for CDI. Samples were tested for the presence of glutamate dehydrogenase antigen (GDH) and toxins A/B of C. difficile; samples positive for GDH and negative for toxins were further tested by culture and PCR for the presence of toxin genes. An analysis was performed to identify potential risk factors for CDI among patients with diarrhea.
5,536 and 6,523 patients were screened during the first and second study periods, respectively. The respective point-prevalence of CDI in all patients was 5.6 and 3.9 per 10,000 patient bed-days whereas the proportion of CDI among patients with diarrhea was 17% and 14.3%. Logistic regression analysis revealed that solid tumor malignancy odds ratio (OR) 2.69, 95% confidence interval (CI): 1.18-6.15, p = 0.019 and antimicrobial administration (OR 3.61, 95% CI: 1.03-12.76, p = 0.045) were independent risk factors for CDI development. Charlson's Comorbidity Index (CCI) >6 was also found as a risk factor of marginal statistical significance (OR 2.24, 95% CI: 0.98-5.10). Median time to CDI from hospital admission was shorter with the presence of solid tumor malignancy (3 vs 5 days; p = 0.002) and of CCI >6 (4 vs 6 days, p = 0.009).
The point-prevalence of CDI in Greek hospitals was consistent among cases of diarrhea over a 6-month period. Major risk factors were antimicrobial use, solid tumor malignancy and a CCI score >6.
A cardiac device (CD) infection is a very important challenge for cardiology and clinical microbiology specialists, because of the increasing use of implantable CDs. Several host- and ...procedure-related factors increase the risk of CD infection. A CD infection commonly involves a permanent pacemaker (PPM) or an implantable cardioverter defibrillator (ICD) device, which like any other foreign body can become infected. Cardiac device infection may be a primary infection when the device and/or pocket itself is the source of infection, usually due to contamination at the time of implant or a secondary infection due to bacteremia from a different source contaminating the leads and/or the device and/or the pocket... (excerpt)
Infections of cardiac implantable electronic devices (CIEDs) are an emerging problem because of increasing implant rates and comorbidities. If undiagnosed and untreated, CIED infection is associated ...with high mortality. Following the new guidelines concerning the use of cardiac resynchronization therapy devices in patients with congestive heart failure,1 CIED implantation has grown further. Unfortunately, this trend has been accompanied by an increase in infection rate, probably due to an increase in comorbidities. A recent analysis of US data2 showed that infection rate grew from 1.61% in 1993 to 2.41% in 2008, possibly due to two factors: ageing of population and increased use of more complex devices. Several studies3,4 have found that the most important risk factors for infection are re-intervention, with device replacement increasing with ageing of the population, and use of dual and triple chamber devices having increased over the last several years.
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