Clo stridium diffic ile Asympto ma tic Ca rrie rs T he Hidde n - - PowerPoint PPT Presentation

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Oct 11, 2022 327 likes •1.48k views

Clo stridium diffic ile Asympto ma tic Ca rrie rs T he Hidde n Pa rt o f the I c e b e rg ?

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  • Clo stridium diffic ile

Asympto ma tic Ca rrie rs – T he Hidde n Pa rt o f the I c e b e rg ?

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Disc lo sure s

  • Merck Canada, BD Diagnostics, AMD Medical, Canadian

Institute for Health Research

  • Merck Canada, Pfizer
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  • OBJE

CT I VE S

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BACK GROUND

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Ba c kg ro und

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Ba c kg ro und

1 out of ever y 200 patients a dmitte d in a c ute

c a re institutio ns in Que b e c de ve lo p CDI

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Pre ve ntio n o f CDI

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Guide line s

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Ba c kg ro und

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  • 4
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  • Stochastic modeling: food would

be responsible for < 1 newly colonized patient /1,000 adms.

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Asympto ma tic Ca rrie rs

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I NCRE ASI NG I NT E RE ST ON C. DI F F I CI L E COL ONI ZAT I ON

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CD-AC a re not a s c o nta g io us a s CDI pa tie nts… b ut a lmo st!

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Ho w nume ro us a re CD-AC?

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Mo de ling Studie s

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Rapid detection of colonized patients can significantly affect the prevalence of CDI and its control, especially in the context of asymptomatic carriers and in-ward transmission.

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  • T

yping Studie s

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  • CDI, HA

CDI, Non-HA CD carrier Screening test (mainly admission) CD carrier Toxin test* Environ. sample

ML VA to tra c k a c q uisitio n o f CDI

* CDI test + (CCNA) but symptoms do not fulfill criteria for CDI

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  • Future infection control measures?
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I nstitut Unive rsita ire de Ca rdio lo g ie e t Pne umo lo g ie de Qué b e c

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  • HA-CDI

ra te s, 2004-2013

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Co ntro l o f CDI

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Co ntro l o f CDI

  • f

CD carriers in CDI

  • to

AC

  • new set of
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CD-AC me a sure s

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RE AL L Y ?

Can’t we just improve standard precautions?

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  • C. diffic ile c a rrie r

I nfe c tio n c o ntro l me a sure s

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  • Similar to CDI patients with

few exceptions:

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Why g lo ve s?

Why not only soap and water ?

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Ha nd wa shing vs.

  • C. diffic ile
  • E

ve n the best ha nd hyg ie ne te c hniq ue is poor

ly effective

to re mo ve C. diffic ile fro m ha nds!

e.g. ABHRS against E. coli: 3.5 to 5 log reduction

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E ffic a c y o f g lo ve s

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Pro phyla xis fo r C. diffic ile c a rrie rs?

secondary prophylaxis

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De te c tio n o f c a rrie rs

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De te c tio n o f c arrie rs

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De te c tio n o f c arrie rs

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De te c tio n o f c arrie rs

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De te c tio n o f c a rrie rs

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De te c tio n o f c a rrie rs

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De te c tio n o f c a rrie rs

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De te c tio n o f c a rrie rs

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De te c tio n o f c a rrie rs

PCR GDH

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F a lse +?

gene by homebrew PCR

396 tested; 16 ACDC detected

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ANAL YSI S

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Outc o me s

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E xte rna l c o ntro l

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He a lthc a re -Asso c ia te d CDI I nc ide nc e ra te in Que b e c , 2004-2014

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I nc ide nc e ra te a mo ng unive rsity ho spita ls, 2011-2012

QHLI

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Ana lyse s

  • Intervention period vs. pre-intervention period
  • Poisson regression (accounts for seasonality)
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RE SUL T S

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Ca rria g e ra te o n a dmissio n

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ARI MA mo de ling

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Se nsitivity a na lyse s

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Po te ntia l Co nfo unde rs

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Po te ntia l Co nfo unde rs

Increased from 37% to 50% during intervention (p<0.001)

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Antimic ro b ia l a nd PPI use

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Antimic ro b ia l use

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Antimic ro b ia l use

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Antimic ro b ia l use

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Antimic ro b ia l a nd PPI use

