Diagnostic and infection control strategies for Clostridioides difficile infections in a setting of high antimicrobial resistance prevalence.

Autor:	Bertolino L; Department of Precision Medicine, University of Campania 'L. Vanvitelli', Naples, Italy., Patauner F; Department of Precision Medicine, University of Campania 'L. Vanvitelli', Naples, Italy., Gagliardi M; Department of Precision Medicine, University of Campania 'L. Vanvitelli', Naples, Italy., D'Amico F; Department of Precision Medicine, University of Campania 'L. Vanvitelli', Naples, Italy., Crivaro V; 'Monaldi' Hospital, AORN Ospedali dei Colli, Naples, Italy., Bernardo M; 'Monaldi' Hospital, AORN Ospedali dei Colli, Naples, Italy., Scherillo I; 'Santa Maria delle Grazie' Hospital, Pozzuoli, Naples, Italy., Bellitti F; 'Santa Maria delle Grazie' Hospital, Pozzuoli, Naples, Italy., Cusano C; A.O.U. 'Sant'Anna e San Sebastiano', Caserta, Italy., Greco R; A.O.U. 'Sant'Anna e San Sebastiano', Caserta, Italy., Panetta V; A.O.U. 'Sant'Anna e San Sebastiano', Caserta, Italy., Durante A; A.O.U. 'Sant'Anna e San Sebastiano', Caserta, Italy., Di Caterino A; 'San Giuseppe Moscati' Hospital, Aversa, Italy., Frieri A; 'Sant'Angelo dei Lombardi' Hospital, Avellino, Italy., Cioffi G; A.O.U.S. Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy., Nappo M; A.O.U.S. Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy., Corrado M; 'Umberto I' Hospital, Nocera, and DEA Nocera-Pagani-Scafati, Italy., Lanzieri M; 'Umberto I' Hospital, Nocera, and DEA Nocera-Pagani-Scafati, Italy., Sabatini P; 'Umberto I' Hospital, Nocera, and DEA Nocera-Pagani-Scafati, Italy., Bettelli R; 'San Giuseppe Moscati' Hospital, Avellino, Italy., Dello Russo R; 'San Giuseppe Moscati' Hospital, Avellino, Italy., Taddeo ML; 'San Giuseppe Moscati' Hospital, Avellino, Italy., Petrone R; 'Luigi Curto' Hospital, Polla, Italy., Di Sevo MG; 'Luigi Curto' Hospital, Polla, Italy., Iannuzzo M; Fatebenefratelli Hospital, Naples, Italy., Iervolino M; A.O. S. Pio, Benevento, Italy., Buonocore R; A.O. S. Pio, Benevento, Italy., D'Agostino F; A.O. S. Pio, Benevento, Italy., Gambardella M; 'San Luca' Hospital, Vallo della Lucania, Italy., De Martino A; 'San Paolo' Hospital, Naples, Italy., Spagnuolo S; 'San Paolo' Hospital, Naples, Italy., Savarese M; 'San Paolo' Hospital, Naples, Italy., Sole S; A.O. 'Santobono Pausilipon', Naples, Italy., Russo C; A.O. Cardarelli, Naples, Italy., Agozzino E; Dipartimento di Medicina Sperimentale, Università della Campania 'L. Vanvitelli', AOU della Campania 'L. Vanvitelli', Naples, Italy., Galdiero M; Dipartimento di Medicina Sperimentale, Università della Campania 'L. Vanvitelli', AOU della Campania 'L. Vanvitelli', Naples, Italy., Martino R; Istituto NazionaleTumori-IRCCS 'Fondazione G. Pascale', Naples, Italy., Calemma R; Istituto NazionaleTumori-IRCCS 'Fondazione G. Pascale', Naples, Italy., Sciambra A; Ospedale Evangelico Betania, Naples, Italy., Aprea C; Ospedale Evangelico Betania, Naples, Italy., Colaccio D; 'S. Giuseppe Melorio' Hospital, S. Maria Capua Vetere, Italy., Di Guida P; 'S. Alfonso Maria de Liguori' Hospital, S. Agata dei Goti, Italy., Venditti M; Fatebenefratelli Hospital, Benevento, Italy., Montella E; A.O.U. 