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recurrent clostridium difficile

Diana C Ford, Mary C Schroeder, Dilek Ince, Erika J Ernst
PURPOSE: The cost-effectiveness of initial treatment strategies for mild-to-moderate Clostridium difficile infection (CDI) in hospitalized patients was evaluated. METHODS: Decision-analytic models were constructed to compare initial treatment with metronidazole, vancomycin, and fidaxomicin. The primary model included 1 recurrence, and the secondary model included up to 3 recurrences. Model variables were extracted from published literature with costs based on a healthcare system perspective...
June 14, 2018: American Journal of Health-system Pharmacy: AJHP
Emily C Bulik-Sullivan, Sayanty Roy, Ryan J Elliott, Zain Kassam, Steven N Lichtman, Ian M Carroll, Ajay S Gulati
Fecal microbiota transplantation (FMT) involves the transfer of stool from a healthy individual into the intestinal tract of a diseased recipient. Although used primarily for recurrent Clostridium difficile infection, FMT is increasingly being attempted as an experimental therapy for other illnesses, including metabolic disorders. D-lactic acidosis (D-LA) is a metabolic disorder that may occur in individuals with short bowel syndrome when lactate-producing bacteria in the colon overproduce D-lactate. This results in elevated systemic levels of D-lactate, metabolic acidosis, and encephalopathy...
June 12, 2018: Journal of Pediatric Gastroenterology and Nutrition
Jan Bruensing, Lukas Buendgens, Christoph Jochum, Ulf Herbers, Ali Canbay, Georg Braun, Christian Trautwein, Wolfgang Huber, Alexander Koch, Frank Tacke
BACKGROUND:  Clostridium difficile associated colitis is a frequent cause of nosocomial diarrhea at the intensive care unit (ICU) and is associated with poor prognosis in critically ill patients. Few studies have evaluated the efficacy of treatment options or adherence to guideline recommendations of Clostridium difficile infections at the ICU. METHODS:  Therefore, on behalf of the Gastroenterology Intensive Care Medicine working group of the DGVS, we have conducted an online-based survey among leading intensivists in Germany...
June 2018: Zeitschrift Für Gastroenterologie
N Bhutiani, J E Schucht, K R Miller, Stephen A McClave
PURPOSE OF REVIEW: Fecal microbial transplantation (FMT) has become established as an effective therapeutic modality in the treatment of antibiotic-refractory recurrent Clostridium difficile colitis. A number of formulations and methods of delivery of FMT are currently available, each with distinct advantages. This review aims to review donor and patient selection for FMT as well as procedural aspects of FMT to help guide clinical practice. RECENT FINDINGS: FMT can be obtained in fresh, frozen, lyophilized, and capsule-based formulations for delivery by oral ingestion, nasoenteric tube, colonoscopy, or enema (depending on the formulation used)...
June 9, 2018: Current Gastroenterology Reports
Shawn Meyers, Jessica Shih, Jon O Neher, Sarah Safranek
Fecal microbial transplant (fmt) is reasonably safe and effective. In patients who have had multiple Clostridium difficile infections (CDIs), fecal microbial transplant (FMT) results in a 65% to 80% cure rate with one treatment and 90% to 95% cure rate with repeated treatments compared with a 25% to 27% cure rate for antibiotics (strength of recommendation [SOR]: B, small open-label randomized controlled trials [RCTs]). Fresh and frozen donor feces, administered by either nasogastric tube or colonoscope, produce equal results (SOR B, RCTs)...
June 2018: Journal of Family Practice
Umar Zahid, Fnu Sagar, Mayar Al Mohajer, Aneela Majeed
Immunocompromised patients undergoing chemotherapy for hematologic malignancy and hematopoietic stem cell transplant (HSCT) recipients are at increased risk of Clostridium difficile (C. difficile) infection (CDI). The recurrence of infection and its associated morbidity and mortality are due to multiple risk factors. Diarrhea is common in HSCT recipients, but the diagnosis of diarrhea caused by CDI is a therapeutic challenge due to frequent Clostridium difficile colonization with diarrhea secondary to non-infectious causes...
