Study Overview: Clostridium difficile infection (CDI) is a healthcare associated infection with significant morbidity and mortality, especially in elderly, hospitalized patients. Antibiotic associated diarrhea (AAD) is also a complication of antibiotic therapy with detrimental effects in hospitalized patients. The use of probiotics for primary prophylaxis of AAD and CDI in hospitalized patients is still controversial. Varying study quality as well as significant heterogeneity make drawing conclusions from prior literature a difficult task. This study was the largest to date examining the efficacy of probiotics in preventing AAD and CDI in hospitalized older patients in the United Kingdom. Study Overview Authors’ affiliations Affiliation with London School of Hygiene & Tropical Medicine, Several Hospitals with the UK Financial support Health Technology Assessment programme; National Institute for Health Research, UK. No pharmaceutical industry involvement. Methods (as described by the author) Design: Type of design, blinding, treatment allocation Randomized, Triple-Blinded (Patients, Research Team, Assessors), Placebo-Controlled Patients/Subjects: How enrolled or recruited/from where?, Inclusion/exclusion criteria, # enrolled per group, Baseline differences 5 Hospitals in the UK were included in the study. Inclusion Criteria: Hospitalized patients ≥ 65 years old, receiving 1 or more antibiotics (within past 7 days) were recruited. Exclusion Criteria: Pre-existing
Clostridium difficile infection or CDI is a disease that is caused from a severe mishap of the microbiota in the gut by antibiotics. This causes the patient to have persistent diarrheal problems from mild symptoms to very extreme and severe symptoms. In the past twenty years, this infection has been on the rise in numbers of problems in public health and has even caused a number of deaths. Although this is not the only infection the transplant can help conquer, C.difficile a great example to portray since in the past ten years it has become a growing health problem.
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 (C. diff) is a type of bacterium that can cause a person to endure diarrhea like symptoms to more drastic symptoms that may involve inflammation of the colon. Most people who come across C. diff are expected to be in a hospital setting for an extensive period of time. It is more accessible to acquire C. diff when a person is of old age, in a hospital setting, and taking antibiotic medication (Mayo Clinic, 2016). Normally, one would think that taking antibiotics would not cause any harm to the body, but would instead help the body fight off diseases. However, once a person who has been taking antibiotics for a long period of time stops taking them, such as in a nursing home or hospital setting, that person can develop some reactions in the absence of those antibiotics (Bartlett, 2012). This reaction, then allows the person to experience diarrhea symptoms, which lead to inflammation of the colon and more drastic colon problems.
Clostridium difficile is a Gram-positive, spore-forming, rod-shaped bacillus that is renowned for being the leading cause of hospital-acquired diarrhea in adult patients. C. difficile is present as normal intestinal flora within 3% to 5% of healthy people2, while its spores are ubiquitous in the environment, especially in hospital settings. It grows at an optimal temperature and pH of 37ºC and 6.5–7.5 respectively.1 It is an obligate anaerobic as it thrives in the absence of oxygen. It is highly motile with the presence of peritrichous flagella, which are evenly spread out along its surface. As briefly mentioned above, this evolving pathogen produces endospores. The bacterium produces dormant spores, which are extremely hardy and resistant to antibiotics, the host’s innate immune system, and once shed into the environment through the host’s feces, they are resistant to unfavorable aerobic conditions3 as well as several types of bleach-free disinfectants, which are commonly used in hospitals.3 The spores will germinate under the favorable conditions of the intestinal tract, resulting in the multiplication of vegetative cells, colonizing in the gastrointestinal tract. The vegetative cells release two powerful exotoxins upon adherence to the epithelial cells of the GI tract. Pathogenic strains of C. difficile produce two exotoxins: toxin A and toxin B. Toxin A is an enterotoxin that causes fluid excretion, resulting in fluid accumulation and watery diarrhea. Toxin B is a potent
Clostridium Difficile (C-Diff) is considered one of the most common infections a patient can acquire within their hospital stay. It is estimated that C-Diff is responsible for 337,000 infections and 14,000 deaths a year (Centers for Disease Control and Prevention, 2012). Working in the emergency department (ED), I have witness first hand how debilitating this gastrointestinal infection can be. Patients are admitted to the ED for having severe watery diarrhea, abdominal pain, and fever. Elderly patients are at increase risk for sepsis and dehydration related to recurrent infections. Appropriate management and education of C-Diff is optimal for patient survival and decrease contamination across lifespan.
