Stool Management Systems for Preventing Environmental Spread of Clostridium difficile (original) (raw)
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Fecal microbiota transplantation (FMT) is a highly effective therapy for recurrent Clostridium difficile infection (CDI). However, transferring undefined living bacteria entails uncontrollable risks for infectious and metabolic or malignant diseases, particularly in immunocompromised patients. We investigated whether sterile fecal filtrates (containing bacterial debris, proteins, antimicrobial compounds, metabolic products and oligonucleotides/DNA), rather than intact microorganisms, are effective in patients with CDI. We performed a clinical case series to investigate the effects of fecal filtrate transfer (FFT) in 5 patients with symptomatic chronic-relapsing CDI at the Department of Internal Medicine I at the University Hospital Schleswig-Holstein (Kiel, Germany). Patients were followed for at least 6 months and up to 33 months. Stool was collected from 5 donors selected by the patients, and fully characterized according to FMT standards. Stool was sterile-filtered to remove smal...
Clostridium difficile Infection and Fecal Bacteriotherapy
Gastroenterology Nursing, 2013
Clostridium difficile, also called "C. diff," is a gram-positive bacillus associated with nosocomial infections involving diarrhea, most often seen in developing countries. The severity of C. diff-associated diarrhea varies tremendously from mild and self-limiting to fulminant and life-threatening. C. diff has become an extremely important pathogen in community health but can be minimized with attention to proper hygiene. This article presents a case study regarding the treatment and management options of C. diff infection using a recent update of clinical guidelines for patient management.
The Bristol stool scale and its relationship to Clostridium difficile infection
Journal of clinical microbiology, 2014
The Bristol stool form scale classifies the relative density of stool samples. In a prospective cohort study, we investigated the associations between stool density, C. difficile assay positivity, hospital-onset C. difficile infection, complications, and severity of C. difficile. We describe associations between the Bristol score, assay positivity, and clinical C. difficile infection.
Global Journal of Pathology and Microbiology, 2014
Clostridium difficile is a global nosocomial pathogen associated with increased morbidity and mortality particularly with the emergence of the hypervirulent strains. C. difficile is ubiquitously present in the environment due to contamination by the excreta of humans and animals. In the hospital environment C. difficile can be isolated from about 30% patients receiving antibiotics or those who are hospitalized. C. difficile spores are not only resistant to antibiotics, but they can also resist the harsh environmental conditions for longer times and thereby facilitate the spread of C. difficile infection (CDI). The primary mode of transmission of the disease is via the feco-oral route as symptomatic patients shed a large number of the pathogen resulting in contamination of the environmental surfaces. CDI occurs in patients with certain risk factors and who acquire the pathogen by ingestion or via contaminated equipments. In a hospital setting, outbreaks can occur in hospitals, nursing homes, and other extended-care facilities due to C. difficile. Therefore strategies to reduce the contamination of C. difficile in the environment will be of prime importance to every health care facility. In this review, the environmental reservoirs of C. difficile, the transmission and the risk factors of CDI are briefly described and the decontamination strategies for containing the pathogen are elaborated.
Fecal specimens for Clostridium difficile Diagnostic Testing are Stable for up to 72 hours at 4°C
Journal of Medical Microbiology & Diagnosis, 2014
Background: Clostridium difficile testing for stool specimens transported from remote geographic locations is a challenge due to long transit times that are often at room temperature. The impact of storage at room temperature versus 4°C on Clostridium difficile diagnostic tests during transport of stool samples has not been well studied Methods: This study assessed the impact of storage at room temperature versus 4°C for up to 72 hours on the stability of glutamate dehydrogenase antigen, Toxin A and B antigens, toxigenic culture and cytopathic effect testing. Twelve diagnostic stool samples that were tested on the day of collection and shown to be C. difficile toxin positive were used for this study. Sample aliquots of each stool were stored at room temperature and 4°C and testing was repeated at 24, 48 and 72 hours. Results: The glutamate dehyrdogenase antigen and toxigenic stool culture tests were shown to be 100% reproducible at room temperature and 4°C for up to 72 hours. Toxin A and B antigen deteriorated to 70% by 72 hours at room temperature but was 90% reproducible if held at 4°C. The cytopathic effect assay was 90% reproducible by 72 hours at room temperature and 4°C. Conclusions: Based on our data we recommend that for laboratories receiving stool samples from remote regions where transit may be prolonged that glutamate dehydrogenase antigen screening followed by nucleic acid amplification testing may be a feasible diagnostic algorithm.
Anaerobe, 2014
Effective isolation of Clostridium difficile from stool samples is important in the research setting, especially where low numbers of spores/vegetative cells may be present within a sample. In this study, three protocols for stool culture were investigated to find a sensitive, cost effective and timely method of C. difficile isolation. For the initial enrichment step, the effectiveness of two different rich media, cycloserine-cefoxitin fructose broth (CCFB) and cycloserine-cefoxitin mannitol broth with taurocholate and lysozyme (CCMB-TAL) were compared. For the comparison of four different, selective solid media; Cycloserine-cefoxitin fructose agar (CCFA), Cycloserine-cefoxitin egg yolk agar (CCEY), ChromID C. difficile and tryptone soy agar (TSA) with 5% sheep's blood with and without preceding broth enrichment were used. As a means to enable differentiation between C. difficile and other fecal flora, the effectiveness of the inclusion of a pH indictor (1% Neutral Red), was also evaluated. The data derived indicated that CCFB is more sensitive than CCMB-TAL, however, the latter had an improved recovery rate. A broth enrichment step had a reduced sensitivity over direct plating. ChromID C. difficile showed the best recovery rate whereas CCEY egg yolk agar was the most sensitive of the four. The addition of 1% Neutral Red did not show sufficient colour change when added to CCEY egg yolk agar to be used as a differential medium. For a low cost, timely and sensitive method of isolating C. difficile from stool samples we recommend direct plating onto CCEY egg yolk agar after heat shock.