• Quality Improvement in Health Care
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• v.22 no.2
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• pp.15-25
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• 2016

Objectives: In this study, we examined the validity of Clostridium difficile culture results as a proxy measure of Clostridium difficile infection, and inferred the epidemiologic characteristics of Clostridium difficile infection by tracking the trends of Clostridium difficile culture results. Methods: We reviewed the medical records to figure out the actual possibilities of Clostridium difficile infection of those with positive or negative results of Clostridium difficile culture during the time span from January 2012 to March 2012. We calculated the positive and negative predictive value of Clostridium difficile culture results for Clostridium difficile infection. Furthermore, epidemiologic characteristics of Clostridium difficile infection in a tertiary general hospital in 2012 were analyzed. Result: The estimated positive predictive value of Clostridium difficile culture tests for Clostridium difficile infection was 100%, and the estimated negative predictive value was around 94.4~99.3% depending on the cutoff value of possibility of Clostridium difficile infection. A total of 622 cases were identified as Clostridium difficile infection in a tertiary general hospital in 2012 and there were 4.9 patients with Clostridium difficile infection per 1,000 inpatients. Conclusion: In conclusion, we identified that Clostridium difficile culture results can be used as a proxy measure of Clostridium difficile infection.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.17 no.2
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• pp.80-84
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• 2014

Clostridium difficile infection has been increasing since 2000 in children and in adults. Frequent antibiotics use, comorbidity, and the development of hypervirulent strains have increased the risk of infection. Despite the high carriage rates of C. difficile, infants rarely develop clinical infection. Discontinuing antibiotics and supportive management usually leads to resolution of disease. Antibiotics use should be stratified depending on the patient's age and severity of the disease.

• Journal of Microbiology and Biotechnology
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• v.26 no.3
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• pp.567-571
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• 2016

We investigated the increased risk of Clostridium difficile infection (CDI) caused by the combined use of antibiotics and an immunosuppressive drug in a mouse model. Our data showed that an approximate return to pretreatment conditions of gut microbiota occurred within days after cessation of the antibiotic treatment, whereas the recovery of gut microbiota was delayed with the combined treatment of antibiotics and dexamethasone, leading to an increased severity of CDI. An alteration of gut microbiota is a key player in CDI. Therefore, our data implied that immunosuppressive drugs can increase the risk of CDI through the delayed recovery of altered gut microbiota.

• Korean Journal of Clinical Pharmacy
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• v.28 no.3
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• pp.174-180
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• 2018

Objective: Clostridium difficile Infection (CDI) is one of the common nosocomial infections. As elderly population increases, the proper treatment has been emphasized. We investigated the risk factors associated with CDI unimprovement in elderly patients. Furthermore, we performed drug use evaluation of old CDI patients and oldest-old CDI patients. Methods: It was a retrospective study using electronic medical record at Kangbuk Samsung Medical Center (KBSMC) from January 2016 to December 2017. Seventy three patients aged 65 years or older, diagnosed with CDI by Clostridium difficile Toxin B Gene [Xpert] were screened and they were assessed for risk factors regarding unimprovement status. We also evaluated drug use evaluation in old patients ($65{\leq}age$<80) and oldest-old patients ($80{\leq}age$) by assessing the use of initial therapy, severity, dose, route, treatment course, days of use, total days of use and treatment outcome of initial therapy. Results: Out of 73 patients aged over 65 years, four patients were excluded because they did not receive any treatment. There were 31 improved patients and 38 unimproved patients after initial therapy. We were able to find out patients with surgical comorbidity or endocrine comorbidity (especially, diabetes mellitus) had 2.885 more risk of becoming unimproved than those patients without surgical comorbidity or endocrine comorbidity. Drug use evaluation for CDI was generally fair, but vancomycin as initial therapy is more recommended than metronidazole. Conclusion: Although age, antibiotics exposure, use of antacids are all important risk factors for CDI, our result did not show statistical significance for these risk factors. However, the study is meaningful because the number of elderly population keeps increasing and recently updated guideline suggests the use of vancomycin as drug of choice for CDI.

• Journal of Veterinary Clinics
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• v.16 no.1
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• pp.218-221
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• 1999

A case of enetritis caused by Clostridium perfringens was observed in 4years old, male California sea lion(Zalophus californianus). Clinical signs were included in anorexia, depression, diarrhea and vomitting, and the animal died on 4 days after showing clinical signs. Grossly, bloody contents were presented in the intestine and the intestinal mucosa were congested and dark redcolored, and also there were serous fluid in the peritoneal cavity. Histopathologically coagulative necrosis destroyed two third of the villus. Clostridium perfringens were isolated from the intestinal contents. Based on the gross and histopathological findings, this case was diagnosed as necrotic enteritis caused by Clostridium perfringens infection.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.21 no.1
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• pp.43-50
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• 2018

