DO ORAL MECHANICAL BOWEL SOLUTIONS CAUSE C. DIFFICILE INFECTION?
INTRODUCTION:
Bowel preparation traditionally consists of cathartics, oral antibiotics, and intravenous antibiotics. Previous studies have shown a strong relationship between the use of antibiotic bowel preparations and a higher rate of postoperative Clostridium difficile colitis due to disruption of the normal enteral microflora. Little data exists to show the relationship between the use of oral mechanical bowel solutions and the development of Clostridium difficile colitis. The aim of this study is to see whether oral mechanical bowel solutions, by themselves, can be implicated as causative agents in the development of Clostridium difficile colitis.
HYPOTHESIS:
We
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RESULTS:
All n=24,522 patients received either GoLYTELY (Braintree Laboratories Inc, Braintree, Mass), HalfLytely & Bisacodyl Tablet Bowel Prep kit (Braintree Laboratories Inc, Braintree, Mass), Citrate of Magnesia (Aaron Industries Inc, Clinton, SC), or Fleet Phospho-soda (C. B. Fleet Co Inc, Lynchburg, Va) as oral bowel preparation solutions prior to their procedure.
Group-A (Surgery group) consisted of 894 patients. Out of those only 45 (0.05%) had documented C. difficile infections. Furthermore, this subset of patients was broken down further to 7 (0.16%) having C. difficile infection upon their admission, 5 (0.11) who underwent emergent surgery and were excluded from the study. 18 (0.4%) other patients also underwent a subtotal colectomy for fulminant colitis and were also exluded. Of the remaining 3 patients, 2 (0.04%) had small bowel obstruction and 1 (0.02%) was treated with antibiotics days to weeks prior to admission, and so these patients were also excluded. This left us with 12 (27%) patients who actually qualified for our study. This group was broken down to 9 (0.2%) patients who were diagnosed with C difficile infection past the 30-day grace period, and 3 (0.07%) patients that were diagnosed within the 30-day grace period. This data suggests that out of the 861 patients examined, only 12 (0.01%) were diagnosed with C. difficile infection
Clostridium difficile associated disease will resolve when the patient discontinues taking the antibiotics to which he/she has been previously exposed (Nipa, 2010). Administration of a different antibiotic is used to treat the infection (Grossman, 2010). The infection can usually be treated with an appropriate course of about 10 days of antibiotics including metronidazole or vancomycin administered orally (Nipa, 2010). On occasion intravenous vancomycin may be necessary (Gould, 2010). The nurse should ensure patients are not only taking the newly prescribed antibiotic, but also responding to the treatment by showing a decrease in symptoms. Symptoms can recur despite antibiotic therapy, close monitoring is essential. In order to avoid risk of further complications, nursing interventions would include careful assessment of white blood cell count, temperature, and hydration status; meticulous skin care and assistance with bowel elimination given the loose frequent stools; and management of abdominal discomfort (Grossman, 2010).
Clostridium difficile is a gram-positive, spore-forming, anaerobic bacillus. Since the turn of the 21st century, there has been a dramatic increase in the number of nosocomial infections associated with antibiotic exposure and an increase in the severity of the disease. Challenges of disease containment include emerging risk factors and recurrence. In 2008 the acute care costs, not including the economic burden placed outside of the hospital, was estimated to be around $4.8 billion in the US. As such, it has become clear that preventative measures are needed to monitor and reduce the risk of infection and recurrence.
