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Title: Jurnal Medical Aradean (Arad Medical Journal)
Abbreviated title: J. Med. Ar.
Publisher: "Vasile Goldis" University Press
Owner: Western University "Vasile Goldis" Arad, Romania
ISSN: 1224-3744
e-ISSN: 2067-7790

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ANTIMICROBIAL THERAPY AND CLOSTRIDIUM DIFFICILE INFECTION PDF Print E-mail

ANTIMICROBIAL THERAPY AND CLOSTRIDIUM DIFFICILE INFECTION

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Title: ANTIMICROBIAL THERAPY AND CLOSTRIDIUM DIFFICILE INFECTION
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Article_Title: ANTIMICROBIAL THERAPY AND CLOSTRIDIUM DIFFICILE INFECTION
Authors: 1Olariu T, 1*Nicolescu A, 2Chiorean A, 3Dunca E, 4Negru D, 5Olariu I
Affiliation: 1„Vasile Goldis” Western University of Arad, Department of Intensive Care, Arad, Romania
2„Iuliu Hatieganu” University of Medicine and Pharmacy, Department of Radiology and Medical Imaging, Cluj Napoca, Romania
3University of Petrosani, Faculty of Mining, Department of Management, Environmental Engineering, Geology, Petrosani, Romania
4County Emergency Hospital Clinic, Department of Laboratory, Arad, Romania
5„Vasile Goldis” Western University of Arad, Department of Dental Medicine, Arad, Romania
Abstract: The study intends to evaluate antibiotic therapy in Clostridium difficile infection (CDI) in order to determine infection fatality risk rates depending on patient's age and type of antibiotic therapy, assuming that those over 60 years old with broad spectrum cephalosporins and quinolones regimens are under aggravating risk factors. A number of 71 CDIs were analyzed of the 183 nosocomial infections registred in Arad Emergency Hospital taking into account patient age, previous admissions, contact with other ICD cases, prior antibiotic treatment and cases evolution. Gram positive bacteria have caused 52.5% of nosocomials, most of them assisted on surgical (17,7%), infectious diseases (15,6%,) and intensive care units ATI (12,5%). Most of them were enterocolitis (40,4%), urinary tract infections (21,8%) and nosocomial pneumoniae (16,1%). The CDI patients'average age was 67 years (extreme 20-88 years, Std.dev.14, 69). The gender ratio was F: M = 1.53, with fatal evolution for 12.7% of cases, the relative risk of death being 2.2791 for female patients. Broad-spectrum cephalosporins were given in 52.11% of cases and the relative risk for adverse outcome in patients over 60 years with ICD associated with third generation cephalosporins treatment was 17.6333 (P = 0.0430, 95% CI 1.0952 to 83.9138). CDI is the first cause of nosocomials in 2016 for Arad Emergency Hospital, being encouraged by broad-spectrum cephalosporins therapy in over 60 years old patients.
Keywords: nosocomial, Clostridium difficile, cephalosporins
References: 1. McDonald LC, Coignard B, Dubberke E, Song X, Horan T, Kutty PK. Recommendations for surveillance of Clostridium difficile-associated disease. Infection Control and Hospital Epidemiology; 28: 140-145, 2007.
2. Bartlett JG, Perl TM. The new Clostridium difficile—What does it mean?. N Engl J Med; 353: 2503-2505, 2005.
3. Bartlett JG, Chang TW, Gurwith M, Gorbach SL, Onderdonk AB. Antibiotic-associated pseudomembranous colitis due to toxin- producing clostridia. N Engl J Med.; 298: 531-534, 1978.
4. Bartlett JG, Moon N, Chang TW, Taylor N, Onderdonk AB. Role of Clostridium difficile in antibiotic-associated pseudomembranous colitis. Gastroenterology; 75: 778-782, 1978.
5. Bettin K, Clabots C, Mathie P, Willard K, Gerding DN. Effectiveness of liquid soap vs. chlorhexidine gluconate for the removal of Clostridium difficile from bare hands and gloved hands. Infect Control Hosp Epidemiol; 15: 697-702, 1994.
6. Bignardi GE. Risk factors for Clostridium difficile infection. J Hosp Infect.; 40: 1-15, 1998.
7. Dallal RM, Harbrecht BG, Boujoukas AJ, Sirio CA, Farkas LM, Lee KK, Simmons RL. Fulminant Clostridium difficile: an underappreciated and increasing cause of death and complications. Ann Surg.; 235: 363-372, 2002.
8. Fekety R. Guidelines for the diagnosis and management of Clostridium difficile-associated diarrhea and colitis. Am J Gastroenterol.; 92: 739-750, 1997.
9. Fekety R, Kim KH, Brown D, Batts DH, Cudmore M, Silva J Jr. Epidemiology of antibiotic-associated colitis; isolation of Clostridium difficile from the hospital environment. Am J Med.; 70: 906-908, 1981.