Purpose: Clostridium difficile colonization and infection are commonly associated with poor outcomes in patients with pediatric inflammatory bowel disease (PIBD). We aimed to investigate the prevalence of C. difficile colonization and infection at the time of diagnosis and to evaluate risk factors associated with the development of C. difficile infection during the course of PIBD treatment. Methods: We retrospectively enrolled a total of 59 children who were newly diagnosed with PIBD at the tertiary medical center. All patients underwent C. difficile toxin assays and cultures initially and at every follow-up during the disease course. Kaplan-Meier survival analysis and Cox regression test were used for statistical analysis. Results: Initial cultures for C. difficile were positive in 13 (22.0%) of 59 PIBD patients, whereas initial toxin assays were positive in 3 patients (5.1%). During treatment, C. difficile cultures converted to positive in 28 (47.5%) in addition to 13 patients who were initially culture-positive, and C. difficile toxins converted to positive in 13 (22.0%) in addition to 3 originally toxin-positive patients. Antibiotic usage alone was significantly associated with the development of C. difficile colonization (p=0.011), and the length of hospitalization was associated with the development of C. difficile infection (p=0.032). Conclusion: C. difficile colonization and infection occur frequently during the disease course of PIBD. Antibiotic usage and longer hospital stay were significant risks factors for the conversion of C. difficile status in PIBD patients undergoing treatment.

• Intestinal research
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• v.13 no.1
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• pp.80-84
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• 2015

The rates and severity of Clostridium difficile infections, including pseudomembranous colitis, have increased markedly. However, there are few effective treatments for refractory or recurrent C. difficile infections and the outcomes are poor. Fecal microbiota transplantation is becoming increasingly accepted as an effective and safe intervention in patients with recurrent disease, likely due to the restoration of a disrupted microbiome. Cure rates of >90% are being consistently reported from multiple centers. We cured a case of severe refractory C. difficile infection with fecal microbiota transplantation in a patient colonized by vancomycin-resistant enterococcus.

• Journal of Veterinary Clinics
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• v.24 no.4
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• pp.588-592
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• 2007

The prevalence of E. coli(K99), Clostridium perfringens and Cryptosporidium parvum on acute diarrhea in suckling Korean native calves was evaluated in the field by a veterinary practice. In diagnosis, fecal samples were directly collected from calves that had diarrhea between 2 and 98 days of age. 40 samples were analyzed in October, 2006 and December, 2006. Clostridium perfringens and Cryptosporidium parvum were detected in 15(37.5%) and 4(10.0%) of the samples from diarrhetic calves, respectively. However, E. coli(K99) was not detected in the samples from diarrhetic calves. There was no significant difference(p>0.05) between October(5, 25.0%) and December(10, 50.0%) in incidence of detected Clostridium perfringens from diarrhetic calves. On the other hand, significant differences (p<0.05) in the detection rate of Clostridium perfringens were found between the within 1 month age and all other age groups. In the detection of Cryptosporidium parvum, there was no significant difference(p<0.05) between October (2, 10.0%) and December(2, 10.0%) in the incidence of detected Cryptosporidium parvum from diarrhetic calves. These results suggest that causative agents of calf diarrhea occurred frequently with Clostridium perfringens infection than E. coli(K99) and Cryptosporidium parvum.

• Journal of Veterinary Clinics
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• v.25 no.4
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• pp.310-313
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• 2008

C. perfringens is the most important enteric clostridial pathogen of animals. C. perfringens type A has been associated with hemorrhagic enteritis in a wide lange of domestic and wild mammals. But all types of C. perfringens can be normal inhabitants of the intestine of most mammals. We have a special case that showed C. perfringens type A infection in a hippopotamus (Hippopotamus amphibius) cub at Seoul Grand Park Zoo. Male, hippopotamus cub died in 3 days after birth. Clinical features of the hippopotamus cub have showed lethargy and anorexia before death. Gross post-mortem findings of the hippopotamus were hemorrhagic enteritis of intestine. Histopathologically, ruminant stomach and intestine showed hemorrhagic lesions and the lumen of the small intestine was filled with mucoid and hemorrhagic fluid. Also, intestine and stomach of hippopotamus were distended with gas and hemorrhagic fluid. C. perfringens was isolated in culture of small intestine and the presence of C. perfringens type A was confirmed by PCR. This case indicated that C. perfringens type A could be considered as a virulence factor responsible for causing death of a newborn hippopotamus.

• Food Science of Animal Resources
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• v.37 no.3
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• pp.368-375
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• 2017

Clostridium difficile infection (CDI) is the main cause of hospital-acquired diarrhea that can cause colitis or even death. The medical-treatment cost and deaths caused by CDI are increasing annually worldwide. New approaches for prevention and treatment of these infections are needed, such as the use of probiotics. Probiotics, including Bifidobacterium spp. and Lactobacillus, are microorganisms that confer a health benefit to the host when administered in adequate amounts. The effect of Bifidobacterium longum ATCC 15707 on infectious disease caused by C. difficile 027 was investigated in a mouse model. The survival rates for mice given the pathogen alone, and with live cells, or dead cells of B. longum were 40, 70, and 60%, respectively. In addition, the intestinal tissues of the B. longum-treated group maintained structural integrity with some degree of damage. These findings suggested that B. longum ATCC 15707 has a function in repressing the infectious disease caused by C. difficile 027.