Factors Favouring the Development of Clostridium Difficile Infection in Critically Ill Patients

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Clostridium difficile, an anaerobic, spore-forming, toxin-forming, gram-positive bacillus present in the bacterial flora of the colon is the principal cause of nosocomial diarrhoea in adults.

Aim: Assessment of favouring factors of Clostridium difficile infections as well as the interactions between them, in critically ill hospitalized patients undergoing complex medical and surgical treatments.

Material and Methods: A retrospective case-control study involving eighty patients admitted in the Intensive Care Unit (ICU) of the County Clinical Emergency Hospital Tîrgu-Mureş was conducted between January and October 2014. Patients aged eighteen years and over, who had undergone complex medical and surgical treatment, were divided into two subgroups. Group 1 included patients who developed diarrhoea but were not diagnosed as having a Clostridium difficile infection (CDI). Group 2 included patients who developed diarrhoea due to CDI as indicated by a positive culture and the expression of exotoxin. The assessed parameters were age, length of stay (LOS), antibiotic spectrum, association with proton pump inhibitors (PPI) or H2-receptor antagonists, immunological status, the presence or lack of gastrointestinal tract surgery.

Results: The mean age was 64.6 years with an average LOS of 10 days. Fifty-six percent of patients came to the ICU from internal medicine wards and forty-three percent from surgical wards. 20.5% of them were immunosuppressed. Co-association of ceftriaxone and pantoprazole significantly increased the risk of CDI compared to co-administration of any other antibiotic or pantoprazole (p=0.01). The odds ratio for Pantoprazole together with any antibiotic versus antibiotic therapy alone was significantly higher (p=0.018) with a sevenfold increase in the risk of positive exotoxin increase.

Conclusions: Antibiotic use is associated with “no risk to develop CDI” in the first five days of administration. PPIs associated therapy increased the risk of CDI in first seventy-two hours regardless of the antibiotic type, and contributes to an active expression of CD exotoxin.

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  • 1. Walters PR Zuckerbraun BS. Clostridium difficile infection. Clinical Challenges and management strategies. Critical Care Nurse. 2014;34:2-35.

  • 2. Barletta JF Sclar DA. Proton pump inhibitors increase the risk for hospital-acquired Clostridium difficile infection in critically ill patients. Crit Care. 2014;18:714.

  • 3. Vindigni SM Surawicz CM. C. difficile Infection: Changing epidemiology and management paradigms. Clin Transl Gastroenterol. 2015;6e99 .

  • 4. Miller BA Chen LF Sexton DJ Anderson DJ. Comparison of the burdens of hospital onset healthcare facility-associated Clostridium difficile infection and of healthcare-associated infection due to methicillin-resistant Staphylococcus aureus in community hospitals. Infect Control Hosp Epidemiol. 2011;32:387-90.

  • 5. Vaishnavi C. Clinical spectrum & pathogenesis of Clostridium difficile associated diseases. Indian J Med Res. 2010; 131:487-99.

  • 6. McDonald LC Killgore GE Thompson A et al. An epidemic toxin gene variant strain of Clostridium difficile. N Engl J Med. 2005;353:2433-41.

  • 7. Vecchio AL Zacur GM. Clostridium difficile infection: an update on epidemiology risk factors and therapeutic options. Curr Opin Gastroenterol. 2012;28:1-9.

  • 8. Biswal S. Proton pump inhibitors and risk for Clostridium difficile associated diarrhea. Biomed J. 2014;37:178-83.

  • 9. Oake N Taljaard M Walraven C Wilson K Roth V Forster AJ. The effect of hospital-acquired Clostridium difficile infection on in-hospital mortality. Arch Intern Med. 2010;170:1804-10.

  • 10. Poutanen SM Simor AE. Clostridium difficile associated diarrhea in adults. CMAJ. 2004;171:51-8.

  • 11. Voth DE Ballard JD. Clostridium difficile toxins: Mechanisms of action and role in disease. Clin Microbiol Rev. 2005;18:247-63.

  • 12. Donskey CJ. The role of the intestinal tract as a reservoir and source for transmission of nosocomial pathogens. Clin Infect Dis. 2004;39:219-26.

  • 13. Pepin J Saheb N Coulombe MA et al. Emergence of fluoroquinolones as the predominant risk factor for Clostridium difficile-associated diarrhea: A cohort study during an epidemic in Quebec. Clin Infect Dis. 2005;41:1254-60.

  • 14. Neal KR Scott HM Slack RCB Logan RFA. Omeprazole as a risk factor for campylobacter gastroenteritis: case control study. BMJ 1996;321:414-5.

  • 15. Williams C. Occurrence and significance of gastric colonization during acid-inhibitory therapy. Best Pract Res Clin Gastroenterol. 2001;15:511-21.

  • 16. Linsky A Gupta K Lawler EV Fonda JR Hermos JA. Proton pump inhibitors and risk for recurrent Clostridium difficile infection. Arch Intern Med. 2010;170:772-8.

  • 17. Klingensmith ME Neville LL Delpire E Wolfe MM Soybel DI. Gastrin-mediated effects of omeprazole on rat colon mucosa. Surgery. 1999;126:272-8.

  • 18. Liebensten Z Wenisch C Patruta S Parschalk B Daxbock F Garninger W. Omeprazole treatment diminishes intra- and extra-cellular neutrophil reactive oxygen production and bacterial activity. Crit Care Med. 2002;30:1118-22.

  • 19. Dial S Delaney JAC Barkun AN Suissa S. Use of gastric acid-suppressive agents and the risk of communityacquired Clostridium difficile-associated disease. JAMA. 2005;294:2989-95.

  • 20. MacLaren R Reynolds PM Allen RR. Histamine-2 Receptor Antagonists vs Proton Pump Inhibitors on Gastrointestinal Tract Hemmorhage and Infectious Complications in the Intensive Care Unit FREE. JAMA Intern Med. 2014;174:564-74.

  • 21. Dubberke ER Reske KA Yan Y Olsen MA MacDonald LC Fraser VJ. Clostridium difficile-associated disease in a setting of endemicity: identification of novel risk factors. Clin Infect Dis. 2007;45:1543-9.

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