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Anti-CDI a ntimic ro b ia ls

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I nte nsity o f CDI te sting

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% o f ne g a tive CDI te sts

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L ONG-T E RM F

  • llo w-up
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L

  • ng -te rm I

mpa c t

0.0 5.0 10.0 15.0 20.0 25.0 30.0 35.0

1 5 9 13 17 21 25 29 33 37 41 45 49 53 57 61 65 69 73 77 81 85 89 93 97 101 105 109 113 117 121 125 129 133 137 141 145 149 153 157 161

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L

  • ng -te rm I

mpa c t

0.0 5.0 10.0 15.0 20.0 25.0 30.0 35.0

1 5 9 13 17 21 25 29 33 37 41 45 49 53 57 61 65 69 73 77 81 85 89 93 97 101 105 109 113 117 121 125 129 133 137 141 145 149 153 157 161

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L

  • ng -te rm fo llo w-up
  • QHLI
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I mpa c t o f the I so la tio n Pre c a utio n Burde n

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  • Figure. Prevalence of isolation- days for C. difficile infection (CDI) or colonization April 2008- August 2016. Data presented as the number of isolation- days per 1,000 patient- days per 4- week
  • period. Averages represent the average isolation prevalence for C. difficile for the entire periods and for the first and last 12 months of the last period. Healthcare- associated CDI incidence rates

during each study period are presented on the lower panel. Abbreviations: CDI: Clostridium difficile infection; pd: patient- days

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  • Figure. Prevalence of isolation- days for C. difficile infection (CDI) or colonization April 2008- August 2016. Data presented as the number of isolation- days per 1,000 patient- days per 4- week
  • period. Averages represent the average isolation prevalence for C. difficile for the entire periods and for the first and last 12 months of the last period. Healthcare- associated CDI incidence rates

during each study period are presented on the lower panel. Abbreviations: CDI: Clostridium difficile infection; pd: patient- days

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  • Figure. Prevalence of isolation- days for C. difficile infection (CDI) or colonization April 2008- August 2016. Data presented as the number of isolation- days per 1,000 patient- days per 4- week
  • period. Averages represent the average isolation prevalence for C. difficile for the entire periods and for the first and last 12 months of the last period. Healthcare- associated CDI incidence rates

during each study period are presented on the lower panel. Abbreviations: CDI: Clostridium difficile infection; pd: patient- days

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SLIDE 96
  • Figure. Prevalence of isolation- days for C. difficile infection (CDI) or colonization April 2008- August 2016. Data presented as the number of isolation- days per 1,000 patient- days per 4- week
  • period. Averages represent the average isolation prevalence for C. difficile for the entire periods and for the first and last 12 months of the last period. Healthcare- associated CDI incidence rates

during each study period are presented on the lower panel. Abbreviations: CDI: Clostridium difficile infection; pd: patient- days

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  • Figure. Prevalence of isolation- days for C. difficile infection (CDI) or colonization April 2008- August 2016. Data presented as the number of isolation- days per 1,000 patient- days per 4- week
  • period. Averages represent the average isolation prevalence for C. difficile for the entire periods and for the first and last 12 months of the last period. Healthcare- associated CDI incidence rates

during each study period are presented on the lower panel. Abbreviations: CDI: Clostridium difficile infection; pd: patient- days

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Pro po rtio n o f Ca rrie rs with Re c e nt Ho spita liza tio n a t the QHL I

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Co st-Be ne fit E stima te

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Po te ntia l E c o no mic Va lue

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Co st-b e ne fit a na lysis

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Co st-b e ne fit a na lysis

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Unkno wns a nd Re se a rc h Ag e nda

  • Very pro-infection control hospital
  • carriers who must receive ATB?
  • ust receive ATB?
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GDH + but ToxAB -

Patients with diarrhea who are carriers of toxigenic

  • C. difficile but without detectable toxin levels :

are they contagious?

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Source of new CDI cases

  • : 3%
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  • C. diffic ile te sting – ma ny te sts, ma ny

po te ntia l use s

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Po te ntia l use o f CD c a rrie r iso la tio n during o utb re a ks?

Preliminary data from 2 healthcare centers

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  • CDI outbreaks are not created equal
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Ac kno wle dg e me nts

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