ABSTRACT
In recent years, the incidence and severity of Clostridium difficile infections has increased.Additionally, resistance of C. difficile to frequently used antibiotics is rising. To improve ourunderstanding of C. difficile, there is a need for molecular characterization of different strains andantibiotic resistance testing. We investigated the efficacy of GenoType CDiff kit (Hain Lifesciences)in identification of C. difficile and its various strains in northern Israel. The kit involves a molecularassay that detects C. difficile from stool samples or colonies and identifies the different strains andmutations in the gyrA gene that cause moxifloxacin resistance. Forty-nine C. difficile positive sampleswere examined by the kit following DNA extraction from both colonies and stool. The identificationrate (95.9%) of C. difficile was much higher when DNA was extracted from colonies, compared toextraction from stool (46.9%). Low frequencies of ribotype027 strain (2%) and of ribotype078 strain(4%) were found. There was a high concordance between genotype (mutation in gyrA) andphenotype (Etest) for moxifloxacin resistance (Kappa=0.72). A high percentage of moxifloxacinresistantstrains was found. Our findings indicate that the GenoType CDiff kit is very effective incharacterization of C. difficile strains and less effective for identification of C. difficile directly fromstool samples.
ABSTRACT
OBJECTIVE: The Institute of Medicine (IOM) recommended a gestational weight gain for full-term twin pregnancies of 17-25 kg for normal Body mass Index patients', and characterize its guidelines on during twin pregnancies as "provisional". Indeed, they are exclusively based on observational epidemiological data. The objective of this study was to investigate whether the IOM's gestational weight gain guidelines are optimal for maternal and neonatal. OUTCOMES STUDY DESIGN: We included all consecutive twin pregnancies delivering two live births retrospectively. Monoamniotic pregnancies, major congenital abnormalities, twin-to-twin transfusion syndrome, patients with missing gestational weight gain data in the last month before delivery, and patients with a body mass index (BMI) ≤18.5 were excluded. To control for gestational length, we divided the total weight gain by the gestational age in weeks at the last weight measurement to obtain the weight gain per week. Patients were classified as having low gestational weight gain, adequate gestational weight gain, or excessive gestational weight gain, with the results adjusted for BMI and tobacco use. RESULTS: There were 878 patients in our level-III university hospital maternity ward who met the inclusion criteria in 1997-2013. Excessive gestational weight gain women had greater rates of preeclampsia than adequate gestational weight gain women did. Low gestational weight gain women showed a lower rate of gestational hypertension than AGWG women did. Delivery before 37 weeks of gestation (26.9% vs. 17.3%, p = 0.009), birth weight <2500 g, respiratory distress syndrome, and transfer to the neonatal intensive care unit were more frequent in the LGWG group compared with the AGWG group. Apgar score <7 at 5 min were more frequent in the EGWG group. CONCLUSION: Adequate gestational weight gain was associated with better outcomes. Our results suggest that the IOM guidelines for twin pregnancy are appropriate and therefore should be routinely used.
