Prevalence and trends of Clostridioides difficile infection among persons requiring maintenance hemodialysis: A systematic review and meta-analysis.

OBJECTIVE: Clostridioides difficile infection (CDI) is among the most common cause of healthcare-associated infections. Persons requiring maintenance hemodialysis (MHD) are at increased risk of CDI and associated mortality compared to persons not requiring MHD. Given the clinical impact of CDI among persons requiring MHD, we aimed to quantify the burden of CDI and trends over time in this patient population. STUDY DESIGN: A systematic review and meta-analysis of studies reporting rates of CDI among persons requiring MHD in MEDLINE, Embase, Web of Science Core Collection, CINAHL, and Cochrane Central Register of Controlled Trials were performed. Searches were conducted on May 17, 2021, and March 4, 2022. RESULTS: In total, 2,408 titles and abstracts were identified; 240 underwent full text review. Among them, 15 studies provided data on rates of CDI among persons requiring MHD, and 8 of these also provided rates among persons not requiring MHD. The pooled prevalence of CDI among persons requiring MHD was 19.14%, compared to 5.16% among persons not requiring MHD (odds ratio [OR], 4.35; 95% confidence interval [CI], 2.07-9.16; P = .47). The linear increase in CDI over time was significant, increasing an average of 31.97% annually between 1993 and 2017 (OR, 1.32; 95% CI, 1.1-1.58; P < .01). The linear annual increase was similar among persons requiring and not requiring MHD (OR, 1.28; 95% CI, 1.13-1.45; P = .11). CONCLUSIONS: Persons requiring MHD have a 4-fold higher risk of CDI compared to persons not requiring MHD, and rates of CDI are increasing over time in both groups.

Pneumocystis pneumonia in a treatment-naive rheumatoid arthritis patient.

A HIV-negative, newly diagnosed patient with rheumatoid arthritis (RA) was found to have pneumocystis jiroveci pneumonia. The infection was treated with three weeks of atovaquone and corticosteroids. Clinicians should be aware of pneumocystis pneumonia as an infection in RA patients not receiving treatment.

Resolution of atrial-ventricular block secondary to Listeria monocytogenes with antimicrobials.

Listeria endocarditis is a rare, but serious disease with high mortality rate. Currently, little is known regarding the optimal treatment modality of Listeria endocarditis in affected individuals. Here, we present the case of a 66-year-old female with history of mitral and aortic replacement with bioprosthetic valve, and hospital course complicated by Listeria monocytogenes infective endocarditis with atrial-ventricular (AV) block. Listeria monocytogenes infection was eradicated by a 6-week antimicrobials course involving ampicillin and gentamicin, culminating in the resolution of AV block. On further investigation, the patient admitted to frequent consumption of salami and provolone cold-cut sandwiches, which based on previous evidence in literature is hypothesized to be the source of infection. Our findings suggest the development of perivalvular abscesses as the cause of the AV block. To our knowledge, this is the first reported case in literature where AV block secondary to listeriosis resolved with treatment solely by antimicrobials. While further research and larger studies are needed to extend our findings, patients with AV block secondary to listeriosis may benefit from optimized management with antimicrobials.