Clostridium difficile, a bacterium that causes diarrhea in hospitalized patients, is on the rise in the United States as well as in other countries. This study was done to determine the extent of the problem in Florida's acute care hospitals. The Agency for Healthcare Administration (AHCA) provided data for patients discharged from Florida's acute care hospitals for the years 1998 through 2004. This study will focus on changes in the prevalence of Clostridium difficile associated disease (CDAD) over time. The mortality and morbidity of patients that have CDAD will also be examined to show if the disease is increasing over time. Factors investigated in this study that may influence the prevalence of CDAD include gender, race, length of hospital stay, age, and the cost per patient discharged. In Florida the prevalence of CDAD has risen from 3.41 per 1,000 discharged patients in 1998 to 8.11 per 1,000 discharged patients in 2004. The mortality increased from 9.48% for CDAD positive patients in 1998 to 10.11% for CDAD positive patients in 2004. Age plays a role in both the prevalence and mortality of this disease. In 2004 the mortality of patients who were positive for Clostridium difficile was 4.1% for those individuals that were 30-40 years old compared to 0.54% mortality for those patients in the same age group that did not have CDAD. The corresponding mortality for the patients aged 70-80 for the year 2004 was 11.1% for persons who had CDAD and 3.58% mortality for patients discharged with no CDAD. The analysis showed that CDAD prevalence is increasing in Florida acute care hospitals. During 1998-2004 mortality rates for patients diagnosed with CDAD is also increasing. This analysis also indicates that age is a factor that increases the death rates for patients that are CDAD positive. A more concerted effort to implement hospital techniques that prevent the increasing prevalence of Clostridium difficile in Florida hospitals is recommended.

Class of 2014 Abstract / Specific Aims: Clostridium difficile associated diarrhea (CDAD) frequently occurs in patients exposed to broad-spectrum antibiotics which can result in a life threatening illness. The role of probiotics in the prevention of CDAD is not well established and many medical centers across the United States are opting to remove probiotics from common CDAD prophylaxis. We aim to evaluate the efficacy of lactobacillus probiotics during the use of broad-spectrum antibiotic therapy in the acute care setting for the prophylaxis of CDAD at Kindred Hospital. Methods: We performed a single center, retrospective data analysis efficacy trial of inpatients receiving beta-lactam, fluoroquinolone or clindamycin antibiotics from the Kindred Hospital database. Two study groups will be compared: patients who received lactobacillus probiotic therapy based on protocol since May 2011 and patients who did not receive probiotic therapy. The presence or absence of CDAD will be used to evaluate probiotic efficacy. Main Results: Of the ### patients screened, ## were assigned to the treatment group and ## were assigned to the non-treatment group, a total of ## patients were analyzed for the primary endpoint. CDAD occurred in ## patients (xx%) receiving probiotic therapy while CDAD occurred in ## patients (xx%) not receiving probiotic therapy (relative risk [RR]: xx.x; p=0.xxx). Conclusion: [Anticipated] We identified no statistically significant evidence that the use of lactobacillus was effective in the prevention of CDAD. Further knowledge of the pathophysiology of CDAD and proper antibiotic use is needed for future studies.

Class of 2012 Abstract / Specific Aims: To identify the number of Clostridium difficile-associated disease (CDAD) cases in hospitalized oncology patients between 2005 and 2009. To identify the occurrence of mortality, comorbidities, and the amount of hospital charges in this patient population. Predictive variables for mortality and hospital charges were also identified. Methods: Data retrieved from the Nationwide Inpatient Sample were used to retrospectively identify the number of CDAD cases in hospitalized oncology patients, the occurrence of mortality and comorbidities, and the amount of hospital charges incurred between 2005 and 2009. Multivariate logistic regression was used to identify predictors of mortality and a lognormal regression was used to identify predictors of inpatient charges. Main Results: From 2005 to 2009, we identified 210,449 cases of CDAD in hospitalized adult patients with cancer. Total inpatient charges for all CDAD cases over the five-year period exceeded 18 billion dollars. The percentage of cases that resulted in death was 13%. Variables that were found to be predictors of mortality included increased age (OR 1.019, CI 1.018-1.020), chronic pulmonary disease (OR 1.231, CI 1.191-1.272), coagulopathy (OR 2.085, CI 2.011-2.162), liver disease (OR 1.159, CI 1.072-1.253), fluid and electrolyte disorders (OR 1.561, CI 1.518-1.605), renal failure (OR 1.405, CI 1.349-1.462), and weight loss (OR 1.408, CI 1.362-1.456)(all p<.001). Conclusions: This study identified a large number of CDAD cases in hospitalized adult cancer patients. Several factors that appeared to be predictive of mortality and inpatient charges were also identified, which may be useful knowledge for clinicians who need to identify at-risk patients.