'Federico II', Naples, Italy., Guerriero F; 'Landolfi Solofra' Hospital, Solofra, Italy., Perrotta R; 'Landolfi Solofra' Hospital, Solofra, Italy., Di Filippo U; 'S. Francesco d'Assisi Hospital', Oliveto Citra, Italy., Pizza A; Agropoli Hospital, Italy., Di Fronzo A; 'S. Giovanni di Dio' Hospital, Frattamaggiore, Italy., Lombardi A; 'S. Giovanni di Dio' Hospital, Frattamaggiore, Italy., Capuano L; Rizzoli Hospital, Ischia, Italy., De Stefano A; 'Santa Maria della Pietà' Hospital, Casoria, Italy., Mastropietro A; Maddaloni Hospital, Italy., Mastro M; Piedimonte Matese Hospital, Italy., Loffreda R; Piedimonte Matese Hospital, Italy., Maccarone L; Marcianise Hospital, Italy., Di Tora A; 'San Rocco' Hospital, Sessa Aurunca, Italy., Oto S; Ariano Irpino Hospital, Italy., Tammaro C; Ariano Irpino Hospital, Italy., Mondelli AC; Roccadaspide Hospital, Italy., Ruocco M; 'Dell'Immacolata' Hospital, Sapri, Italy., Ferraro B; 'Dell'Immacolata' Hospital, Sapri, Italy., Petrosino A; 'Maria SS. Addolorata' Hospital, Eboli, Italy., Presta SSA; 'Santa Maria della Speranza' Hospital, Battipaglia, Italy., Durante Mangoni E; Department of Precision Medicine, University of Campania 'L. Vanvitelli', Naples, Italy; Unit of Infectious and Transplant Medicine, AORN Ospedali dei Colli - Monaldi Hospital, Naples, Italy.
Jazyk:	angličtina
Zdroj:	Le infezioni in medicina [Infez Med] 2021 Mar 01; Vol. 29 (1), pp. 70-78.
Abstrakt:	Clostridioides difficile (CD) is a major nosocomial pathogen and the leading cause of antibiotic-associated diarrhoea. In light of the strong association between antimicrobial use and CD infections (CDI), it may be hypothesised that areas at higher prevalence of antimicrobial resistance, like the region of Campania in southern Italy, could also have a higher rate of CDI. In this multicentre, region-based, prospective study, we analysed such issues, exploiting CDI incidence data collected from local hospitals. In 2016, the Italian National Centre for Disease Control supported a project involving three Italian regions: Friuli Venezia Giulia, Lazio and Campania. In Campania, a network of 49 hospitals willing to participate in the project was created. The project consisted of two phases: a survey on practice patterns concerning CDI and an epidemiological surveillance study. We identified a stringent need to improve awareness about CDI among the regional health-care community, as a widespread lack of surveillance programmes for CDI control was observed (existing in only 40% of participating facilities). Moreover, almost half of the participating hospitals (n=16, 43%) had no standardised procedures or protocols to control and prevent CDI. In the second phase of the study, we collected data of CDI cases during a six-month surveillance programme. In all, 87 CDI cases were observed, for a total of 903,334 patient bed-days and 122,988 admissions. According to the above data, CDI incidence was 0.96 cases/10000 patient bed-days, much lower than expected based on prior studies conducted elsewhere. The results of our study suggest CDI remains a rather neglected clinical issue in Campania. Despite a high burden of antimicrobial resistance and antimicrobial use in our geographic setting, we observed a very low incidence of CDI. Such a low incidence could be explained by underdiagnosis, but could also be related to actual diet, the lower patient age or the specific genetic background. However, further studies are warranted to either confirm or rebut the above hypotheses.
Databáze:	MEDLINE
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