Severe Clostridium difficile infection: incidence and risk factors at a tertiary care university hospital in Vienna, Austria.

BACKGROUND: Clostridium difficile infection (CDI) is the major cause of hospital-acquired bacterial diarrhoea. The incidence of CDI has been increasing in Canada, the US and Europe and severe cases are becoming more common. METHODS: A retrospective cohort study investigating all patients with an episode of CDI present at the Vienna University Hospital between 01 January 2012 and 31 December 2012 was conducted. All microbiologically confirmed C. difficile toxin positive cases were included, ribotyped and analysed regarding their clinical course. RESULTS: A total of 278 patients with CDI were recorded, with an overall CDI incidence of 5.23 per 10,000 patients-days. Around 84,5 % (235/278) of CDI cases would have been classified as severe CDI according to European Society of Clinical Microbiology and Infectious Diseases (ESCMID) if all criteria were used. According to Society for Healthcare Epidemiology of America and the Infectious Diseases Society of America (SHEA/IDSA) guidelines only 16.5 % (46/278) could be classified as severe; with a severe CDI incidence of 4.41 and 0.86 per 10,000 patient-days, respectively. Multivariate analysis showed only a co-morbidity index of ≥ 3 (p = 0.013) as independent risk factor for severe CDI. No link between ribotype 027 and severity or clustering was observed in our study population. CONCLUSIONS: Special attention in terms of restrictive antibiotic prescription should be given to patients having a Charlson co-morbidity ≥ 3 at the time of hospital admission. SHEA/IDSA guidelines were more accurate than ESCMID criteria in predicting severe CDI in our collective, of mostly severely ill patients, in a tertiary care hospital setting.

Comparison of 3 severity criteria for Clostridium difficile infection.

Effective severity criteria are needed to guide management of Clostridium difficile infection (CDI). In this retrospective study, outcomes were compared between patients with mild-moderate versus severe CDI according to 3 different severity criteria: those included in the 2010 Society for Healthcare Epidemiology of America/Infectious Diseases Society of America guidelines, those from a recent clinical trial, and our hospital-specific guidelines.

Risk of Clostridium difficile-associated disease among patients receiving proton-pump inhibitors in a Quebec medical intensive care unit.

Our study was conducted to determine whether use of gastric acid-suppressive agents increased the risk of Clostridium difficile-associated disease (CDAD) in a medical intensive care unit of one of the first hospitals to be threatened by the current CDAD epidemic in Quebec, Canada. Our findings suggest that efforts to determine risk factors for CDAD should focus on other areas, such as older age and antibiotic use.

Factores de riesgo relacionados con enterocolitis necrotizante en el servicio de neonatología, Hospital Escuela Oscar Danilo Rosale Argüello en el período comprendido de enero a diciembre del 2000 / Factors of risks related with necrotizing enterocolitis in the neontology service, Hospital Oscar Danilo Rosales Argüello, in the period incrluded from juanuary to december of 2000

Se realizó un estudio descriptivo en el Hospital Escuela Oscar Danilo Rosales, León Nicaragua, en el período comprendido de enero a diciembre del 2000, en el servicio de neonatología. Durante el período de estudio se registraron 18 casos de enterocolitis necrotizante ingresados en la unidad de cuidados intensivos neonatales. Entre los factores epidemiológicos maternos se determino que la edad materna menor de 19 años no es factor de riesgo de enterocolitis necrotizante. Entre los datos neonatales la asfixia estuvo presente en el 44.4 porciento de los casos y en los controles de 16.7 porciento. El peso que predominó en los casos estaba entre el rango de 1500 a 1999 gramos en un 38.9 porciento para los casos, correspondo al 18.5 porciento en los controles con 66.7 porciento. La prematurez se encontró en el 77.8 porciento de los casos y en los controles fue de 18.5 porciento, los recién nacidos a términos correspondió al 22.2 porciento. Para los casos y al 81.5 porciento para el grupo control

Multisystem organ failure and capillary leak syndrome in severe necrotizing enterocolitis of very low birth weight infants.

BACKGROUND: Classification systems for necrotizing enterocolitis (NEC) in preterm infants have been developed to define severity grades relevant for treatment and prognosis. Multisystem organ failure (MSOF) and capillary leak syndrome (CLS) also have prognostic value in these patients. The aim of this retrospective study was to investigate the incidence and predictive value of MSOF and CLS according to the classification criteria. METHODS: The records of 1,022 very low birth weight infants admitted from 1982 to 1996 were reviewed for diagnosis of NEC stage IIA or higher (classification of Walsh and Kliegman). Among those patients (n = 50) the incidence of MSOF and CLS was determined, separately for surgical or conservative treatment. RESULTS: Twelve patients were assigned to stage II, 22 to stage IIIa, and 16 to stage IIIb; 31 infants underwent operation. Mortality rate was not influenced by the grade. In eight patients only gastrointestinal symptoms were found, whereas in 23 patients, up to three organ systems and in 19 patients, four or more organ systems were affected. Mortality depended on the number of involved organ systems. CLS occurred postoperatively in 10 of the 31 infants; eight of them died. CONCLUSION: The prognostic values of MSOF and CLS are higher than that of classification criteria in NEC of VLBW infants.