April 2, 2018: Curēus
Alessandra di Masi, Loris Leboffe, Fabio Polticelli, Federica Tonon, Cristina Zennaro, Marianna Caterino, Pasquale Stano, Stephan Fischer, Marlen Hägele, Martin Müller, Alexander Kleger, Panagiotis Papatheodorou, Giuseppina Nocca, Alessandro Arcovito, Andrea Gori, Margherita Ruoppolo, Holger Barth, Nicola Petrosillo, Paolo Ascenzi, Stefano Di Bella
The pathogenic effects of Clostridium difficile are primarily attributable to the production of the large protein toxins A (TcdA) and B (TcdB). These toxins monoglucosylate Rho GTPases in the cytosol of host cells, causing destruction of the actin cytoskeleton with cytotoxic effects. Low human serum albumin (HSA) levels indicate a higher risk of acquiring and developing a severe C. difficile infection (CDI) and are associated with recurrent and fatal disease. Our results show that HSA at physiological concentrations rescues human epithelial colorectal adenocarcinoma cells and protects stem cell-derived human intestinal organoids from intoxication by a TcdA:TcdB mixture...
June 2, 2018: Journal of Infectious Diseases
Shaaz Fareed, Neha Sarode, Frank J Stewart, Aneeq Malik, Elham Laghaie, Saadia Khizer, Fengxia Yan, Zoe Pratte, Jeffery Lewis, Lilly Cheng Immergluck
Background: Fecal Microbiota Transplantation (FMT) is an innovative means of treating recurrent Clostridium difficile infection (rCDI), through restoration of gut floral balance. However, there is a lack of data concerning the efficacy of FMT and its impact on the gut microbiome among pediatric patients. This study analyzes clinical outcomes and microbial community composition among 15 pediatric patients treated for rCDI via FMT. Methods: This is a prospective, observational, pilot study of 15 children ≤18 years, who presented for rCDI and who met inclusion criteria for FMT at a pediatric hospital and pediatric gastroenterology clinic...
2018: PeerJ
Patricia L Pringle, Mariam Torres Soto, Raymond T Chung, Elizabeth Hohmann
No abstract text is available yet for this article.
May 31, 2018: Clinical Gastroenterology and Hepatology
Anna M Seekatz, Emily Wolfrum, Christopher M DeWald, Rosemary K B Putler, Kimberly C Vendrov, Krishna Rao, Vincent B Young
Recurrence of Clostridium difficile infection (CDI) places a major burden on the healthcare system. Previous studies have suggested that specific C. difficile strains, or ribotypes, are associated with severe disease and/or recurrence. However, in some patients a new strain is detected in subsequent infections, complicating longitudinal studies focused on strain differences that may contribute to disease outcome. We examined ribotype composition over time in patients who did or did not develop recurrence to examine infection with multiple C...
May 31, 2018: Anaerobe
Muthu Dharmasena, Xiuping Jiang
The well-known nosocomial pathogen, Clostridium difficile , has recently been recognized as a community associated pathogen. As livestock animals carry and shed C. difficile in the feces, animal manure-based composts may play an important role in disseminating toxigenic C. difficile into the agricultural environment. The present study surveyed C. difficile contamination of commercially available composts and animal manure. Presumptive C. difficile isolates were confirmed by testing for tpi house-keeping gene in addition to Gram-staining...
June 1, 2018: Applied and Environmental Microbiology
G Ianiro, L Masucci, G Quaranta, C Simonelli, L R Lopetuso, M Sanguinetti, A Gasbarrini, G Cammarota
BACKGROUND: Faecal microbiota transplantation (FMT) is a highly effective treatment against recurrent Clostridium difficile infection. Far less evidence exists on the efficacy of FMT in treating severe Clostridium difficile infection refractory to antibiotics. AIM: To compare the efficacy of two FMT-based protocols associated with vancomycin in curing subjects with severe Clostridium difficile infection refractory to antibiotics. METHODS: Subjects with severe Clostridium difficile infection refractory to antibiotics were randomly assigned to one of the two following treatment arms: (1) FMT-S, including a single faecal infusion via colonoscopy followed by a 14-day vancomycin course, (2) FMT-M, including multiple faecal infusions plus a 14-day vancomycin course...
May 30, 2018: Alimentary Pharmacology & Therapeutics
Bruno Amantini Messias, Bárbara Freitas Franchi, Pedro Henrique Pontes, Daniel Átila DE Andrade Medeiros Barbosa, César Augusto Sanita Viana
Clostridium difficile infection is a common complication following intestinal dysbiosis caused by abusive antibiotic use. It presents medical importance due to the high rates of recurrence and morbidity. Fecal microbiota transplantation is an effective alternative for the treatment of recurrent and refractory C. difficile infection and consists of introducing the intestinal microbiota from a healthy donor into a patient with this infection. The exact physiological mechanism by which fecal microbiota transplantation alters the intestinal microbiota is not well established, but it is clear that it restores the diversity and structure of the microbiota by promoting increased resistance to colonization by C...
