Clostridium difficile Infections: The Continuous Challenge (original) (raw)
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Clostridium Difficile Infection - An Optimistic View
Jurnalul de Chirurgie, 2017
Background: Clostridium difficile infection (CDI) is one of the most common infectious complications affecting vulnerable patients, i.e., after surgery or immunosuppressive therapies, posing a significant risk in an oncological unit. Materials and methods: We analyzed data recovered from 164 cases of CDI during the period of 2014-2016 in the Regional Oncologic Institute Iasi, majority admitted in the surgical and hematological units. In all cases diagnostic was confirmed if stool samples tested positive for GDH and at least one of the toxins A or B. Results: The study shows a large population of elder patients (median age 64 years) with female dominance (54%). Out of 117 surgical cases 64% had surgical procedures on the gastro-intestinal tract. Although 20% of patients had equivocal symptoms from admission, the average interval (from admission) until first symptoms developed was 7 days. The confirmation of the diagnosis came in the next day/24h in 68% of cases, leading to initiation of efficient therapy. Although CDI is regarded as an antibiotic associated disease, our data revealed that only one third of patients received antibiotic treatment in the last 3 months. Among the risk factors that may have an influence over development of CDI, antisecretory therapy was delivered to 37% of cases. Epidemiology reports showed that less than 8% of patients had previous contact with other CDI confirmed case. Overall mortality was 4.87% and CDI related mortality was 0.85%. Conclusions: Even though CDI still poses a great threat during prolonged hospitalization and is especially dangerous in oncologic patients, the early recognition of disease onset and the easy access to diagnostic tests triggers an immediate course of treatment and decreases complication and the risk of spreading.
Materia socio-medica, 2013
Introduction: Clostridium difficile (C. difficile) is currently the leading cause of healthcare-associated diarrhea, but almost nothing is known about the extent of C. difficile infection (CDI) in Bosnia and Herzegovina. Goal: We aimed to retrospectively analyze CDI in hospitalized patients at University Clinical Center (UCC) Tuzla, Bosnia and Herzegovina from January 2009 through June 2012. Methods: We analyzed all patients (except children ages 0-2), diagnosed with CDI based on anamnestic and epidemiological, clinical picture and microbiological tests (proof of toxins in the stool by enzyme-linked immunosorbent assay). Results: From a total of 989 patients tested for C. difficile toxin (60.2 per 10,000 inpatient days) 347 (35.08%) were positives. The mean incidence rate of CDI was 2.23 per 10,000 inpatient days (range 1.32-2.87). Annual rates of hospitalization were 15.68 per 10,000 admissions (range 8.99-20.35). Most patients had a previously identified risk profile of old age, comorbidity and recent use of antibiotics. 41/276 (14.86%) patients had died, and 11/41 (26.82%) were CDI-associated deaths. Complicated CDI were registered in 53/276 (19.21%) patients, and recurrent infections in 65/276 (23.55%). Conclusion: Our data suggest that CDI is largely present in our setting which represents a serious problem and points to the importance of international surveillance, detection and control of CDI.
Clostridium difficile infections: do we know the real dimensions of the problem?
International Journal of Antimicrobial Agents, 2013
Clostridium difficile infection (CDI) is the primary cause of nosocomial diarrhea in industrialized countries, usually occurring as a complication of antibiotic therapy in elderly patients. Landmark events contributed to boost the interest on CDI over the last 10 years, including the emergence of unusually severe and recurrent CDI due to the NAP1/BI/027 strain, and reports suggesting that CDI is also significantly encountered in patients previously considered at no risk, such as community-acquired CDI in patients with no recent antibiotic use, or CDI during pregnancy. Despite this growing interest from the medical community, we don't know the real dimensions of the disease for the following reasons: i) despite comprehensive guidelines have been published in Europe and in America, most laboratories still use diagnostic tests with sub-optimal sensitivity as a 'ruleout' test. Hence a significant proportion of CDI remain undiagnosed; ii) the use of PCR as a stand-alone test by others, will probably overestimate the real incidence of CDI, and jeopardize any comparison between institutions with different diagnostic procedures; iii) transversal studies, with optimal design and diagnostic tests, are rapidly outdated, due to the dramatic changes in CDI epidemiology that may occur from one year to the other. To get an accurate picture of the real dimensions of CDI issue, we need more systematic use of adequate and homogenous diagnostic strategy on the field, and the implementation of continuous monitoring of CDI incidence through surveillance programs.
Frontiers in Microbiology
The beneficial effect of colonization of the gastrointestinal tract by non-toxigenic Clostridioides difficile (NTCD) strains as a preventive of toxigenic C. difficile infection (CDI) has been known since the early 1980s. Investigators in both the USA and United Kingdom demonstrated that prior colonization by randomly selected NTCD strains provided prevention against infection by toxigenic C. difficile in hamsters, albeit with limited durability. In the 1980s two patients with multiply recurrent CDI in the UK were treated with vancomycin followed by NTCD to prevent further recurrences, with one success and one failure. Epidemiologic studies of hospitalized patients using weekly rectal swab cultures demonstrated that asymptomatic colonization of patients by toxigenic C. difficile was much more common than CDI, but also that the rate of asymptomatic NTCD colonization of patients was unexpectedly high. Development of molecular strain typing of C. difficile was instrumental in characterizing different strains of both toxigenic C. difficile and NTCD leading to identification of NTCD strains that were effective human colonizers. These strains were reintroduced in hamsters in the 1990s and shown to prevent CDI efficiently and durably when challenged with epidemic toxigenic C. difficile strains. One strain of NTCD, NTCD-M3, was manufactured under cGMP standards and was demonstrated to be safe in a phase 1 volunteer trial. NTCD-M3 was then tested in a phase 2 double-blind placebo controlled trial for the prevention of recurrent CDI in patients experiencing their first CDI episode or first CDI recurrence. NTCD-M3 was given at doses of 10 4 or 10 7 spores per day orally for 7 or 14 days following successful treatment of CDI with vancomycin and/or metronidazole. CDI recurred in 30% of placebo patients and 11% of all NTCD-M3 patients (p = 0.006); recurrence rate for the best dose, 10 7 spores/d × 7 days, was 5% (p = 0.01 vs. placebo). Detection of colonization predicted prevention success; among the 86 patients who were colonized with NTCD-M3 the recurrence rate was 2% vs. 31% in patients who received NTCD-M3 but were not colonized (p < 0.001). Additional trials of NTCD-M3 for primary prevention of CDI and prevention of CDI recurrence seem warranted by these promising results.
Updates on the pathogenesis, epidemiology and diagnosis of Clostridium Difficile infection
Romanian Journal of Infectious Diseases, 2018
The infection with Clostridium difficile (CDI) is a cause of acute gastroenteritis (AGE), which is likely to severely develop into pseudomembranouse colitis (PMC), ileus and toxic megacolon. At the begining, CDI was considered a nosocomial infection, later proven to be communitary-acquired infections. The susceptibility for CDI is related to the alteration in intestinal microbiota after antibiotics or immunosuppressant treatments, postoperative disruption of mucosal barriers, trauma, tumour proliferation, ischemia or necrosis, as well as in other conditions caused by aging, alcoholism, diabetes, neoplasias, immunosuppression, angiopathies. Concern regarding the outbreak of new CDI-epidemics is still high, due to genetic and bacterial variability and spores resistance in outer environment. The diagnosis of CDI is a continuous challenge for clinicians, based on the correlation between clinical, epidemiological data and complex laboratory investigations.