Hygiene aspekte bei Clostridium difficile

Transkript

1 Hygiene aspekte bei Clostridium difficile O Janata Krankenhaushygiene Donauspital im SMZ Ost Wien O Janata

2 Inhalt gibt es ein Problem? wie mit Erregerquelle umgehen? wie Übertragung verhindern? Hygienemaßnahmen versus antibiotic stewardship O Janata

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4 Pubmed C. difficile Stichwort O Janata

5 Pubmed C. difficile Review O Janata

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7 Discharge rate for Clostridium difficile infection from US short-stay hospitals by age Clin Infect Dis August 1;55 (suppl_2): S 65-S 70 O Janata Current Status of Clostridium difficile Infection Epidemiology

8 Cl. difficile Umgebung - Erdreich, Heu, Sand, Gewässer, Meer, Swimmingpool Dung von Kühen, Eseln, Pferden, Hauskatze, -hund (20 40 %) Lebensmittel Mensch im Stuhl, urethral, vaginal O Janata

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12 Clostridium difficile infection and colonization in pediatric oncology patients BURGNER et al; Pediatric Infectious Disease Journal: December 1997 C diff & Toxin + 19% Clostridium difficile in a pediatric outpatient population BOENNING et al; Pediatric Infectious Disease Journal: September/October 1982 C diff positiv 15% 9% 7% Diarrhoe (149) asymptomatisch (58) Diarrhoe (171) asymptomatisch (135) O Janata

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14 Clostridium difficile in Lebensmittel nach Hensgen S. et al; CMI 2012 Lebensmittel % CD positive % Toxin positiv davon 027 Faschiertes 0 20 % % 7 67 % Rind un-/gekocht 0 40 % 100 % 29 % Schwein un-/gekocht 0 40 % % 7 57 % Geflügel 0 44 % 100 % - Fisch 0 4 % 80 % - Gemüse 2 8 % % - Milch 0 % - - O Janata

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19 Hygienemassnahmen bei C difficile Massnahme Diagnose rasch stellen Einzelzimmer / Kohortierung Medizinprodukte im Zimmer (z.b. Stethoskop) Übermantel, Haube, Mund-Nasenschutz, Handschuhe,... Händehygiene Sporen -abwaschend Sporozide Flächendesinfektion, Wischen Dauer der Maßnahmen bis Stuhl geformt (+ 48 Std.) danach intensivierte Reinigung, Ausgasen value

20 Frequency of Clostridium difficile contamination of skin sites of 27 patients with C. difficile associated disease (CDAD) (A) and frequency of acquisition on sterile gloves after contact with skin sites of a subset of 10 patients (B). O Janata

21 Acquisition of C. difficile on sterile gloves after contact with a CDAD-affected patient s groin. Of note, the patient had showered 1 h before collection of the culture specimen

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24 CLIN INFECT DIS 50 (11): , Line indicating the total number of Clostridium difficile colonies recovered at various times throughout the day (total of 10 patients tested for 2 days). The number of patients the colonies were isolated from is indicated in parentheses. O Janata

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26 Kaplan-Meier estimation of time from resolution of diarrhea (day 0) to negative results of culture specimens of abdomen and/or chest skin of patients with Clostridium difficile associated disease CID 2008:46, February

27 Wie lange muss man CDI-Patienten isolieren?

28 Therapie für C. difficile Carrier? S Johnson, Ann Intern Med negativ C diff positiv 1 1 Vancomycin 4x125 mg Metronidazol 2x500 mg Placebo 3 x tgl. Nach 10 Tagen Therapie Vancomycin Placebo 2 Monate später

29 Raum -hygiene für den nächsten Patienten CID 2013, editorial Patienten mit selbem Erreger im Zimmer gelegen MRSA 19 % VRE % C difficile 11 % Drees M: Prior environmental contamination increases the risk of acquisition of VRE, Clin Infect Dis 2008 Huang SS: Risk of acquiring antibiotic-resistant bacteria from prior room occupants. Arch Intern Med 2006 Nseir S: Risk of acquiring multidrug-resistant gram-negative bacilli from prior room occupants in the ICU. Clin Microbiol Infect 2011 Shaughnessy MK: Evaluation of hospital room assignment and acquisition of Clostridium difficile infection, Infect Control Hosp Epidemiol 2011 Datta R: Environmental cleaning intervention and risk of acquiring multidrug-resistant organisms from prior room occupants. Arch Intern Med 2011

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36 Hygienemassnahmen bei C difficile Massnahme Diagnose rasch stellen Einzelzimmer / Kohortierung Medizinprodukte im Zimmer (z.b. Stethoskop) Übermantel, Haube, Mund-Nasenschutz, Handschuhe,... Händehygiene Sporen -abwaschend sporozide Flächendesinfektion, Wischen Dauer der Maßnahmen bis Stuhl geformt (+ 48 Std.) Schlussreinigung, Ausgasen CDI Surveillance zur Erkennung von Ausbrüchen value B B B A A B C B B

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41 C. difficile vermeiden / reduzieren Quelle was wer / was Hygiene antimicrobial stewardship Mensch Natur, Tiere Spital Übertragung Direkt, Hände Luft Umgebung CD Infektion Darmflora Antibiotika Prophylaxe O Janata

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49 Treatment of Asymptomatic Clostridium difficile Carriers (Fecal Excretors) with Vancomycin or Metronidazole Stuart Johnson, Ann Intern Med. 15 August 1992;117(4): Pts mit asymptomatischer Ausscheidung von C. diff randomisiert Tx für 10 Tage Vancomycin 4 x 125 mg Metronidazol 2 x 500 mg Placebo 3 x tgl. Kulturen am Tx Ende Vancomycin 9 von 10 negativ Metronidazol 3 von 10 negativ Placebo 2 von 10 negativ Kulturen nach 2 Monaten Vancomycin 4 von 6 positiv Placebo 1 von 9 positiv

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52 Spore CFU/mL DIFICLIR inhibition of C. difficile spore production Effects of DIFICLIR and vancomycin on spore production following drug exposure Control (no drug) DIFICLIR (1/4 MIC) Vancomycin (1/4 MIC) Detection limit Drug added Time (hours) CFU, colony-forming units; MIC, minimum inhibitory concentration DIFICLIR inhibits the production of spores, whereas spore production increases following vancomycin treatment O Janata Gomez et al. ICAAC Poster C1-632.

53 Incidence of Clostridium difficile infection per 1000 hospitalizations by age (Healthcare Utilization Project Kids and Inpatient Database, United States, ) O Janata

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