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Sahil Khanna - One of the best experts on this subject based on the ideXlab platform.

  • 2019 update of the WSES guidelines for management of Clostridioides (Clostridium) Difficile Infection in surgical patients
    World Journal of Emergency Surgery, 2019
    Co-Authors: Massimo Sartelli, Stefano Di Bella, Luis Furuya-kanamori, Nadir Abuzeid, Goran Augustin, Fikri M. Abu-zidan, Lynne V Mcfarland, Sahil Khanna, Luca Ansaloni, Miklosh Bala
    Abstract:

    In the last three decades, Clostridium Difficile Infection (CDI) has increased in incidence and severity in many countries worldwide. The increase in CDI incidence has been particularly apparent among surgical patients. Therefore, prevention of CDI and optimization of management in the surgical patient are paramount. An international multidisciplinary panel of experts from the World Society of Emergency Surgery (WSES) updated its guidelines for management of CDI in surgical patients according to the most recent available literature. The update includes recent changes introduced in the management of this Infection.

  • clinical predictors of recurrent Clostridium Difficile Infection in out patients
    Alimentary Pharmacology & Therapeutics, 2014
    Co-Authors: Raina Shivashankar, Sahil Khanna, Patricia P Kammer, Larry M Baddour, Scott W Harmsen, Alan R Zinsmeister, Darrell S Pardi
    Abstract:

    Summary Background Clostridium Difficile Infection (CDI) recurs in 20–30% of patients. Aim To describe the predictors of recurrence in out-patients with CDI. Methods Out-patient cases of CDI in Olmsted County, MN residents diagnosed between 28 June 2007 and 25 June 2010 were identified. Recurrent CDI was defined as recurrence of diarrhoea with a positive C. Difficile PCR test from 15 to 56 days after the initial diagnosis with interim resolution of symptoms. Patients who had two positive tests within 14 days were excluded. Cox proportional hazard models were used to assess the association of clinical variables with time to recurrence of CDI. Results The cohort included 520 out-patients; 104 had recurrent CDI (cumulative incidence of 17.5% by 30 days). Univariate analysis identified increasing age and antibiotic use to be associated with recurrent CDI. Severe CDI, peripheral leucocyte count and change in serum creatinine >1.5-fold were not. In a multiple variable model, concomitant antibiotic use was associated with risk of recurrent CDI (HR = 5.4, 95% CI 1.6–17.5, P = 0.005), while age (HR per 10 year increase = 1.1, 95% CI 0.9–1.3, P = 0.22); peripheral leucocyte count >15 × 109/L (HR = 1.0, 95% CI 0.5–2.1, P = 0.92); and change in serum creatinine greater than 1.5-fold (HR = 0.8, 95% CI 0.4–1.5, P = 0.44) were not. Conclusions Antibiotic use was independently associated with a dramatic risk of recurrent Clostridium Difficile Infection in an out-patient cohort. It is important to avoid unnecessary systemic antibiotics in patients with Clostridium Difficile Infection, and patients with ongoing antibiotic use should be monitored closely for recurrent Infection.

  • community acquired Clostridium Difficile Infection an increasing public health threat
    Infection and Drug Resistance, 2014
    Co-Authors: Arjun Gupta, Sahil Khanna
    Abstract:

    There has been a startling shift in the epidemiology of Clostridium Difficile Infection over the last decade worldwide, and it is now increasingly recognized as a cause of diarrhea in the community. Classically considered a hospital-acquired Infection, it has now emerged in populations previously considered to be low-risk and lacking the traditional risk factors for C. Difficile Infection, such as increased age, hospitalization, and antibiotic exposure. Recent studies have demonstrated great genetic diversity for C. Difficile, pointing toward diverse sources and a fluid genome. Environmental sources like food, water, and animals may play an important role in these Infections, apart from the role symptomatic patients and asymptomatic carriers play in spore dispersal. Prospective strain typing using highly discriminatory techniques is a possible way to explore the suspected diverse sources of C. Difficile Infection in the community. Patients with community-acquired C. Difficile Infection do not necessarily have a good outcome and clinicians should be aware of factors that predict worse outcomes in order to prevent them. This article summarizes the emerging epidemiology, risk factors, and outcomes for community-acquired C. Difficile Infection.