[The corroborative capacity and value of imaging diagnosis and duplex sonography in newborn infants with necrotizing enterocolitis]. / Aussagefähigkeit und Stellenwert von bildgebender Diagnostik und Duplexsonographie bei Neugeborenen mit nekrotisierender Enterokolitis.

In this prospective study 101 sonographic examinations of superior mesenteric artery blood flow velocities, indices and blood flow volume were consecutively performed in 41 newborn to diagnose necrotising enterocolitis (NEC). Intramural and portal venous gas was also estimated. The artifacts of air in the AMS and the portal system were examined in an experimental study. The results of sonography and abdominal radiography were equivalent in the case of definitely established NEC, portal venous gas being more sensitive to detection by sonography. Abdominal radiography was indicated as the primary examination in case of a clearly identified clinical course. Sonography should be performed so that fewer radiographs will be required in the following course of disease.

[Nonocclusive intestinal infarct and necrotizing enterocolitis in the adult]. / Infarto intestinale non occlusivo ed enterocolite necrotizzante dell'adulto.

A case of full-thickness necrosis of the small bowel, and colon, which required partial resection of the jejunum and total resection of the ileum and colon is reported. The case gives the chance for a review of the Literature on intestinal necrosis not caused by vascular occlusion. Nonocclusive intestinal ischemia, acute neonatal necrotizing enterocolitis and adult necrotizing enterocolitis including the Pig-bel disease, common in Papua-New Guinea, are examined. Resemblances and differences in etiology, pathophysiology and clinical findings are discussed. The hypothesis that the process of "bacterial translocation" plays a central role in the pathogenesis of bowel infarction, representing therefore a possible link between infective and vascular mechanisms, is emphasized. Important suggestions on massive intestinal necrosis management are also reported.

An endoscopic study of antibiotic-associated hemorrhagic colitis.

Colonoscopy was performed on acute stage within 72 hours from onset in 48 patients with antibiotic-associated hemorrhagic colitis (AAHC). From our observations we have developed a new endoscopic classification of AAHC and investigated the incidence of each finding in further detail. We have classified in principle the endoscopic findings of the 48 subjects into two groups: major and minor ones respectively. Category of major findings were: 1) diffuse mucosal hemorrhage (100%); 2) spotty mucosal hemorrhage (100%), and 3) linear mucosal hemorrhage (22.9%), while minor findings were: 1) irregular ulcers in 10.4%; 2) aphthoid ulcers in 6.3%, and 3) linear erosions or ulcers in 4%. Minor findings were ulcers or erosions present over the hemorrhagic mucosa associated with the moderate degree of inflammation. A histopathologic study of colon biopsy specimens from 24 patients with AAHC showed hemorrhage and inflammatory cell infiltration in the lamina propria mucosae varying from mild to moderate in extent. It was concluded that AAHC was a colonic mucosal hemorrhagic disease caused by the destruction of mucosal vessels from unknown causes and in this disease mild to moderate inflammation was partially followed by ulceration over the edematous and hemorrhagic mucosa of the colon.

[Necrotizing enterocolitis of the newborn. Review for the clinician]. / L'entérocolite nécrosante du nouveau-né. Révision pour le clinicien.

With the advent of modern neonatology and the survival of most premature infants, necrotizing enterocolitis of the newborn (NEC) has become a relatively frequent illness. NEC, although affecting mainly premies, may still be found in any infant, even full term ones. We therefore believe that it is important for all physicians to become somewhat familiar with this entity. The pathogenesis of NEC is comprised of several variables: mesenteric ischemia, gastrointestinal immaturity, enteral feedings and even possibly infection. A diagnosis of NEC is based on a combination of clinical and radiological grounds. On radiographs, pneumatosis intestinalis and air in the portal vein are of special significance. NEC is classified in three broad categories: suspected NEC, definite NEC and advanced NEC. The treatment is either medical or surgical, depending on the severity and the evolution of the disease. It is important to emphasize that any infant who is deteriorating deserves very tight clinical and radiological follow-up. This follow-up should take place in a center where pediatric surgeons are ready to intervene rapidly should there be a need. Even if in some cases NEC is very severe, sometimes fatal, approximately 85% of infants suffering from it survive and among them more than 70% do so without any long term sequelae.

Enterocolite necrotizante: análise de 34 casos / Necrotizing enterocolitis: analysis of 34 cases

Foram analisados 34 casos de enterocolite necrotizante neonatal. Os autores demonstraram os prováveis fatores desencadenates e, considerando os critérios atuais de classificaçäo, correlacionaram os achados clínicos e radiológicos observados nessa condiçäo

A review of pigbel (necrotising enteritis) in Papua New Guinea, 1961-1984.

Pigbel has been recognised as a major cause of mortality and morbidity in the Papua New Guinea Highlands for over 20 years. The clinical features, epidemiology and pathogenesis of this disease have been elucidated, leading to the development of an effective vaccine (Clostridium perfringens type C beta toxoid) for the prevention of pigbel.