The epidemiology of Clostridium difficile infection in a national kidney transplant center.

BACKGROUND: We aimed to describe the epidemiology and outcomes of CDI in a national kidney transplant center from 2008 to 2015. METHODS: Adult kidney and kidney-pancreas transplant recipients were included for analysis if they met the surveillance CDI case definition. Rates of new healthcare-associated CDI (HA-CDI) were expressed per 10 000 KTR/KTPR bed days used (BDU) to facilitate comparisons. RESULTS: Fifty-two cases of CDI were identified in 42 KTRs and KPTRs. This corresponded to an average annual rate of 9.6 per 10 000 BDU, higher than that seen among general hospital inpatients locally, nationally, and internationally. Of the 45 cases (87%) that were considered HA-CDI, nine (20%) had symptom onset in the community. Recent proton-pump inhibitor (PPI) and broad-spectrum antimicrobial exposure preceded the majority of cases. KTRs and KPTRs with CDI had a longer mean length of hospital stay (35 days) than those KTR and KPTRs admitted during the same period that did not have CDI (8 days). CONCLUSIONS: Education regarding CDI must be extended to transplant recipients and their general practitioners. Other targets for future CDI rate reduction must include stringent antimicrobial stewardship (both in hospital and in the community) and judicious PPI prescribing.

Necrotizing fasciitis: The need for urgent surgical intervention and the impact of intravenous drug use.

BACKGROUND: Necrotizing fasciitis (NF) is a relatively rare infection of soft tissues. This study reviewed the epidemiology and pathophysiology of admissions to a tertiary referral hospital over a twelve year period comparing outcomes and findings with international norms and to identify potential areas of change to optimise outcomes. STUDY DESIGN: A retrospective review of patients diagnosed with NF from Jan 1st 1999 to Dec 31st 2011 was performed. Patient demographics, risk factors, operative procedures, microbiology results and outcomes were recorded. Comparative analysis was performed. RESULTS: 37 patients were admitted with NF, comprising 30 males and 7 females with a median age of 55 years. The most common site of infection was the perineum (51%). The overall mortality rate was 29% and was significantly associated with age greater than 60 years (p = 0.0018) and the presence of one or more risk factor (p = 0.0046). The number of surgical procedures ranged from one to fifteen with a median length of stay of 35.5 days. There was a significant increase in the number of admissions in 2009-2010 (p < 0.001), coinciding with the emergence of NF in intravenous drug users (IVDU). 43% of patients (n = 16/37) required skin grafting, which was significantly higher in the IVDU group (n = 5/6, p = 0.0232). CONCLUSIONS: Necrotizing fasciitis remains a significant life-threatening event. The diversity of causative pathogens emphasises the need for prompt microbiology/infectious diseases consultation. The increased occurrence within the IVDU cohort in this study highlights the need for a heightened level of clinical suspicion in these patients to prompt early surgical intervention.