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Prevalence and Seasonality of Clostridioides difficile over 12 Years at a Tertiary Hospital in Brazil

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Abstract

Clostridioides difficile is the main pathogen responsible for antibiotic-associated diarrhea in adults. Besides its challenging diagnosis, C. difficile infection (CDI) causes substantial morbidity and mortality. Commercially, there are assays with different targets and performances in sensitivity and specificity. The objectives of this study were to: (1) evaluate the prevalence and seasonal variability of CDI rates at a tertiary hospital in southern Brazil over 12 years and (2) determine the impact of using a two-step algorithm test in the laboratory diagnosis. Between January 2007 and May 2019, fecal samples from 2275 patients were analyzed in a cross-sectional study. Four commercial tests were adopted for the diagnosis of CDI, the immunochromatographic test for toxin A from 2007 to 2010; the enzyme-linked immunosorbent assay method for toxins A and B from 2011 to March 2017; and the rapid enzyme immunoassay (EIA) for GDH and toxins A and B, associated with a Polymerase Chain Reaction (PCR) for the toxin B gene from June 2017 to 2019. The annual prevalence was 8.7% from 2007 to March 2017, increasing between June 2017 and 2019 to 14.7% when the C. diff Quik Chek Complete + GeneXpert C. difficile (two-step algorithm) test was adopted. The number of samples (691) and percentage of CDI cases (10.5%) were higher in winter, but the difference has no statistical significance (P > 0.05). An accurate diagnosis and adequate knowledge of the local seasonality of CDI allow the effective implementation of prevention and control strategies for nosocomial CDI, in addition to effective treatment for patients.

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Fig. 1
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Change history

  • 03 November 2022

    A spell error in the word “Clostridiodes” has been corrected to read as “Clostridioides” in the article title.

References

  1. Curry SR (2017) Clostridium difficile. Clin Lab Med 37(2):341–369. https://doi.org/10.1016/j.cll.2017.01.007

    Article  PubMed  Google Scholar 

  2. Leffler DA, Lamont JT (2015) Clostridium difficile infection. N Engl J Med 373(3):286–288. https://doi.org/10.1056/NEJMc1506004

    Article  Google Scholar 

  3. Guh AY, Mu Y, Winston LG, Johnston H, Olson D, Farley MM et al (2020) Trends in U.S. burden of Clostridioides difficile infection and outcomes. N Engl J Med 382(14):1320–1330. https://doi.org/10.1056/NEJMoa1910215

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Burnham CAD, Carroll KC (2013) Diagnosis of Clostridium difficile infection: an ongoing conundrum for clinicians and clinical laboratories. Clin Microbiol Rev 26(3):604–630. https://doi.org/10.1128/CMR.00016-13

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Crobach MJT, Dekkers OM, Wilcox MH, Kuijper EJ (2009) European Society of Clinical Microbiology and Infectious Diseases (ESCMID): data review and recommendations for diagnosing Clostridium difficile infection (CDI). Clin Microbiol Infect 15(12):1053–1066. https://doi.org/10.1111/j.1469-0691.2009.03098.x

    Article  CAS  PubMed  Google Scholar 

  6. Alcalá L, Marín M, Madrid M et al (2010) Comparison of ImmunoCard toxins A&B and the new semiautomated Vidas Clostridium difficile Toxin A&B tests for diagnosis of C. difficile infection. J Clin Microbiol 48(3):1014-101g5. https://doi.org/10.1128/JCM.01642-09

    Article  PubMed  PubMed Central  Google Scholar 

  7. Laboratory Detection of Toxigenic Clostridium difficile (2010). ASM.Org. Accessed 20 June 2020

  8. Cançado GGL, Silva ROS, Nader AP, Lobato FCF, Vilela EG (2018) Impact of simultaneous glutamate dehydrogenase and toxin A/B rapid immunoassay on Clostridium difficile diagnosis and treatment in hospitalized patients with antibiotic-associated diarrhea in a university hospital of Brazil. J Gastroenterol Hepatol 33(2):393–396. https://doi.org/10.1111/jgh.13901

    Article  CAS  PubMed  Google Scholar 

  9. Cançado GGL, Abreu ES, Nardelli MJ, Serwa P, Brachmann M (2021) A cost of illness comparison for toxigenic Clostridioides difficile diagnosis algorithms in developing countries. Anaerobe 70:102390. https://doi.org/10.1016/j.anaerobe.2021.102390

    Article  CAS  PubMed  Google Scholar 

  10. Venables WN, Ripley BD (2002) Generalized linear models in modern applied statistics with S. statistics and computing. Springer, New York