  • Clostridium Difficile Infection in patients with chronic kidney disease
    Mayo Clinic proceedings, 2012
    Co-Authors: Mira T Keddis, Sahil Khanna, Darrell S Pardi, Larry M Baddour, Amit Noheria, Qi Qian
    Abstract:

    Objective To examine the rate of Clostridium Difficile Infection (CDI) and hospital-associated outcomes in a national cohort of hospitalized patients with chronic kidney disease (CKD) and assess the impact of long-term dialysis on outcome in these patients.

  • outcomes in community acquired Clostridium Difficile Infection
    Alimentary Pharmacology & Therapeutics, 2012
    Co-Authors: Sahil Khanna, Darrell S Pardi, Scott Aronson, Patricia P Kammer, Larry M Baddour
    Abstract:

    Summary Background Community-acquired Clostridium Difficile Infection (CA-CDI) is an increasingly appreciated condition. It is being described in populations lacking traditional predisposing factors that have been previously considered at low-risk for this Infection. As most studies of CDI are hospital-based, outcomes in these patients are not well known. Aim To examine outcomes and their predictors in patients with CA-CDI. Methods A sub-group analysis of a population-based epidemiological study of CDI in Olmsted county, Minnesota from 1991–2005 was performed. Data regarding outcomes, including severity, treatment response, need for hospitalisation and recurrence were analysed. Results Of 157 CA-CDI cases, the median age was 50 years and 75.3% were female. Among all CA-CDI cases, 40% required hospitalisation, 20% had severe and 4.4% had severe-complicated Infection, 20% had treatment failure and 28% had recurrent CDI. Patients who required hospitalisation were significantly older (64 years vs. 44 years, P < 0.001), more likely to have severe disease (33.3% vs. 11.7%, P = 0.001), and had higher mean Charlson comorbidity index scores (2.06 vs. 0.84, P = 0.001). They had similar treatment failure and recurrence rates as patients who did not require hospitalisation. Conclusions Community-acquired Clostridium Difficile Infection can be associated with complications and poor outcomes, including hospitalisation and severe Clostridium Difficile Infection. As the incidence of community-acquired Clostridium Difficile Infection increases, clinicians should be aware of risk factors (increasing age, comorbid conditions and disease severity) that predict the need for hospitalisation and complications in patients with community-acquired Clostridium Difficile Infection.

Colleen R Kelly - One of the best experts on this subject based on the ideXlab platform.

Alexander Khoruts - One of the best experts on this subject based on the ideXlab platform.

Darrell S Pardi - One of the best experts on this subject based on the ideXlab platform.

  • clinical predictors of recurrent Clostridium Difficile Infection in out patients
    Alimentary Pharmacology & Therapeutics, 2014
    Co-Authors: Raina Shivashankar, Sahil Khanna, Patricia P Kammer, Larry M Baddour, Scott W Harmsen, Alan R Zinsmeister, Darrell S Pardi
    Abstract:

    Summary Background Clostridium Difficile Infection (CDI) recurs in 20–30% of patients. Aim To describe the predictors of recurrence in out-patients with CDI. Methods Out-patient cases of CDI in Olmsted County, MN residents diagnosed between 28 June 2007 and 25 June 2010 were identified. Recurrent CDI was defined as recurrence of diarrhoea with a positive C. Difficile PCR test from 15 to 56 days after the initial diagnosis with interim resolution of symptoms. Patients who had two positive tests within 14 days were excluded. Cox proportional hazard models were used to assess the association of clinical variables with time to recurrence of CDI. Results The cohort included 520 out-patients; 104 had recurrent CDI (cumulative incidence of 17.5% by 30 days). Univariate analysis identified increasing age and antibiotic use to be associated with recurrent CDI. Severe CDI, peripheral leucocyte count and change in serum creatinine >1.5-fold were not. In a multiple variable model, concomitant antibiotic use was associated with risk of recurrent CDI (HR = 5.4, 95% CI 1.6–17.5, P = 0.005), while age (HR per 10 year increase = 1.1, 95% CI 0.9–1.3, P = 0.22); peripheral leucocyte count >15 × 109/L (HR = 1.0, 95% CI 0.5–2.1, P = 0.92); and change in serum creatinine greater than 1.5-fold (HR = 0.8, 95% CI 0.4–1.5, P = 0.44) were not. Conclusions Antibiotic use was independently associated with a dramatic risk of recurrent Clostridium Difficile Infection in an out-patient cohort. It is important to avoid unnecessary systemic antibiotics in patients with Clostridium Difficile Infection, and patients with ongoing antibiotic use should be monitored closely for recurrent Infection.