Introduction: Recently, Clostridium difficile has garnered both national and international attention, occurring with greater frequency, severity and resistance to standard treatments. In 2001, Clostridium difficile-associated disease, CDAD, became epidemic and its rate doubled from 2000 to 2003. As a substantial cause of healthcare-associated morbidity, CDAD is no longer just a pharmacotherapy nuisance. Specifically, the objectives of this research are to determine the incidence of both primary and secondary cases of CDAD among patients in the UHC database, determine how many primary cases had previous admissions with secondary cases of CDAD, and determine how many primary cases go on to be readmitted as primary or secondary cases.Methods: This cross-sectional study used the dataset from the University HealthSystem Consortium (UHC) covering the first quarter of 2002 through the second quarter of 2006, to identify the incidence of primary and secondary CDAD within hospitals participating in the UHC's Clinical Resource Manager (CRM) program. The UHC-CRM database was used to provide epidemiologic data in regards to CDAD cases, hospital-wide variables and patient characteristics. The data was analyzed using SAS statistical software.Results: During the time period studied, a total of 17,636 CDAD cases were identified out of 2,805,901 total hospital discharges. Of those, 80.4% or 14,178 fit the definition of primary with 3,454 cases labeled as secondary. The mean discharge rate of primary CDAD cases, per 1,000 adult discharges among CRM-participating hospitals per quarter, ranged from 3.14 (SD 2.33) to 6.72 (SD 4.0). The mean incidence of secondary CDAD per 1,000 adult discharges among CRM-participating hospitals per quarter, ranged from 0.79 (SD 0.74) to 1.59 (SD 0.86). The mean discharge rate of all CDAD cases, per 1,000 (adult discharges) among CRM-participating hospitals per quarter, ranged from 3.93 (SD 3.04) to 8.11 (SD 4.52). The rate of CDAD case discharges shows an increasing trend, more than doubling from 2002 to 2006. Among previous primary CDAD admissions, 7.75% were readmitted as a primary CDAD cases (p-value Conclusions: CDAD cases are on the rise, with all CDAD cases diagnosed on discharge from doubling from 2002 to 2006. There is no current national surveillance system for tracking CDAD cases. This study begins to shed light on the increasing incidence of CDAD cases within the hospital setting. By providing a baseline, future research can use this information to make more extensive tracking and surveillance systems for CDAD cases.

Class of 2006 Abstract / Background: The processes’ underlying a recent rise in the rate of Clostridium difficile associated diarrhea (CDAD) at the Southern Arizona Veterans Administration Health Care System (SAVAHS) is unclear. Past changes to formulary in workhorse oral flouroquinolone from levofloxacin to gatifloxacin are under scrutiny. An infection-control component was also possible. Methods: 142 patients suspected of having CDAD had stool specimens submitted for toxin assay from late July to late Oct of 2004. A retrospective chart review was performed using the Veterans Administration Computerized Patient Record System (CPRS) to examine total antibiotic use in the three months prior to having specimens submitted for laboratory toxin analysis. A subset-analysis was performed on 100 specimens submitted for toxin analysis. Parallel culture was performed and 9 isolates of C. difficile were obtained for molecular analysis and fingerprinting. Results: Of the 142 patients sampled, 20 tested positive for C. difficile toxin with the remaining 122 patients testing negative. Antibiotic usage was categorized by total antibiotic use and gatifloxacin use. 98 patients received at least 1 antibiotic within the preceding 3 months with 44 patients receiving no antibiotic therapy of any kind. Of the 98 patients that received antibiotic therapy, 44 received gatifloxacin, however, all of these patients also received at least one other antibiotic. Of the nine isolates fingerprinted, two distinct genetic clusters were identified.

This is a two-part project. Proton pump inhibitors (PPIs) have been associated with increased risk of C. difficile infections and increased toxin production when combined with antimicrobial therapy. The first part of this project involved characterization of a hypervirulent NAP1 C. difficile strain, including genome sequencing and assembly, and the development of methods to study its transcriptomics using RNA-Seq, which will enable future researchers to study different expression patterns when toxigenic C. difficile is challenged with PPIs and/or antimicrobials in vitro. The second part of this project involved characterizing a clinical isolate of a NAP1 C. difficile displaying a markedly elevated MIC to metronidazole (MIC = 16 mg/mL), which initially exhibited MIC of 32 mg/mL. A method of obtaining a metronidazole-susceptible revertant from this isolate was developed and a revertant was obtained. The genomes of both isolates were sequenced, assembled, and aligned, then compared to each other for polymorphisms.

This is a two-part project. Proton pump inhibitors (PPIs) have been associated with increased risk of C. difficile infections and increased toxin production when combined with antimicrobial therapy. The first part of this project involved characterization of a hypervirulent NAP1 C. difficile strain, including genome sequencing and assembly, and the development of methods to study its transcriptomics using RNA-Seq, which will enable future researchers to study different expression patterns when toxigenic C. difficile is challenged with PPIs and/or antimicrobials in vitro. The second part of this project involved characterizing a clinical isolate of a NAP1 C. difficile displaying a markedly elevated MIC to metronidazole (MIC = 16 mg/mL), which initially exhibited MIC of 32 mg/mL. A method of obtaining a metronidazole-susceptible revertant from this isolate was developed and a revertant was obtained. The genomes of both isolates were sequenced, assembled, and aligned, then compared to each other for polymorphisms.

Clostridium difficile is a major cause of infectious diarrhea in hospitalized patients. Clostridium difficile-associated disease (CDAD) is of gaining importance now due to its increasing incidence and severity. However, little is known about the C. difficile infections in the Czech Republic. The aim of the study was to characterize C. difficile strains recently isolated (2008 to 2011) from patients hospitalized with gastrointestinal disease in four Prague health care institutions using molecular typing methods; PCR toxinotyping, PCR ribotyping and MLVA (multilocus variable number tandem repeat analysis). Among 273 C. difficile strains, we identified 8 toxinotypes (0, III, IV, V, VI, VIII, IX a XXIII) and 63 ribotypes, of which ribotypes 596 (23,4 % patient), 017 (13,9 %) and 176 (7 %) were the most frequent. According to PCR ribotyping, the situation in the Czech Republic is the most similar to the situation in Poland. Within ribotypes 017, 017/1 and 017/2 and ribotypes 596 and 596/1, 5 and 4 distinct clusters were identified by MLVA, none of which was institution-specific. Additionally, pathogenic C.difficile were isolated from piglet faeces (63,3 %) in a single piglet farm, evaluating the role of C. difficile as an emerging animal pathogen. All piglet isolates belonged to the toxinotype 0 and the ribotype...

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