2 results
Clostridioides difficile infection (CDI) treatment outcomes and recurrence factor at a pediatric hospital
- Martin Tuan Tran, Jasjit Singh, Wendi Gornick, Beth Huff, Negar Ashouri
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- Journal:
- Antimicrobial Stewardship & Healthcare Epidemiology / Volume 2 / Issue S1 / July 2022
- Published online by Cambridge University Press:
- 16 May 2022, p. s28
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Background: CDI is the single most common cause of nosocomial diarrhea in both adults and children. Available data regarding treatment outcomes in hospitalized children remain limited. CDI recurrence in children has been reported in 20%–30% of cases. Consensus regarding the best testing method for CDI is lacking. The 2018 IDSA guideline recommends a multistep algorithm with detection of glutamate dehydrogenase antigen plus toxin, followed by detection of toxigenic C. difficle with nucleic acid amplification test (NAAT) if results are discordant. Methods: We included patients aged 1–26 years admitted from July 2020 through June 2021 with CDI symptoms and positive toxin or NAAT. Healthcare facility-onset CDI (HO-CDI) was defined as positive specimen collected >3 days after admission. Community-onset CDI (CO-CDI) was defined as positive specimen collected ≤3 days after admission. Community-onset healthcare facility-associated CDI (CO-HCFA-CDI) was defined as positive specimen from a patient who was discharged from the facility ≤4 weeks prior. Recurrence was defined as an episode of CDI occurring within 60 days after onset of a previous infection. Results: Mean age of the 63 patients meeting inclusion criteria was 11.2 years (range, 1–21 years). Most patients (n = 37; 58.7%) were male, tested negative for C. difficile toxins (n = 39; 61.9%), and had mild-to-moderate disease (n = 61; 96.8%). Patients with immunocompromising conditions were common, including malignancy (n = 38; 60.3%), inflammatory bowel disorder (n = 8; 12.7%), and history of solid organ transplant (n = 5; 7.9%). Previously healthy without chronic medical conditions were uncommon (n = 4; 6.3%). CO-CDI was most common (n = 26; 41.3%) followed by HO-CDI (n = 23; 36.5%). Also, 34 patients (53.9%) were exposed to antibiotics within the previous 30 days, 16 (47.0%) of whom received 2 or more antibiotics. Sulfamethoxazole–trimethoprim was the most prescribed agent (13; 38%), most (12; 92.3%) as prophylaxis for Pneumocystis jirovecii pneumonia. Furthermore, 42 patients (66.7%) were receiving gastric acid suppressant agents. Laxatives were given to 14 patients (22.2%) within 72 hours of testing, despite electronic reminders. Most were treated with oral vancomycin (n = 46; 73.0%). In addition, 5 patients (7.9%) did not receive CDI treatment at the discretion of the treating physician; all were toxin negative. CDI was cured in 58 patients (92.1%) with only 5 (7.9%) experiencing recurrence infection. Patients testing positive for C. difficile toxin were more likely to experience infection recurrence compared to those with a negative toxin screen: 4 of 24 (16.7%) versus 1 of 39 (2.6%) (P = .044). Conclusions: Most patients with CDI were treated with oral vancomycin at our institution. We observed significantly lower rate of recurrence than previously reported. Toxin-positive patients experienced higher recurrence rate. Prospective studies are needed to confirm our findings.
Funding: None
Disclosures: None
No Device, No Problem? Healthcare-Associated Bloodstream and Urinary Tract Infections in a Children’s Hospital
- Wendi Gornick, Beth Huff, Jasjit Singh
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 41 / Issue S1 / October 2020
- Published online by Cambridge University Press:
- 02 November 2020, pp. s73-s74
- Print publication:
- October 2020
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Background: Central-line–associated bloodstream infection (CLABSI) and catheter-associated urinary tract infection (CAUTI) definitions continue to be refined to ensure accuracy. As facilities decrease CLABSI and CAUTI, and as midline catheters become more widely utilized, we sought to understand our non–central-line bloodstream infections (NCLBSI) and non–catheter-associated urinary tract infections (NCAUTI). Total healthcare-associated bloodstream infections (HABSIs) and urinary tract infections (HAUTIs) may provide more objective measures. Methods: The CHOC Children’s Hospital is a 334-bed quaternary-care hospital in Orange, California, with 146 intensive care unit (ICU) beds. We retrospectively reviewed all HABSIs (CLABSIs + NCLBSIs) and HAUTIs (CAUTIs + NCAUTIs) from July 1, 2016, to June 30, 2019, for demographic and microbiologic data. Both HABSI and HAUTI were defined as healthcare-associated infection when the date of event occurs on or after the third calendar day of admission. CLABSI and CAUTI were both defined using CDC-NHSN criteria. Mucosal barrier injury laboratory-confirmed bloodstream infections were excluded. Results: In a 3-year period, there were 100 HABSIs, of which 26 (26%) were NCLBSIs. The mean age for HABSI was 81 months. Enteric gram-negative infections (42%) and Staphylococcus aureus (35%) were the most common etiology for NCLBSI. The most common etiologies for CLABSI were coagulase-negative staphylococci (23%), Staphylococcus aureus (22%), and enteric gram-negatives (22%). Pseudomonas aeruginosa accounted for 16% of CLABSIs, but no NCLBSIs (Fig. 1). There was 1 midline catheter NCLBSI. There were 49 HAUTIs, of which 39 (80%) were NCAUTIs. One asymptomatic bacteremic urinary tract infection was included with the CAUTIs. The mean age for HAUTI was 55 months. The most common etiology of CAUTI was Pseudomonas aeruginosa (50%), whereas for NCAUTI the most common etiology was enteric gram-negative organisms (69%) (Fig. 2). In total, 11 HAUTIs (22%) resulted in secondary sepsis. Most HABSIs and HAUTIs occurred in the ICU setting. There were 6 deaths (6%) among HABSI patients and 3 deaths (8%) among HAUTI patients within 2 weeks of infection (Fig. 3). Conclusions: A preponderance of HABSIs were CLABSIs, but most HAUTIs were NCAUTIs. Although patient demographic and microbiologic differences exist in CLABSIs and NCLBSIs as well as CAUTIs and NCAUTIs, S. aureus and P. aeruginosa are important pathogens, particularly in device-associated infections. Trending total numbers of HABSIs and HAUTIs may be less subjective and may avert the shifting of categories seen with increased use of midline catheters. In addition, non–device-associated infections are potential causes of morbidity and mortality.
Funding: None
Disclosures: None