Diss. (sammanfattning) Uppsala : Sveriges lantbruksuniv., 2004. / Härtill 4 uppsatser.

Inom sjukvården finns det två former av isolering. Smittskyddsisolering är till för att hindra smittspridning när en person blir smittad av en infektion som kan vara farlig för allmänheten och skyddsisolering används när en person är extra infektionskänslig, exempelvis efter cytostatikabehandling för cancer. Syftet med studien var att beskriva hur patienter upplever isoleringsvård inom den somatiska slutenvården. Vald metod var en litteraturstudie där åtta kvalitativa artiklar användes. Sex teman identifierades i resultatet: Behov av anhöriga, Behov av stöd från sjuksköterskan, Känsla av instängdhet, Behov av kontroll, Behovet av information och Känslan av frihet. Studien visade att isolering leder till känslor av ensamhet, känslan av övergivenhet, psykisk ohälsa och skam. Det visade sig att behovet av medmänsklig kontakt och information var av stor betydelse för patienter för att kunna hantera sin tid under isolering. Många beskrev att det inte bara var negativt att ha ett eget rum utan det gav känslor av ro och underlättade vid besök. Att ha tillgång till tv, telefon och internet var för patienterna olika sätt för att få stimulans och få tiden att gå, som annars kunde kännas långsam. Sjuksköterskan var ett viktigt stöd och en källa till medmänsklighet. Att ha ett fönster med utsikt över omgivningen gjorde upplevelsen mer uthärdlig för flertalet av patienterna.

The widespread use of antibiotics has led to dramatic increases in the incidence and severity of Clostridium difficile infection (CDI). No group of patients suffers more from CDI than the elderly. Nursing homes (NH) represent the perfect storm of a vulnerable group of frail elders living in confined communities. Nursing home residents suffer from increased morbidity and mortality from CDI and corresponding high rates of C. difficile colonization. Upwards of 40 to 50% of CDI current cases originate from NHs and the prevalence of colonization rates remain high within these facilities, with as many as half of the residents being colonized with C. difficile at any given time. One factor that has become of increasing interest and a target of preventive strategies is the human intestinal microbiome. A healthy, diverse microbiome interacts with the host immune system and contributes to pathogen resistance. In this investigation, we first examine elder specific variables to determine if the associated risks of CDI differ by home living environment (nursing home versus community-dwelling). We then go on explore the relationships of NH environment, frailty, nutritional status, and residents’ age with microbiome composition and potential metabolic function. Finally, we describe the C. difficile colonization patterns among elderly NH residents and the associated risk of colonization based on clinical variables and microbiome determinants. A better understanding of the microbiome’s contribution to C. difficile colonization will provide the basis for informing rational interventions and public health policies to better combat CDI in the nursing home.

Clostridium difficile is the most common bacterial cause of infectious diarrhoea in healthcare environments and in 2014 was responsible for 13,785 infections in the UK. C. difficile infection (CDI) is spread via the faecal-oral route and by contact with contaminated surfaces. However, despite the healthcare concerns no tests are available to validate if sufficient cleaning has been conducted. In addition, Polymerase Chain Reaction (PCR) and Enzyme Immunoassays (EIAs)-based tests used to diagnose CDI lack sensitivity and specificity and hence false negative results are commonly obtained. To overcome these concerns the aim of the PhD research has been to develop the first diagnostic test that exploits the specific interactions of C. difficile bacteriophages (phages), viruses that specifically infect and kill C. difficile. In order to develop a C. difficile phage-based test, first suitable phages that can be used for the test were identified and this was conducted by screening 35 different C. difficile phages against 160 clinically relevant C. difficile isolates. Five phages were found to infect the most number of isolates and were investigated further to identify whether a phage-based diagnostic could be developed based on phages binding (adsorption) to different C. difficile subgroups. However, for all five phages, adsorption rates were not consistently high for C. difficile subgroups in comparison to other common bacteria found in similar locations to C. difficile. Therefore, to increase specificity of the phage-based diagnostic test a new approach was taken by tagging two phages with luminescence luxAB genes (reporter phages), which would be expressed once C. difficile cells were infected with the phages. To design the C. difficile reporter phages, non-essential phage genes were replaced with the luxAB genes, but this study revealed mutagenesis of C. difficile was troublesome and extensive optimisation was required. In addition, once the reporter phages had successfully been constructed the luxAB genes were unstable within the phage genome and were lost during phage replication. Despite extensive optimisation and due to time constrains the luxAB genes were not stabilised within the phages but future work will focus on stabilising the genes.

