Engraftment and Augmentation of Microbiome Following Fecal Microbiota Transplantation for Recurrent Clostridium difficile Infection

Christine Lee, Stephen Rush, J Scott Weese, Peyman Goldeh, Peter Kim
2017 Open Forum Infectious Diseases  
Background. Pseudomonas aeruginosa (PA), one of the species of the ESKAPE pathogens that are known to "escape" the effects of many antimicrobials, is often difficult to treat. Ceftolozane-tazobactam (C/T) is an anti-pseudomonal cephalosporin/β-lactamase inhibitor recently approved by FDA and EMEA. We examined its activity against global clinical isolates of PA, including isolates non-susceptible (NS, intermediate or resistant) to other agents. Methods. In 2016, 158 hospitals in 51 countries
more » ... ected 5533 PA from intra-abdominal (IAI), urinary (UTI), and respiratory tract infections (RTI). MICs were determined using CLSI broth microdilution and interpreted with both CLSI and EUCAST breakpoints, as the susceptible breakpoints for C/T, cefepime (FEP), meropenem (MEM), and piperacillin-tazobactam (P/T) are the same using both criteria. Results. Overall regional susceptibility of PA to C/T, prevalence of FEP-NS, MEM-NS, and P/T-NS phenotypes, and susceptibility of these phenotypes to C/T are shown below: Background. Traditionally a hospital-acquired pathogen, Clostridium difficile is increasingly recognized as an important cause of diarrhea in community settings. Health disparities in C. difficileinfection (CDI) have been reported, but little is known about the social determinants of health that influence community-associated (CA) CDI incidence. We sought to identify socioeconomic status (SES) factors associated with increased CA-CDI incidence. Methods. Population-based CDI surveillance is conducted in 35 U.S. counties through the Centers for Disease Control and Prevention's Emerging Infections Program. A CA-CDI case is defined as a positive C. difficile stool specimen collected as an outpatient or within three days of hospitalization in a person aged ≥ 1 year who did not have a positive test in the prior 8 weeks or an overnight stay in a healthcare facility in the prior 12 weeks. ArcGIS software was used to geocode 2014-2015 CA-CDI case addresses to a 2010 census tract (CT). Incidence rate was calculated using 2010 Census population denominators. CT-level SES factors were obtained from the 2011-2015 American Community Survey 5-year estimates and divided into deciles. To account for CT-level clustering effects, separate generalized linear mixed models with negative binomial distribution were used to evaluate the association between each SES factor and CA-CDI incidence, adjusted by age, sex and race. Results. Of 9686 CA-CDI cases, 9417 (97%) had addresses geocoded to a CT; of these, 62% were female, 82% were white, and 35% were aged ≥65 years. Annual CA-CDI incidence was 42.9 per 100,000 persons. After adjusting for age, sex and race, CT-level SES factors significantly associated with increased CA-CDI incidence included living under the poverty level (rate ratio [RR] 1.12; 95% confidence interval [CI] 1.09-1.53), crowding in homes (RR 1.11; 95% CI 1.01-1.21), low education (RR 1.11; 95% CI 1.07-1.15), low income (RR 1.15; 95% CI 1.12-1.17), having public health insurance (RR 1.21; 95% CI 1.18-1.24), receiving public assistance income (RR 1.69; 95% CI 1.55-1.84), and unemployment (RR 1.14; 95% CI 1.07-1.22). Conclusion. Areas with lower SES have modestly increased CA-CDI incidence. Understanding the mechanisms by which SES factors impact CA-CDI incidence could help guide prevention efforts in these higher-risk areas.
doi:10.1093/ofid/ofx163.942 fatcat:ths2ggs33jfdjls2bhpohpcf5y