While most people on antibiotics are at the greatest risk of developing Clostridium difficile, there are specific groups of people who also have a chance of being infected. This includes the older population, people who 's immune system is compromised such as cancer patients, people who have a feeding tube, and people who have come in contact with infected patients (Fordtran, 2006, pp. 3). Most cases of Clostridium difficile can be found in a healthcare setting. This includes nursing homes where the older population resides, hospitals where immune compromised patients are receiving treatment as well as patients on antibiotic therapy. (Mayo Clinic Staff, 2017). The bacteria is found in the stool. It is then passed from one person to another through contaminated surfaces. If a person touches a contaminated surface, then their contaminated hand touches their mouth or any other mucus membrane, they are at risk of developing the infection. Clostridium difficile can survive for long periods of time on these contaminated surfaces which is why healthcare settings have the highest record because germs spread quickly (Mayo Clinic Staff, 2017). When in contact with
Ingestion of the endospore causes infection. Once it reaches the preferred anaerobic environment of the gut, the endospores germinate and begin releasing toxins A and B (Burns & Minton 2011). The presence of C. difficile does not necessarily mean infection. A patient can be positive for C. difficile but have normal stool, which means there is colonization without infection. Patients who have the C. difficile pathogen without experiencing any symptoms allow it to be passed along undetected which contributes to the ongoing spread to others. Only when toxin A and toxin B are released at suitable levels does C. difficile become pathogenic to humans. Once infected, typical symptoms include watery diarrhea, abdominal pain, colitis, fever, and fecal leukocytes. Moderate to severe Clostridium difficile infection (CDI) consist of profuse diarrhea, abdominal distention, leukocytosis, systemic inflammatory response, pseudomembranous colitis, megacolon and death (Sunenshine & McDonald, 2006). With the combination of a highly resilient endospores, and asymptomatic carriers, this allows C. difficile to persist in the environment and spread to patients with compromised immune systems, or older patients who have a high risk of contracting CDI with a higher severity than healthy adults (Laffan, Bellantoni, Greenough, Zenilman, 2006).
Clostridium difficile is a spore forming, anaerobic, toxin-producing, gram-positive bacillus that is the most common cause of nosocomial, antibiotic-associated diarrhea (15-25%).1,2,3 The pathogenesis of C. difficile-associated diarrhea (CDAD) is the result of broad spectrum antibiotics, such as clindamycin, flouroquinolones or ceftriaxone, which reduces the population of normal bowel flora and allowing for an overgrowth of C. difficile.1,2 The toxins synthesized by C. difficile, A and B, lead to the inflammation and damage of the intestinal mucosa creating the symptoms of C. difficile infection (CDI). These symptoms can range from asymptomatic carriers, to mild diarrhea to sudden and occasionally deadly colitis. The clinical practice guidelines for the treatment of CDAD recommends the use of metronidazole (MET) and vancomycin (VAN) that is dependent upon the severity of the CDI.1,2,3
Clostridium difficile is a gram-positive spore-forming bacteria; first isolated and published in 1935 by Hall and O’Toole. This was accomplished from the stool of a healthy infant. However, it was not until 1978 that C. difficile was identified as being associated with many cases of antibiotic-resistant diarrhea.1 C. difficile has since become one of the leading causes of nosocomial infections in the United States. A study conducted in 2015 has estimated that C. difficile infection has an incident of 453,000 (95% confidence interval) in the United States.2 This has placed a tremendous burden on the US healthcare system. According to data from 2008, C. difficile infections have accumulated an excess cost of $4.8 billion to the US healthcare system.3
Clostridium difficile, or C. difficile for short, are words that every healthcare worker hates to hear that their patient has, or may potentially have. This spore forming bacterium has significant healthcare-associated infection potential. An especially virulent strain has affected health care facilities throughout the U.S. and North America in the past few years. What C. difficile is, its symptoms, how it is transmitted, and the prevention transmission are important issues to all healthcare workers. These questions and issues will be covered in this paper.
Clostridium difficile is a highly contagious infection of the colon that's hard to contain and occurs in many health care facilities. With the proper interventions, it can be prevented and contained. The purpose of this paper is to discuss an article about C. diff and give suggestions on how to avoid an outbreak at a health care facility.