  • Clostridium Difficile Infection in patients with chronic kidney disease
    Mayo Clinic proceedings, 2012
    Co-Authors: Mira T Keddis, Sahil Khanna, Darrell S Pardi, Larry M Baddour, Amit Noheria, Qi Qian
    Abstract:

    Objective To examine the rate of Clostridium Difficile Infection (CDI) and hospital-associated outcomes in a national cohort of hospitalized patients with chronic kidney disease (CKD) and assess the impact of long-term dialysis on outcome in these patients.

  • outcomes in community acquired Clostridium Difficile Infection
    Alimentary Pharmacology & Therapeutics, 2012
    Co-Authors: Sahil Khanna, Darrell S Pardi, Scott Aronson, Patricia P Kammer, Larry M Baddour
    Abstract:

    Summary Background Community-acquired Clostridium Difficile Infection (CA-CDI) is an increasingly appreciated condition. It is being described in populations lacking traditional predisposing factors that have been previously considered at low-risk for this Infection. As most studies of CDI are hospital-based, outcomes in these patients are not well known. Aim To examine outcomes and their predictors in patients with CA-CDI. Methods A sub-group analysis of a population-based epidemiological study of CDI in Olmsted county, Minnesota from 1991–2005 was performed. Data regarding outcomes, including severity, treatment response, need for hospitalisation and recurrence were analysed. Results Of 157 CA-CDI cases, the median age was 50 years and 75.3% were female. Among all CA-CDI cases, 40% required hospitalisation, 20% had severe and 4.4% had severe-complicated Infection, 20% had treatment failure and 28% had recurrent CDI. Patients who required hospitalisation were significantly older (64 years vs. 44 years, P < 0.001), more likely to have severe disease (33.3% vs. 11.7%, P = 0.001), and had higher mean Charlson comorbidity index scores (2.06 vs. 0.84, P = 0.001). They had similar treatment failure and recurrence rates as patients who did not require hospitalisation. Conclusions Community-acquired Clostridium Difficile Infection can be associated with complications and poor outcomes, including hospitalisation and severe Clostridium Difficile Infection. As the incidence of community-acquired Clostridium Difficile Infection increases, clinicians should be aware of risk factors (increasing age, comorbid conditions and disease severity) that predict the need for hospitalisation and complications in patients with community-acquired Clostridium Difficile Infection.

  • the epidemiology of community acquired Clostridium Difficile Infection a population based study
    The American Journal of Gastroenterology, 2012
    Co-Authors: Sahil Khanna, Darrell S Pardi, Scott Aronson, Patricia P Kammer, Robert Orenstein, Jennifer L St Sauver, Scott W Harmsen, Alan R Zinsmeister
    Abstract:

    The Epidemiology of Community-Acquired Clostridium Difficile Infection: A Population-Based Study

Larry M Baddour - One of the best experts on this subject based on the ideXlab platform.