10. George RH, Symonds JM, Dimock F, Brown JD, Arabi Y, Shinagawa N, Keighley MRB, Alexander-Williams J, Burdon DW. Identification of Clostridium difficile as a cause of pseudomembranous colitis. BMJ; 1:695, 1971.
11. Gerding DN, Johnson S, Peterson LR, Mulligan ME, Silva J Jr. Clostridium difficile-associated diarrhea and colitis. SHEA Position Paper. Infect Control Hosp Epidemiol;16: 459-477, 1995.
12. Johnson S, Clabots CR, Linn FV, Olson MM, Peterson LR, Gerding DN. Nosocomial Clostridium difficile colonisation and disease. Lancet.; 336: 97-100, 1990.
13. Johnson S, Gerding DN. Clostridium difficile-associated diarrhea. Clin Infect Dis.; 26: 1027-1036, 1998.
14. Johnson SJ, Gerding DN. Clostridium difficile. In: Antimicrobial Therapy & Vaccines. 2nd ed. Yu V, et al. New York: Apple Trees Productions; 2002.
15. Larson HE, Price AB, Honour P, Borriello SP. Clostridium difficile and the aetiology of pseudomembranous colitis. Lancet.; 201:1063-1066, 1978.
16. Mayfield JL, Leet T, Miller J, Mundy LM. Environmental control to reduce transmission of Clostridium difficile. Clin Infect Dis.; 31: 995-1000, 2000.
Read_full_article: pdf/vol20/iss1/2 JMA  - Olariu.pdf
Correspondence: • Olariu Teodora, MD, PhD, Full Professor
„Vasile Goldis” Western University of Arad, Romania, Department of Intensive Care
No.86 Liviu Rebreanu Street, 310045, Arad, Romania, Phone: +40-257-212204
• Nicolescu Amalia, MD, PhD, Teaching Assistant
„Vasile Goldis” Western University of Arad, Romania, Department of Intensive Care
No.86 Liviu Rebreanu Street, 310045, Arad, Romania, Phone: +40-257-212204
• Chiorean Angelica, MD, PhD, Lecturer
„Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj Napoca, Romania”, Department of Radiology and Medical Imaging
No. 1-3 Clinicilor Street, 3400, Cluj-Napoca, Romania, Phone: +40-64-120933
• Dunca Emilia, Eng, PhD, Associate Professor
University of Petrosani, Faculty of Mining, Department of Management, Environmental Engineering, Geology
No.20 University Street, 332006, Petroșani, Romania, Phone: + 40-54-549749
• Negru Dana, MD, PhD
County Emergency Hospital Clinic, Arad, Department of Laboratory
No. 2-4 Andreny Karoly Street, Arad, 310037, Romania, Phone: +40 - 357407200
• Olariu Iustin, MD, PhD
„Vasile Goldis” Western University of Arad, Romania, Department of Dental Medicine
No.86 Liviu Rebreanu Street, 310045, Arad, Romania, Phone: +40-257-21220
Read full article
Article Title: ANTIMICROBIAL THERAPY AND CLOSTRIDIUM DIFFICILE INFECTION
Authors: 1Olariu T, 1*Nicolescu A, 2Chiorean A, 3Dunca E, 4Negru D, 5Olariu I
Affiliation: 1„Vasile Goldis” Western University of Arad, Department of Intensive Care, Arad, Romania
2„Iuliu Hatieganu” University of Medicine and Pharmacy, Department of Radiology and Medical Imaging, Cluj Napoca, Romania
3University of Petrosani, Faculty of Mining, Department of Management, Environmental Engineering, Geology, Petrosani, Romania
4County Emergency Hospital Clinic, Department of Laboratory, Arad, Romania
5„Vasile Goldis” Western University of Arad, Department of Dental Medicine, Arad, Romania
Abstract: The study intends to evaluate antibiotic therapy in Clostridium difficile infection (CDI) in order to determine infection fatality risk rates depending on patient's age and type of antibiotic therapy, assuming that those over 60 years old with broad spectrum cephalosporins and quinolones regimens are under aggravating risk factors. A number of 71 CDIs were analyzed of the 183 nosocomial infections registred in Arad Emergency Hospital taking into account patient age, previous admissions, contact with other ICD cases, prior antibiotic treatment and cases evolution. Gram positive bacteria have caused 52.5% of nosocomials, most of them assisted on surgical (17,7%), infectious diseases (15,6%,) and intensive care units ATI (12,5%). Most of them were enterocolitis (40,4%), urinary tract infections (21,8%) and nosocomial pneumoniae (16,1%). The CDI patients'average age was 67 years (extreme 20-88 years, Std.dev.14, 69). The gender ratio was F: M = 1.53, with fatal evolution for 12.7% of cases, the relative risk of death being 2.2791 for female patients. Broad-spectrum cephalosporins were given in 52.11% of cases and the relative risk for adverse outcome in patients over 60 years with ICD associated with third generation cephalosporins treatment was 17.6333 (P = 0.0430, 95% CI 1.0952 to 83.9138). CDI is the first cause of nosocomials in 2016 for Arad Emergency Hospital, being encouraged by broad-spectrum cephalosporins therapy in over 60 years old patients.
