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Toxigenic Clostridium difficile colonization among hospitalised adults; risk factors and impact on survival

OBJECTIVES: To establish risk factors for Clostridium difficile colonization among hospitalized patients in England. METHODS: Patients admitted to elderly medicine wards at three acute hospitals in England were recruited to a prospective observational study. Participants were asked to provide a stoo...

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Autores principales: Behar, Laura, Chadwick, David, Dunne, Angela, Jones, Christopher I., Proctor, Claire, Rajkumar, Chakravarthi, Sharratt, Paula, Stanley, Philip, Whiley, Angela, Wilks, Mark, Llewelyn, Martin J.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: W.B. Saunders 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5464213/
https://www.ncbi.nlm.nih.gov/pubmed/28435086
http://dx.doi.org/10.1016/j.jinf.2017.04.006
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author Behar, Laura
Chadwick, David
Dunne, Angela
Jones, Christopher I.
Proctor, Claire
Rajkumar, Chakravarthi
Sharratt, Paula
Stanley, Philip
Whiley, Angela
Wilks, Mark
Llewelyn, Martin J.
author_facet Behar, Laura
Chadwick, David
Dunne, Angela
Jones, Christopher I.
Proctor, Claire
Rajkumar, Chakravarthi
Sharratt, Paula
Stanley, Philip
Whiley, Angela
Wilks, Mark
Llewelyn, Martin J.
author_sort Behar, Laura
collection PubMed
description OBJECTIVES: To establish risk factors for Clostridium difficile colonization among hospitalized patients in England. METHODS: Patients admitted to elderly medicine wards at three acute hospitals in England were recruited to a prospective observational study. Participants were asked to provide a stool sample as soon as possible after enrolment and then weekly during their hospital stay. Samples were cultured for C. difficile before ribotyping and toxin detection by PCR. A multivariable logistic regression model of risk factors for C. difficile colonization was fitted from univariable risk factors significant at the p < 0.05 level. RESULTS: 410/727 participants submitted ≥1 stool sample and 40 (9.8%) carried toxigenic C. difficile in the first sample taken. Ribotype 106 was identified three times and seven other ribotypes twice. No ribotype 027 strains were identified. Independent predictors of colonization were previous C. difficile infection (OR 4.53 (95% C.I. 1.33–15.48) and malnutrition (MUST score ≥2) (OR 3.29 (95% C.I. 1.47–7.35)). Although C. difficile colonised patients experienced higher 90-day mortality, colonization was not an independent risk for death. CONCLUSIONS: In a non-epidemic setting patients who have previously had CDI and have a MUST score of ≥2 are at increased risk of C. difficile colonization and could be targeted for active surveillance to prevent C. difficile transmission.
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spelling pubmed-54642132017-07-01 Toxigenic Clostridium difficile colonization among hospitalised adults; risk factors and impact on survival Behar, Laura Chadwick, David Dunne, Angela Jones, Christopher I. Proctor, Claire Rajkumar, Chakravarthi Sharratt, Paula Stanley, Philip Whiley, Angela Wilks, Mark Llewelyn, Martin J. J Infect Article OBJECTIVES: To establish risk factors for Clostridium difficile colonization among hospitalized patients in England. METHODS: Patients admitted to elderly medicine wards at three acute hospitals in England were recruited to a prospective observational study. Participants were asked to provide a stool sample as soon as possible after enrolment and then weekly during their hospital stay. Samples were cultured for C. difficile before ribotyping and toxin detection by PCR. A multivariable logistic regression model of risk factors for C. difficile colonization was fitted from univariable risk factors significant at the p < 0.05 level. RESULTS: 410/727 participants submitted ≥1 stool sample and 40 (9.8%) carried toxigenic C. difficile in the first sample taken. Ribotype 106 was identified three times and seven other ribotypes twice. No ribotype 027 strains were identified. Independent predictors of colonization were previous C. difficile infection (OR 4.53 (95% C.I. 1.33–15.48) and malnutrition (MUST score ≥2) (OR 3.29 (95% C.I. 1.47–7.35)). Although C. difficile colonised patients experienced higher 90-day mortality, colonization was not an independent risk for death. CONCLUSIONS: In a non-epidemic setting patients who have previously had CDI and have a MUST score of ≥2 are at increased risk of C. difficile colonization and could be targeted for active surveillance to prevent C. difficile transmission. W.B. Saunders 2017-07 /pmc/articles/PMC5464213/ /pubmed/28435086 http://dx.doi.org/10.1016/j.jinf.2017.04.006 Text en © 2017 The Authors http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Article
Behar, Laura
Chadwick, David
Dunne, Angela
Jones, Christopher I.
Proctor, Claire
Rajkumar, Chakravarthi
Sharratt, Paula
Stanley, Philip
Whiley, Angela
Wilks, Mark
Llewelyn, Martin J.
Toxigenic Clostridium difficile colonization among hospitalised adults; risk factors and impact on survival
title Toxigenic Clostridium difficile colonization among hospitalised adults; risk factors and impact on survival
title_full Toxigenic Clostridium difficile colonization among hospitalised adults; risk factors and impact on survival
title_fullStr Toxigenic Clostridium difficile colonization among hospitalised adults; risk factors and impact on survival
title_full_unstemmed Toxigenic Clostridium difficile colonization among hospitalised adults; risk factors and impact on survival
title_short Toxigenic Clostridium difficile colonization among hospitalised adults; risk factors and impact on survival
title_sort toxigenic clostridium difficile colonization among hospitalised adults; risk factors and impact on survival
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5464213/
https://www.ncbi.nlm.nih.gov/pubmed/28435086
http://dx.doi.org/10.1016/j.jinf.2017.04.006
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