  • clinical predictors of recurrent Clostridium Difficile Infection in out patients
    Alimentary Pharmacology & Therapeutics, 2014
    Co-Authors: Raina Shivashankar, Sahil Khanna, Patricia P Kammer, Larry M Baddour, Scott W Harmsen, Alan R Zinsmeister, Darrell S Pardi
    Abstract:

    Summary Background Clostridium Difficile Infection (CDI) recurs in 20–30% of patients. Aim To describe the predictors of recurrence in out-patients with CDI. Methods Out-patient cases of CDI in Olmsted County, MN residents diagnosed between 28 June 2007 and 25 June 2010 were identified. Recurrent CDI was defined as recurrence of diarrhoea with a positive C. Difficile PCR test from 15 to 56 days after the initial diagnosis with interim resolution of symptoms. Patients who had two positive tests within 14 days were excluded. Cox proportional hazard models were used to assess the association of clinical variables with time to recurrence of CDI. Results The cohort included 520 out-patients; 104 had recurrent CDI (cumulative incidence of 17.5% by 30 days). Univariate analysis identified increasing age and antibiotic use to be associated with recurrent CDI. Severe CDI, peripheral leucocyte count and change in serum creatinine >1.5-fold were not. In a multiple variable model, concomitant antibiotic use was associated with risk of recurrent CDI (HR = 5.4, 95% CI 1.6–17.5, P = 0.005), while age (HR per 10 year increase = 1.1, 95% CI 0.9–1.3, P = 0.22); peripheral leucocyte count >15 × 109/L (HR = 1.0, 95% CI 0.5–2.1, P = 0.92); and change in serum creatinine greater than 1.5-fold (HR = 0.8, 95% CI 0.4–1.5, P = 0.44) were not. Conclusions Antibiotic use was independently associated with a dramatic risk of recurrent Clostridium Difficile Infection in an out-patient cohort. It is important to avoid unnecessary systemic antibiotics in patients with Clostridium Difficile Infection, and patients with ongoing antibiotic use should be monitored closely for recurrent Infection.

  • Clostridium Difficile Infection in patients with chronic kidney disease
    Mayo Clinic proceedings, 2012
    Co-Authors: Mira T Keddis, Sahil Khanna, Darrell S Pardi, Larry M Baddour, Amit Noheria, Qi Qian
    Abstract:

    Objective To examine the rate of Clostridium Difficile Infection (CDI) and hospital-associated outcomes in a national cohort of hospitalized patients with chronic kidney disease (CKD) and assess the impact of long-term dialysis on outcome in these patients.

  • outcomes in community acquired Clostridium Difficile Infection
    Alimentary Pharmacology & Therapeutics, 2012
    Co-Authors: Sahil Khanna, Darrell S Pardi, Scott Aronson, Patricia P Kammer, Larry M Baddour
    Abstract:

    Summary Background Community-acquired Clostridium Difficile Infection (CA-CDI) is an increasingly appreciated condition. It is being described in populations lacking traditional predisposing factors that have been previously considered at low-risk for this Infection. As most studies of CDI are hospital-based, outcomes in these patients are not well known. Aim To examine outcomes and their predictors in patients with CA-CDI. Methods A sub-group analysis of a population-based epidemiological study of CDI in Olmsted county, Minnesota from 1991–2005 was performed. Data regarding outcomes, including severity, treatment response, need for hospitalisation and recurrence were analysed. Results Of 157 CA-CDI cases, the median age was 50 years and 75.3% were female. Among all CA-CDI cases, 40% required hospitalisation, 20% had severe and 4.4% had severe-complicated Infection, 20% had treatment failure and 28% had recurrent CDI. Patients who required hospitalisation were significantly older (64 years vs. 44 years, P < 0.001), more likely to have severe disease (33.3% vs. 11.7%, P = 0.001), and had higher mean Charlson comorbidity index scores (2.06 vs. 0.84, P = 0.001). They had similar treatment failure and recurrence rates as patients who did not require hospitalisation. Conclusions Community-acquired Clostridium Difficile Infection can be associated with complications and poor outcomes, including hospitalisation and severe Clostridium Difficile Infection. As the incidence of community-acquired Clostridium Difficile Infection increases, clinicians should be aware of risk factors (increasing age, comorbid conditions and disease severity) that predict the need for hospitalisation and complications in patients with community-acquired Clostridium Difficile Infection.