    Book  Google Scholar 

  11. Acuña-Amador L, Quesada-Gómez C, Rodríguez C (2022) Clostridioides difficile in Latin America: a comprehensive review of literature (1984–2021). Anaerobe 74:102547. https://doi.org/10.1016/j.anaerobe.2022.102547

    Article  PubMed  Google Scholar 

  12. Pires RN, Monteiro AA, Saldanha GZ, Falci DR, Caurio CFB, Sukiennik TCT et al (2018) Hypervirulent Clostridium difficile strain has arrived in Brazil. Infect Control Hosp Epidemiol 39(3):371–373. https://doi.org/10.1017/ice.2017.280

    Article  PubMed  Google Scholar 

  13. Marcon AP, Gamba MA, Vianna LA (2006) Nosocomial diarrhea in the intensive care unit. Braz J Infect Dis 10(6):384–389. https://doi.org/10.1590/s1413-86702006000600005

    Article  PubMed  Google Scholar 

  14. Trindade C, Domingues RMC, Ferreira E (2019) The epidemiology of Clostridioides difficile infection in Brazil: a systematic review covering 30 years. Anaerobe 8:13–21. https://doi.org/10.1016/j.anaerobe.2019.03.002

    Article  Google Scholar 

  15. Maestri AC, Raboni SM, Morales HMP, Ferrari LF, Tuon FFB, Losso A et al (2020) Multicenter study of the epidemiology of Clostridioides difficile infection and recurrence in southern Brazil. Anaerobe 64:102238. https://doi.org/10.1016/j.anaerobe.2020.102238

    Article  CAS  PubMed  Google Scholar 

  16. Crobach MJT, Planche T, Eckert C et al (2016) European Society of Clinical Microbiology and Infectious Diseases: update of the diagnostic guidance document for Clostridium difficile infection. Clin Microbiol Infect 22(4):S63-81. https://doi.org/10.1016/j.cmi.2016.03.010

    Article  PubMed  Google Scholar 

  17. Miendje Deyi VY, Vandenberg O, Mascart G et al (2008) Diagnostic value of five commercial tests for the rapid diagnosis of Clostridium difficile-associated disease. Clin Lab 54:9–13

    PubMed  Google Scholar 

  18. Berry N, Sewell B, Jafri S, Puli C, Vagia S, Lewis A et al (2014) Real-time polymerase chain reaction correlates well with a clinical diagnosis of Clostridium difficile infection. J Hosp Infect 87(2):109–114. https://doi.org/10.1016/j.jhin.2014.03.005

    Article  CAS  PubMed  Google Scholar 

  19. Shin S, Kim M, Kim M et al (2012) Evaluation of the Xpert Clostridium difficile assay for the diagnosis of Clostridium difficile infection. Ann Lab Med 32(5):355–358. https://doi.org/10.3343/alm.2012.32.5.355

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Bai Y, Sun X, Jin Y, Wang Y, Li J (2017) Accuracy of Xpert Clostridium difficile assay for the diagnosis of Clostridium difficile infection: a meta-analysis. PLoS ONE 12(10):e0185891. https://doi.org/10.1371/journal.pone.0185891

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. McDonald LC, Gerding DN, Johnson S et al (2018) Clinical practice guidelines for Clostridium difficile infection in adults and children: 2017 update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA). Clin Infect Dis 66(7):e1–e48. https://doi.org/10.1093/cid/cix1085

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Kraft CS, Parrott JS, Cornish NE, Rubinstein ML, Weissfeld AS, McNult P et al (2019) A laboratory medicine best practices systematic review and meta-analysis of nucleic acid amplification tests (NAATs) and algorithms including NAATs for the diagnosis of Clostridioides (Clostridium) difficile in adults. Clin Microbiol Rev 32(3):e00032. https://doi.org/10.1128/CMR.00032-18

    Article  PubMed  PubMed Central  Google Scholar 

  23. Nomlomo E, Nana T (2020) The impact of diagnostic methods on the diagnosis of Clostridiodes difficile infection. S Afr Med J 110(2):135–139. https://doi.org/10.7196/SAMJ.2020.v110i2.13684

    Article  CAS  PubMed  Google Scholar 

  24. Carroll KC, Mizusawa M (2020) Laboratory tests for the diagnosis of Clostridium difficile. Clin Colon Rectal Surg 33(20):73–81. https://doi.org/10.1055/s-0039-3400476

