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All Journal Indonesian Journal of Tropical and Infectious Disease
Ni Luh Putu Harta Wedari, Ni Luh Putu Harta
Jurusan Pendidikan Dokter, Fakultas Kedokteran Universitas Udayana
Earth & Planetary Sciences Health Professions Medicine & Pharmacology Public Health

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Clostridium difficile Infection (CDI) by Hypervirulent BI/NAP1/027 Strain: a Comprehensive Review of Toxigenicity, Pathogenesis, Risk Factors, and Preventative Measures Budayanti, Ni Nyoman Sri; Aryana, I Gusti Putu Suka; Wedari, Ni Luh Putu Harta
Indonesian Journal of Tropical and Infectious Disease Vol. 10 No. 1 (2022)
Publisher : Institute of Topical Disease Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/ijtid.v10i1.31030

Abstract

Clostridium difficile is an anaerobic bacil gram-positive bacteria, able to form spores and toxin, that is transmitted among humans through the fecal–oral route. Clostridium difficile infection (CDI), a typical nosocomial infection has been contributed to a signifi cant proportion of morbidity and mortality among in-patients with a case-fatality rate of 14% within 30 days after diagnosis. Profound culture and toxin examination for C. difficile are still minimal in many hospitals in various Asian countries. Consequently, C. difficile reports in Asia remain rare. Highly virulent form of C. difficile caused greater fatality and epidemics severity. Elderly age, hospitalization, exposure to antibiotics e.g., cephalosporins, fluoroquinolones, clindamycin, and penicillin contributed as main risk factors. Hypervirulent strain BI/NAP1/027 demonstrated to carry CdtLoc gene locus encodes CD196 ADP-ribosyltransferase (CDT) or known as binary toxin. Virulence factors are TcdA, TcdB, CDTa CDTb in which hypersporulation and mutation of TcD gene by hypervirulent strain led to toxin hyperexpression. Early cases detection, building management team to evaluate patient positive with all C. difficile toxins, hand hygiene improvement, continuation of contact precautions after diarrhea resolution, audit of infection control, and restriction of antimicrobials should be implemented as preventative measures. Focus measures also should emphasize on development of vaccine of C. difficile to boost immune state of elderly people. This review aims to describe severity of disease caused by hypervirulent BI/NAP1/027 C. difficile strain, its mechanism or pathogenesis, risk factors, current treatment options available, along with proposed preventative measures and infection control.
Risk Factors Associated with Suspected Clostridium difficile Infection (CDI) in Elderly Diarrhea Patients at Prof. Dr. I.G.N.G. Ngoerah Hospital Aryana, I Gusti Putu Suka; Budayanti, Ni Nyoman Sri; Wedari, Ni Luh Putu Harta
Indonesian Journal of Tropical and Infectious Disease Vol. 11 No. 3 (2023)
Publisher : Institute of Topical Disease Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/ijtid.v11i3.47664

Abstract

Clostridium difficile infection (CDI) is a typical healthcare-associated infection that contributes to a significant proportion of morbidity and mortality among hospitalized patients. Anaerobe microbiological laboratory examinations cannot be performed at Prof. Dr. I.G.N.G. Ngoerah Hospital, leading to many undetected cases; therefore, it is crucial to determine the risk factors. Identification  of cases may help to prevent, recognize, and  appropriately treat CDI, reducing morbidity and mortality. This study aimed to determine the risk factors associated with suspected CDI in elderly patients with diarrhea due to their vulnerability to immunosenescence. This research used medical records as secondary data to determine the risk factors associated with suspected CDI in elderly diarrhea patients at Prof. Dr. I.G.N.G. Ngoerah Hospital during the year period of 2017 to 2021 with total of 70 samples who met inclusion criteria by purposive sampling technique. One hundred percent of all samples had a history of hospitalization for ³ 48 h. There were 53 patients (77.1%) had a history of antibiotic use, 26 (37.1%) proton pump inhibitors (PPIs), 66 (94.3%) chemotherapy, 66 (94.3%) urinary tract infections, 6 (8.6%) kidney disease, and 7 (10%) myocardial infarction. Seven (10%) patients had vascular disease, and 11 (15.7%) had diabetes mellitus. Risk factors associated with suspected CDI in elderly patients with diarrhea at Prof. Dr. I.G.N.G. Ngoerah Hospital include hospitalization ³ for 48 hours, use of antibiotics in the last few months, proton pump inhibitors, decreased immune system, urinary tract infection, kidney disease, myocardial infarction, vascular disease, and diabetes mellitus.
Co-Authors Aryana, I Gusti Putu Suka Ni Nyoman Sri Budayanti