Clostridium difficile or more commonly called C. difficile or C. diff is a spore producing rod shaped bacterium that can cause infections of which result in a broad spectrum of disease ranging from mild diarrhea and fever to pseudomembranous colitis and life threating inflammation of the colon. C. difficile commonly located in the feces of humans and is spread though spores. Over the last 20 years the prevalence of healthcare-associated C. difficile infection (CDI) has increased to an estimated prevalence of colonization as high as 50% in hospitalized patients. (Cohen et al., 2010) This rise in prevalence is associated with new epidemic strains of C. diff that, are causing in an increase of incidence and disease severity. C. difficile infections are most commonly associated with healthcare facilities like hospitals and long-term care facilities and are also the most common cause of infectious diarrhea in the healthcare setting. With the disease severity on the rise people who are most at risk are generally the ones already in the hospital and have lower immune response. C. difficile’s main rout of transmission is through direct or indirect contact with spores on a contaminated surface. After contact whether a person develops C. difficile or not, is directly connected with a person’s immune response. If the disease is contracted there are a variety of treatments available. Prevention before contraction is the main source of struggle with C. difficile especially in the
Clostridium difficile also known a C. difficile or C. diff is an inflammatory infection created in the intestine primarily caused by taking antibiotics. Most people don’t show symptoms of having the C. diff bacteria in your intestines until that person has taken a course of antibiotics. Clostridium difficile bacteria can be found anywhere in the environment. It is found is soil, water, human and animal feces, food products and processed meats (Mayo clinic staff, 2013). Treatments to cure C. diff include antibiotics and surgery. Once having C. diff you want to make sure that you can prevent from getting it again. The best way to prevent from getting
Clostridium difficile (C-diff) is a bacterium of the intestine that usually develops after the start of antibiotics in at risk patients. C-diff causes inflammation of the intestine by irritating the lining of the intestinal wall. C-diff can cause many symptoms with lose stool multiple times throughout the day for more than two days being the most common. Severe infections can lead to hemodynamic changes in the body that could lead to hospitalization and/or surgery. The spores from C-diff can be passed on from months if an affected surface is not properly cleaned after being exposed to the bacteria. Proper hand washing must take place to avoid ingestion of the bacteria. C-diff is a form
Clostridium Difficile is now considered to be one the most important causes of health care-associated infections. C. diff infections are also emerging in the community and in animals used for food, and are no longer viewed simply as unpleasant complications that follow antibiotic therapy. Since 2001, the prevalence and severity of C. diff infection has increased significantly, which has led to research on C. diff. This research summarizes C. diff background, causes, symptoms, infection occurs, diagnosis, treatment, and prevention. This will give the reader some type of aspect about C.diff.
Clostridium difficile is a gram positive, anaerobic, spore forming bacillus. In 1935 it was first described as member of the intestinal flora in healthy neonates [1] , and then in 1978 it was recognised as a cause of diarrhoea [2]. Today it is widely acknowledged as the leading cause of hospital-acquired diarrhoea. This organism can cause a variety of diseases, from mild diarrhoea to severe pseudomembranous colitis, and collectively these are known as C. difficile infections (CDIs) [3]. It is known that the symptoms seen in patients infected with C. difficile are due to the toxins (toxin A and toxin B) that are produced by the organism [4]. Some strains of C. difficile seem to have an increased virulence which can be associated with increased severity, recurrence and increased mortality. This increased virulence is thought to be a result of increased expression of toxins A, B [5]. There is also another toxin produced by C. difficile known as binary toxin, this is also thought to contribute towards increased virulence [6]. A particular strain of C. difficile that does seem to have increased virulence is the strain known as PCR ribotype O27 or North American pulsed (NAP)-field type 01. In Europe PCR ribotype O27 is the sixth most common ribotype [7], and new ribotypes are being detected that appear to have evolved from the O27 lineage [8], making the need for a method to demonstrate strain relatedness highly important. In a hospital setting knowing the
Clostridium difficile is a bacterium that is found in the human colonic flora that can cause diarrhea and more serious conditions, such as colitis. This occurs if the physiological bacterial flora is changed or damaged due to prolonged antibiotic use and if the concentration of C. difficile increases significantly. The prolonged antibiotic use enables C. difficile to multiply and produce large amounts of dangerous toxins. Therapy for those who suffer from this includes rehydration, immediate stop of the causative antibiotic (usually clindamycin or amoxicillin), and new antibiotics to reverse the symptoms such as vancomycin. C. difficile is easily transmitted within hospital settings because its spores are resistant to the commonly used alcohol
Most of the public have heard of broad-spectrum drugs, especially in terms of antibiotic resistance, because they fight a wide range of bacteria but also kills normal flora in the gut (Haddox, 2013). The loss of this gut flora can lead to an abnormal growth of harmful bacteria such as clostridium difficile (C-Diff). The four “C” antibiotics that have a high risk for patient to develop C-diff are clindamycin, cephalosporins, coamoxiclav, and ciprofloxacin (Haddox, 2013). These antibiotics have the highest risk of leading to C-diff development, however all antibiotics increase a patient’s likelihood of a C-diff infection. This effect can last up to 12 weeks post antibiotic administration (Haddox, 2013).