Background: The use of antimicrobials has been presented as a significant risk factor for Clostridium difficile infection (CDI). Nevertheless, it remains unclear which antimicrobials are more likely to be associated with CDI. It is mandatory for acute trusts to report the numbers of diagnosed CDI cases to the Health Protection Agency (HPA). There is no national system to collect and analyse antimicrobial usage data from the trusts. The company IMS collects antimicrobial usage data from the trusts for creating marketing research statistics. Therefore, it was hypothesised that data collected from the HPA and from IMS could be used to undertake an ecological study about the association between CDI cases and antimicrobial use in English trusts. Methods: A trust-level Antimicrobial Usage Database provided by IMS and a database, including the numbers of CDI cases for patients aged 65 years old and above, provided by the HPA, were utilised in this work. These referred to 26 out of the 29 NW SHA trusts (that managed 64 hospitals) for the quarters between 2005 and 2008 inclusive. A sample of antimicrobial usage data collected directly from trusts was used to investigate potential limitations in using the Antimicrobial Usage Database for the purpose of this work. Multilevel models were used to study antimicrobial usage and the number of CDI cases over time. These models were also used to investigate the association between the CDI cases and antimicrobial usage in the trusts. The trends of trust antimicrobial usage over time were compared with DH recommendations for the prevention of CDI through antimicrobial prescribing published in 1994, 2005 and 2008. Results: Discrepancies between the antimicrobial usage recorded in the IMS database and in a sample of antimicrobial usage data collected from trusts were found for 31 out of 155 antimicrobial usage records; only 1 of these referred to an antimicrobial with high usage. Eight out of the 23 antimicrobial groups and 10 out of 63 antimicrobials were presented as having high usage. The antimicrobial usage over time increased significantly for 7 antimicrobial groups, decreased significantly for 2 groups and remained constant for 54 groups. The number of CDI cases reported for patients aged 65 years old and above decreased significantly over the time. Trust antimicrobial usage over time changed in the opposite direction compared to the DH recommendations published in 1994, 2004 and 2008, respectively, for 2 out of 11, 3 out of 12 and 3 out of 14 antimicrobial groups/antimicrobials. The increased usage of 5 antimicrobial groups was significantly associated with an increase in the number of CDI cases and an increased usage of 4 antimicrobial groups was significantly associated with a decreased number of CDI cases. Within the antimicrobial groups that were significantly associated with an increased number of CDI cases, the usage of 8 individual antimicrobials was significantly associated with the CDI cases. Discussion/Conclusion: Collecting antimicrobial usage over time for large groups of trusts is very time consuming and requires extensive data manipulation. The similarity of the results of this study with those of previously published studies suggest that HPA and IMS data may be used to investigate the association between CDI cases and antimicrobial usage in English trusts.

Clostridium difficile ist einer der führenden Nosokomialkeime in Bezug auf postoperative Diarrhoe. Die Inzidenz ist steigend und der Verlauf bei fulminanter Infektion häufig fatal. Es besteht der Anspruch der Vermeidung schwerer Verläufe und der horizontalen Verbreitung des Erregers. Ziel der Arbeit war, für den prä-, intra- und postoperativen Zeitraum Risikofaktoren zu identifizieren, welche Einfluss auf Ausprägung und Schwere der Infektion hatten. Die vorliegende klinische Studie umfasst 2.823 Patienten mit Diarrhoe nach kardiochirurgischem Eingriff, darunter 1.256 Patienten mit Clostridium-difficile-Nachweis, welche im Herzzentrum Leipzig von April 1999 bis April 2011 operativ versorgt worden sind. Die Datenanalyse erfolgte retrospektiv an zuvor festgelegten Parametern, die mittels statistischer Verfahren analysiert wurden. Besonderes Augenmerk wurde auf die Entwicklung gastrointestinaler Komplikationen und die Mortalität gelegt. Risikofaktoren für eine fulminante CDI waren u.a. männliches Geschlecht, kardiopulmonale Komorbiditäten, Diabetes mellitus Typ II, Verwendung von Assist-Systemen, perioperative Transfusionstherapie, sowie lange Operationszeiten und ein verlängerter Aufenthalt auf Intensivstation. Das Überleben bei fulminanter Infektion war mit einer Sterblichkeit von 63,4% bei einer 30-Tages-Mortalität von 21,6% deutlich schlechter als das der Vergleichsgruppen. Die Identifikation der perioperativen Risikofaktoren soll eine individualisierte Stratifizierung und damit die optimale Überwachung von Hochrisikopatienten für einen frühen Therapiebeginn und im besten Falle eine Prävention möglich machen.

