ABSTRACT
Few standardised data are available on mortality rates in patients with Clostridium difficile infection (CDI). The literature often reports 'attributable' mortality or cannot be universally applied. We aimed to investigate the pattern and trends in all-cause mortality in a large unselected cohort of patients affected by CDI. This was done by means of a retrospective cohort study between 2002 and 2008 of all patients with positive stool toxin tests indicating CDI in one National Health Service (NHS) Trust, comprising three general hospitals and seven community hospitals. Vital status of the patients was determined from two sources. In total, 2571 patients with a first episode of CDI were identified (1638 females; median age 82.1 years). Cumulative mortality at 7 days, 14 days, 30 days and 1 year was 13.4%, 20.8%, 32.5% and 58.7%, respectively. There was no significant difference in mortality between sex, year of diagnosis or hospital site. Mortality at 30 days increased incrementally from 3.4% in those aged <40 years to 41% in those >90 years. Mortality rates were significantly higher than reported by previous studies but were remarkably consistent over the time period and between different hospitals within the Trust. Prognosis falls with increasing age, and the age of this cohort may explain the high 30-day absolute mortality. CDI infection is associated with high early mortality. To reduce mortality, new interventions need to be introduced soon after diagnosis. There is a need for standardised outcome data for CDI.
Subject(s)
Clostridioides difficile/isolation & purification , Clostridium Infections/microbiology , Clostridium Infections/mortality , Cross Infection/microbiology , Cross Infection/mortality , Adult , Aged , Aged, 80 and over , Bacterial Toxins/analysis , Cohort Studies , Feces/chemistry , Female , Hospitals , Humans , Male , Middle Aged , Retrospective Studies , United Kingdom/epidemiologyABSTRACT
Resistance to third-generation, or extended-spectrum, cephalosporins caused by induction of class I beta-lactamases has been reported rarely from developing countries. Seven isolates of cephalosporin-resistant Gram-negative rods were recovered recently from urine, burns and ulcers in the Queen Elizabeth Hospital, Barbados. The isolates were identified as Acinetobacter calcoaceticus (2), Citrobacter freundii (1), Enterobacter cloacae (1), Morganella morganii (1), Providencia stuartii (1) and Proteus sp. (1). Induction of beta-lactamase by cefoxitin was demonstrated, and minimal inhibitory concentrations (MIC) were determined by agar dilution. beta-lactamases were demonstrated by isoelectric focusing; the presence of chromosomal beta-lactamases was confirmed in at least three of the resistant isolates. The only antibiotics which were uniformly active against these resistant strains were imipenem and ciprofloxacin. These data confirm the existence of resistance to the third-generation cephalosporins in Barbados, and emphasise the necessity for continuous surveillance of resistance patterns in the Caribbean region.
Subject(s)
Cephalosporins/pharmacology , Gram-Negative Bacteria/drug effects , Barbados , Drug Resistance, Microbial , Gram-Negative Bacteria/classification , Gram-Negative Bacteria/isolation & purification , Humans , Microbial Sensitivity TestsABSTRACT
Resistance to third-generation, or extended-spectrum, cephalosporins caused by induction of class I B-lactamases has been reported rarely from developing countries. Seven isolates of cephalosporin-resistant Gram-negative rods were recovered recently from urine, burns and ulcers in the Queen Elizabeth Hospital, Barbados. The isolates were identified as Acinetobacter calcoacetius (2), Citrobacter freundii (1), Enterobacter cloacae (1), Morganella ;morganii (1), Providencia stuartii (1) and Proteus sp. (1). Induction of B-lactamase by cefoxitin was demonstrated, and minimal inhibitory concentratrions (MIC) were determined by agar dilution. B-lactamases were demonstrated by isoelectric focusing; the presence of chromosal B-lactamases were confirmed in at least three of the resistant isolates. The only antibiotics which were uniformly active against these resistant strains were imipenem and ciprofloxacin. These data confirm the existence of resistance to the third-generation cephalosporins in Barbados, and emphasise the necessity for continuous surveillance of resistance patterns in the Caribbean region. (AU)
Subject(s)
Humans , Gram-Negative Bacteria/drug effects , Cephalosporins/pharmacology , Drug Resistance, Microbial , Barbados , Gram-Negative Bacteria/isolation & purificationABSTRACT
Resistance to third-generation, or extended-spectrum, cephalosporins caused by induction of class I B-lactamases has been reported rarely from developing countries. Seven isolates of cephalosporin-resistant Gram-negative rods were recovered recently from urine, burns and ulcers in the Queen Elizabeth Hospital, Barbados. The isolates were identified as Acinetobacter calcoacetius (2), Citrobacter freundii (1), Enterobacter cloacae (1), Morganella ;morganii (1), Providencia stuartii (1) and Proteus sp. (1). Induction of B-lactamase by cefoxitin was demonstrated, and minimal inhibitory concentratrions (MIC) were determined by agar dilution. B-lactamases were demonstrated by isoelectric focusing; the presence of chromosal B-lactamases were confirmed in at least three of the resistant isolates. The only antibiotics which were uniformly active against these resistant strains were imipenem and ciprofloxacin. These data confirm the existence of resistance to the third-generation cephalosporins in Barbados, and emphasise the necessity for continuous surveillance of resistance patterns in the Caribbean region.