Keywords: nosocomial, Clostridium difficile, cephalosporins
References: 1. McDonald LC, Coignard B, Dubberke E, Song X, Horan T, Kutty PK. Recommendations for surveillance of Clostridium difficile-associated disease. Infection Control and Hospital Epidemiology; 28: 140-145, 2007.
2. Bartlett JG, Perl TM. The new Clostridium difficile—What does it mean?. N Engl J Med; 353: 2503-2505, 2005.
3. Bartlett JG, Chang TW, Gurwith M, Gorbach SL, Onderdonk AB. Antibiotic-associated pseudomembranous colitis due to toxin- producing clostridia. N Engl J Med.; 298: 531-534, 1978.
4. Bartlett JG, Moon N, Chang TW, Taylor N, Onderdonk AB. Role of Clostridium difficile in antibiotic-associated pseudomembranous colitis. Gastroenterology; 75: 778-782, 1978.
5. Bettin K, Clabots C, Mathie P, Willard K, Gerding DN. Effectiveness of liquid soap vs. chlorhexidine gluconate for the removal of Clostridium difficile from bare hands and gloved hands. Infect Control Hosp Epidemiol; 15: 697-702, 1994.
6. Bignardi GE. Risk factors for Clostridium difficile infection. J Hosp Infect.; 40: 1-15, 1998.
7. Dallal RM, Harbrecht BG, Boujoukas AJ, Sirio CA, Farkas LM, Lee KK, Simmons RL. Fulminant Clostridium difficile: an underappreciated and increasing cause of death and complications. Ann Surg.; 235: 363-372, 2002.
8. Fekety R. Guidelines for the diagnosis and management of Clostridium difficile-associated diarrhea and colitis. Am J Gastroenterol.; 92: 739-750, 1997.
9. Fekety R, Kim KH, Brown D, Batts DH, Cudmore M, Silva J Jr. Epidemiology of antibiotic-associated colitis; isolation of Clostridium difficile from the hospital environment. Am J Med.; 70: 906-908, 1981.
10. George RH, Symonds JM, Dimock F, Brown JD, Arabi Y, Shinagawa N, Keighley MRB, Alexander-Williams J, Burdon DW. Identification of Clostridium difficile as a cause of pseudomembranous colitis. BMJ; 1:695, 1971.
11. Gerding DN, Johnson S, Peterson LR, Mulligan ME, Silva J Jr. Clostridium difficile-associated diarrhea and colitis. SHEA Position Paper. Infect Control Hosp Epidemiol;16: 459-477, 1995.
12. Johnson S, Clabots CR, Linn FV, Olson MM, Peterson LR, Gerding DN. Nosocomial Clostridium difficile colonisation and disease. Lancet.; 336: 97-100, 1990.
13. Johnson S, Gerding DN. Clostridium difficile-associated diarrhea. Clin Infect Dis.; 26: 1027-1036, 1998.
14. Johnson SJ, Gerding DN. Clostridium difficile. In: Antimicrobial Therapy & Vaccines. 2nd ed. Yu V, et al. New York: Apple Trees Productions; 2002.
15. Larson HE, Price AB, Honour P, Borriello SP. Clostridium difficile and the aetiology of pseudomembranous colitis. Lancet.; 201:1063-1066, 1978.
16. Mayfield JL, Leet T, Miller J, Mundy LM. Environmental control to reduce transmission of Clostridium difficile. Clin Infect Dis.; 31: 995-1000, 2000.
*Correspondence: • Olariu Teodora, MD, PhD, Full Professor
„Vasile Goldis” Western University of Arad, Romania, Department of Intensive Care
No.86 Liviu Rebreanu Street, 310045, Arad, Romania, Phone: +40-257-212204
• Nicolescu Amalia, MD, PhD, Teaching Assistant
„Vasile Goldis” Western University of Arad, Romania, Department of Intensive Care
No.86 Liviu Rebreanu Street, 310045, Arad, Romania, Phone: +40-257-212204
• Chiorean Angelica, MD, PhD, Lecturer
„Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj Napoca, Romania”, Department of Radiology and Medical Imaging
No. 1-3 Clinicilor Street, 3400, Cluj-Napoca, Romania, Phone: +40-64-120933
• Dunca Emilia, Eng, PhD, Associate Professor
University of Petrosani, Faculty of Mining, Department of Management, Environmental Engineering, Geology
No.20 University Street, 332006, Petroșani, Romania, Phone: + 40-54-549749
• Negru Dana, MD, PhD
County Emergency Hospital Clinic, Arad, Department of Laboratory
No. 2-4 Andreny Karoly Street, Arad, 310037, Romania, Phone: +40 - 357407200
• Olariu Iustin, MD, PhD
„Vasile Goldis” Western University of Arad, Romania, Department of Dental Medicine
No.86 Liviu Rebreanu Street, 310045, Arad, Romania, Phone: +40-257-21220