2018: Revista do Colégio Brasileiro de Cirurgiões
S Lee, K Drennan, G Simons, A Hepple, K Karlsson, W Lowman, P C Gaylard, L McNamara, J Fabian
BACKGROUND: Clostridium difficile-associated diarrhoea (CDAD) is a potentially life-threatening condition that is becoming increasingly common. A persistent burden of this infectious illness has been demonstrated over the past 4 years at Wits Donald Gordon Medical Centre (WDGMC), Johannesburg, South Africa, through implementation of active surveillance of hospital-acquired infections as part of the infection prevention and control programme. Oral treatment with metronidazole or vancomycin is recommended, but there is a major problem with symptomatic recurrence after treatment...
April 25, 2018: South African Medical Journal, Suid-Afrikaanse Tydskrif Vir Geneeskunde
Christoph Lübbert, Norman Lippmann, Amrei von Braun
The incidence of Clostridium difficile infections (CDI) remains on a high level globally. In Germany, the burden of disease and especially the number of severe or even lethal cases continue to increase. The main risk factor for the development of CDI is the exposure to broad-spectrum antibiotics, which disturb the intestinal microbiota and therefore enable the colonization with C. difficile. According to IDSA's and SHEA's updated US guidelines, vancomycin is the treatment of choice. Fidaxomicin is as effective as vancomycin, but its advantage is the lower rate of recurrence...
June 2018: Deutsche Medizinische Wochenschrift
Oliver A Cornely, Maureen Watt, Charles McCrea, Simon D Goldenberg, Enrico De Nigris
Objectives: The randomized Phase IIIb/IV EXTEND trial showed that extended-pulsed fidaxomicin significantly improved sustained clinical cure and reduced recurrence versus vancomycin in patients ≥60 years old with Clostridium difficile infection (CDI). Cost-effectiveness of extended-pulsed fidaxomicin versus vancomycin as first-line therapy for CDI was evaluated in this patient population. Methods: Clinical results from EXTEND and inputs from published sources were used in a semi-Markov treatment-sequence model with nine health states and a 1 year time horizon to assess costs and QALYs...
May 24, 2018: Journal of Antimicrobial Chemotherapy
Krishna Rao, Peter D R Higgins, Vincent B Young
Recurrent Clostridium difficile infection (rCDI) frequently complicates recovery from CDI. Accurately predicting rCDI would allow judicious allocation of limited resources, but published models have met with limited success. Thus, biomarkers predictive of recurrence have been sought. This study tested whether PCR ribotype independently predicted rCDI. Stool samples from nonpregnant inpatients ≥18 years of age with diarrhea were included from October 2010 to January 2013 after the patients tested positive for C...
May 2018: MSphere
Thomas Birch, Yoav Golan, Giuliano Rizzardini, Erin Jensen, Lori Gabryelski, Dalya Guris, Mary Beth Dorr
Background: The fully human monoclonal antibody bezlotoxumab binds Clostridioides (Clostridium) difficile toxin B and reduces recurrence rates in patients with C. difficile infection (CDI) receiving antibacterial treatment for a primary or recurrent episode. Objectives: To investigate whether the timing of bezlotoxumab administration relative to the onset of antibacterial treatment affected clinical outcome in the Phase 3 trials MODIFY I (NCT01241552) and MODIFY II (NCT01513239)...
May 16, 2018: Journal of Antimicrobial Chemotherapy
Noa Eliakim-Raz, Jihad Bishara
This review summarizes the latest advances in treating and preventing Clostridium difficile infection (CDI), the most common infectious disease cause of nosocomial diarrhea in adults in developed countries. As customary antibiotic therapies against C. difficile, metronidazole and vancomycin, are broad spectrum, they affect greatly the gut microbiota, which result in very high recurrence rates. Therefore, new strategies are researched intensively. New therapies focus on limiting further destruction of the gut microbiota or restoring the microbiota to its pre-destructed state...
May 21, 2018: Human Vaccines & Immunotherapeutics
Richard L Watson, Christopher J Graber
BACKGROUND: Antimicrobial use is one of the largest modifiable risk factors for development of Clostridium difficile infection (CDI). We sought to determine if a recent diagnosis of CDI affected the appropriateness of subsequent antimicrobial prescribing. METHODS: This study is a retrospective electronic chart review of the Greater Los Angeles Veterans Administration. Medication administration records were reviewed for all patients with new CDI from 2015-2016 to determine the appropriateness (drug choice, duration, and dosage) of all non-CDI antimicrobials prescribed within 90 days pre- and post-initial CDI (iCDI) positive testing...
May 17, 2018: American Journal of Infection Control
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