    Article  PubMed  PubMed Central  Google Scholar 

  25. Vandorp SM, Notermans DW, Alblas J, Gastmeier P, Mentula S, Nagy E, Spigaglia P et al (2016) European Clostridium difficile Infection Surveillance Network (ECDIS-Net) project on behalf of all participants. Survey of diagnostic and typing capacity for Clostridium difficile infection in Europe, 2011 and 2014. Euro Surveill 21:29. https://doi.org/10.2807/1560-7917.ES.2016.21.29.30292

    Article  Google Scholar 

  26. Brown KA, Daneman N, Arora P, Moineddin R, Fisman DN (2013) The co-seasonality of pneumonia and influenza with Clostridium difficile Infection in the United States, 1993–2008. Am J Epidem 178(1):118–125. https://doi.org/10.1093/aje/kws463

    Article  Google Scholar 

  27. Grassly NC, Fraser C (2012) Seasonal infectious disease epidemiology. Proc Biol Sci 273(1600):2541–2550. https://doi.org/10.1098/rspb.2006.3604

    Article  Google Scholar 

  28. Furuya-Kanamori L, McKenzie SJ, Yakob L et al (2015) Clostridium difficile infection seasonality: patterns across hemispheres and continents—a systematic review. PLoS ONE 10(3):e0120730. https://doi.org/10.1371/journal.pone.0120730

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Choe YJ, Smit MA, Mermel LA (2019) Seasonality of respiratory viruses and bacterial pathogens. Antimicrob Resist Infect Control 8:125. https://doi.org/10.1186/s13756-019-0574-7

    Article  PubMed  PubMed Central  Google Scholar 

  30. Rodriguez C, Bouchafa L, Soumillion K, Ngyuvula E, Taminiau B, Van Broeck J et al (2019) Seasonality of Clostridium difficile in the natural environment. Transbound Emerg Dis 66(6):2440–2449. https://doi.org/10.1186/s13756-019-0574-7

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

We thank our colleagues at the Clinical Analysis Laboratory Unit e Health Surveillance Unit do Complexo Hospital de Clínicas, who provided the samples, antimicrobial consumption, and clinical data, and assisted the research. We also thank Enago (www.enago.com) for the English language review.

Funding

This research was supported by a Brazilian Research Program for the Unified Health System: Management Shared Health—PPSUS 2015 edition—Fundação Araucária-PR/SESA-PR/CNPq/MS-Decit.

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Authors and Affiliations

  1. Laboratório de Bacteriologia, Complexo Hospital de Clínicas da Universidade Federal do Paraná-Rua Padre Camargo, 280-Alto da Glória, CEP: 80.062-240, Curitiba, Paraná, Brazil

    Adriane C. Maestri & Keite S. Nogueira

  2. Programa de Pós-graduação em Medicina Interna e Ciências da Saúde, Universidade Federal do Paraná-Rua General Carneiro, 181-Alto da Glória, CEP–80060-900, Curitiba, Paraná, Brazil

    Adriane C. Maestri & Sonia M. Raboni

  3. Curso de Medicina, Universidade Federal do Paraná-Rua Padre Camargo, 280-Alto da Glória, CEP: 80.062-240, Curitiba, Paraná, Brazil

    Paula K. Ando & Gustavo Sarot

  4. Programa de Pós-graduação em Microbiologia, Parasitologia e Patologia, Universidade Federal do Paraná, Centro Politécnico, Av. Cel. Francisco H. dos Santos, 100-Jardim das Américas, CEP-81531-980, Curitiba, Paraná, Brazil

    Fernanda de Castilho & Keite S. Nogueira

  5. Departamento de Infectologia, Complexo Hospital de Clínicas da Universidade Federal do Paraná, Rua General Carneiro, 181–Alto da Glória, CEP–80060-900, Curitiba, Paraná, Brazil

    Sonia M. Raboni

Authors
  1. Adriane C. Maestri
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  4. Fernanda de Castilho
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  5. Sonia M. Raboni
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  6. Keite S. Nogueira
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by ACM, PKA, GS, FdC, SMR and KdSN. The first draft of the manuscript was written by ACM, and PKA, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Keite S. Nogueira.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

The Human Research Ethics Committee approved the study of the Hospital de Clinicas Complex – UFPR (CEAE = 59027716.5.1001.0096).

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Maestri, A.C., Ando, P.K., Sarot, G. et al. Prevalence and Seasonality of Clostridioides difficile over 12 Years at a Tertiary Hospital in Brazil. Curr Microbiol 79, 354 (2022). https://doi.org/10.1007/s00284-022-03062-6

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