Many Americans die each year from complications connected to Clostridium difficile. It can ill a significant number of individuals as well as animals. The Clostridium difficile infection is the result of poor hygiene, misuse, overuse of antibiotics and an aging population. In this paper I will be discussing the following topics, what clostridium difficile means, what it causes, signs and symptoms, complications, treatment and the prevention.
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
Clostridium difficile involves a gram-positive spore-forming bacterium, which is a normal element of the colon flora in people. The Clostridium difficile can cause antibiotic-associated diarrhea when the competing bacteria in the gut flora are all killed by antibiotic treatment. The Clostridium difficile infection is one of the serious healthcare-related infection and also a rising health care problem. In the early 1970s, the Clostridium difficile has been known to have the ability to cause pseudomembranous colitis. As stated, the infection is the most cause of nosocomial infectious diarrhea (Aktories & Wilkins, 2000). Individuals that are colonized with clostridium difficile serve as the reservoir for infection and this is by contaminating the environment with spores of such bacteria. This will lead to the spread of the organism on the health care worker’s hands or even through the use of medical equipment. In this paper, we are going to focus on the effective prevention strategies for clostridium difficile. What are the effective prevention strategies for clostridium difficile?
The healthcare professional can expect to encounter various conditions within their scope of experience. Clostridium difficile represents one of the most common and challenging nosocomial infections that can cause life-threatening complications such as hypervolemia, sepsis, pain, and peritonitis (Grossman and Mager 155). The recognition, diagnosis, treatment and inhibition of transmission of this bacterium are imperative in order to limit infection and prevent death.
Clostridium difficile was discovered and isolated from neonates in 1935. It was initially considered a component of the fecal flora of newborns and not thought to be pathogenic (Keessen, Gaastra, & Lipman, 2010). The history of C. diff and other antibiotic resistant pathogens are closely related with the history of antibiotics. The first antibiotic discovered was penicillin by Alexander Fleming while working with Staphylococcus. With this discovery, a surge of natural and synthetic drugs was discovered to treat bacterial infections. During the 1970s, clindamycin and cephalosporins were highly used as an effective antibiotic against bacterial infection but at the same time disrupted the normal, healthy bowel flora, allowing C.
CDI cannot be treated with many antibiotics, and as early as 2000 another strain appeared that was resistant to even more antibiotics, including fluoroquinolones (“Antibiotic/Antimicrobial Resistance.”). This new strain creates more toxins and can show up in people not normally considered at risk for CDI infection, like those who have not been hospitalized or treated with antibiotics (“C. difficile infection.”). This aggressive strain only adds more danger to an already resistant bacteria. As antibiotics became more common, they were prescribed for thousands of common illnesses. Over time, Clostridium difficile has built up a resistance to antibiotics to become a major concern. Even more frightening, it has started to appear in the community. In fact, the Centers for Disease Control rate it as an urgent threat. Superbugs like CDI are becoming a more ever-present threat and we must continually work towards newer and more effective treatments to counteract the bacterias frightening ability to resist us (“Antibiotic/Antimicrobial Resistance.”). CDI is just one of many superbugs, however, and others pose just as great a
Clostridium difficile infection is a suprainfection cause by prolong use of antibiotics. Board spectrum antibiotic such as Penicillins, clindamycin, and cephalosporins are the antimicrobial drugs most commonly associated with C difficile colitis. According to Owens, in his research, C. difficile is primarily acquired in hospitals. Spread by spores, it can colonize a patient’s gut after helpful gut bacteria are killed by antibiotics. Its toxins can cause severe diarrhea and colitis, and it can be fatal (Owens 2013). On the other hand Kim in his research agreed clostridium difficile infection has been considered a hospital-acquired infection. However, a recent population-based study found 41% of CDIs were actually community acquired. It is becoming apparent that community acquired CDI affects populations previously thought to be at low risk; younger patients and patients who had no exposure to antibiotics in the 12 weeks before the infection. Thus, it is necessary to advocate and teach patient about
Patients that come in with watery diarrhea are normally tested for Clostridium difficile. Watery diarrhea is the most common sign of an infection that is recurrent for about two to three times a day for mild to moderate infection and in addition to minor abdominal pain. Indications of a severe infection includes severe diarrhea occurring 10 to 15 times a day. More symptoms that a patient with a severe infection caused by Clostridium difficile might present are intolerable abdominal pain, fever, dehydration due to diarrhea, blood and pus in the stool, nausea, and elevated counts of white blood cells (Mayo Clinic Staff, 2013). However, people that are commonly at risk for infection of C. diff should be tested and those patients are ones that
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).