Thesis advisor: Catherine Y. Read / Background. Clostridium difficile infections (CDI) account for 20-30% of healthcare-acquired infections, resulting in serious patient and economic burdens. CDI incidence has grown rapidly due to overuse of antibiotics and an aging population, posing a significant public health threat. Fecal microbiota transplantation (FMT) using donor stool has demonstrated clinical efficacy rates up to 94% and long-term restoration of a healthy intestinal microbiome. Challenges with donor screening, lack of research about optimal stool donor characteristics and intestinal microbiome composition, and a poorly fit screening model, create barriers to the availability of FMT. Purpose. This study aimed to generate essential information about FMT donor characteristics predictive of passing the screening and donor intestinal microbiome compositions associated with FMT clinical efficacy. The primary aims were to 1) identify previously unstudied characteristics of prospective FMT donors that are predictive of passing a stool bank’s screening process; and 2) determine whether donor intestinal microbial diversity is related to FMT clinical efficacy in preventing recurrent CDI. Methods. This study was conducted as a secondary analysis on a cohort of previously screened donors (n=770). Aim 1 was tested through a logistic regression of donor characteristics (gender, age, body mass index, frequency of bowel movements, diet, tobacco and alcohol use, and seasonality) with screening outcomes. Aim 2 was tested through a simple regression evaluating donor intestinal microbial diversity and rates of FMT clinical efficacy. Results. One donor characteristic in the logistic regression, frequency of bowel movements (p = 0.018), was significantly predictive of whether a donor passed the screening. Specifically, donors who had fewer than two bowel movements per day were more likely to pass. All other characteristics were not predictive. Similarly, the linear regression evaluating alpha diversity and FMT clinical efficacy was not significantly predictive of clinical efficacy (p = 0.140). Conclusion. Findings were used to support recommendations for improving prospective donor screening that nurses and other clinicians can implement to decrease challenging logistics, reduce costs and barriers, and potentially increase FMT clinical efficacy. / Thesis (PhD) — Boston College, 2019. / Submitted to: Boston College. Connell School of Nursing. / Discipline: Nursing.

No description available.

Study Objective: To compare the rates and severity of hospital-acquired Clostridium difficile infection (CDI) among patients taking proton pump inhibitors (PPIs) versus those not taking PPIs. Design: Retrospective, single-center, cohort study. Setting: Tertiary community hospital with a teaching service. Patients: A total of 41,663 patients with CDI who were hospitalized between January 2013 and May 2014; of those, 17,471 patients (41.9%) had received at least one dose of a PPI (PPI group), and 24,192 patients (58.1%) had no PPI exposure (control group). Measurements and Main Results: A total of 348 patients had CDI during the study period, with 269 cases present on admission. Hospital-acquired CDI was defined as CDI diagnosis occurring on or after the third calendar day of admission. After excluding those patients with CDI on admission, 65 (0.38%) of 17,302 patients later developed CDI in the hospital in the PPI group compared with only 14 (0.058%) of 24,092 patients in the control group. Of these patients, 36 patients (0.21%) in the PPI group met the definition of severe CDI compared with 8 (0.03%) in the control group. This demonstrated an unadjusted relative risk (RR) of 6.46 (95% confidence interval [CI] 3.63–11.51, p<0.0001) of developing hospital-acquired CDI and an unadjusted RR of 6.27 (95% CI 2.91–13.48, p<0.0001) of developing severe CDI while taking a PPI. When evaluating only patients who developed severe-complicated CDI, there were 22 cases in the PPI group and 2 cases in the control group, demonstrating an unadjusted RR of 15.3 (95% CI 3.6–65.13, p=0.0002) of developing severe-complicated CDI. Confounding variables were similar between groups. Conclusion: PPI use was associated with an increase in both the rate and severity of hospital-acquired CDI.

No description available.