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Clostridium difficile

S J Vermeersch, Y Vandenplas, A Tanghe, M Elseviers, L Annemans
Interest in administration of probiotics to prevent antibiotic-associated diarrhoea (AAD) in hospitalized patients is increasing. We determined the cost of antibiotic-associated diarrhoea in hospital settings for non-complicated and Clostridium difficile (C.diff) complicated AAD, and performed a health-economic analysis of AAD prevention with S. boulardii CNCM I-745 (S. boulardii) from data collected in 1 university and 3 regional hospitals in Flanders. Using a decision tree analytic model, costs and effects of S...
April 2018: Acta Gastro-enterologica Belgica
Magali Pirson, Jean-Etienne Poirrier, Sophie Joubert, Julie Van den Bulcke, Pol Leclercq, Laura Avena, Burcin Bilge, Pauline Blanquet, Karine Calet, Baudouin Byl
INTRODUCTION: Intestinal Clostridium difficile Infection (CDI) treated in hospitals may concern patients whose reason for admission is CDI (primary diagnosis) or who have acquired CDI during their stay (secondary diagnosis). OBJECTIVES: The objective of this study is to evaluate the cost for social security and hospitals and the length of hospital stays related to CDIs as the main reason for admission. METHOD: This study was carried out in 2012 in 13 Belgian hospitals...
April 2018: Acta Gastro-enterologica Belgica
Dennis Schöttelndreier, Katrin Seeger, Guntram A Grassl, Markus R Winny, Robert Lindner, Harald Genth
Toxin-producing strains of Clostridioides difficile and Clostridium perfringens cause infections of the gastrointestinal tract in humans and ruminants, with the toxins being major virulence factors, essential for the infection, and responsible for the onset of severe symptoms. C. difficile toxin A (TcdA) and toxin B (TcdB), and the large cytotoxin (TpeL) from C. perfringens are single chain bacterial protein toxins with an AB-like toxin structure. The C-terminal delivery domain mediates cell entry of the N-terminal glycosyltransferase domain by receptor-mediated endocytosis...
2018: Frontiers in Microbiology
Haruhisa Fukuda, Takahisa Yano, Nobuyuki Shimono
BACKGROUND: Hospital-onset Clostridium difficile infections (CDIs) have a considerable clinical and economic impact on patients and payers. Quantifying the economic impact of CDIs can guide treatment strategies. However, previous studies have generally focused on acute care hospitals, and few have included cost estimates from non-acute care hospitals such as long-term care facilities. AIM: This study aimed to quantify the hospital-onset CDI-attributable inpatient expenditures and length-of-stay durations in all healthcare institutions that provide inpatient care (including acute and non-acute care) in Japan...
July 18, 2018: PharmacoEconomics
Rayo Morfin-Otero, Elvira Garza-Gonzalez, Guillermo Garcia Garcia, Hector R Perez-Gomez, Sara A Aguirre-Diaz, Esteban Gonzalez-Diaz, Sergio Esparza-Ahumada, Alfonso Fernandez-Ramirez, Francisco Cardenas-Lara, Adrian Martinez-Melendez, Rodrigo Escobedo-Sanchez, Margarita Ibarra-Hernandez, Gerardo Leon Garnica, Eduardo Rodriguez-Noriega
BACKGROUND: Clostridium difficile infection (CDI) is a leading cause of healthcare-associated diarrhea worldwide. Patients with chronic kidney disease (CKD) are especially vulnerable, as they are exposed to CDI risk factors including frequent antibiotics. MATERIALS AND METHODS: In order to identify the risk factors for CDI in CKD patients, a 33-month long case-control study was carried out at a tertiary-care hospital in Mexico. CDI was confirmed at the genetic level, and univariate and multivariate analyses were performed to identify the association between risk factors, biomarkers, and outcome options (survival, relapse, death)...
July 19, 2018: Clinical Nephrology
Matthew A Moffa, Thomas L Walsh, Amy Tang, Derek N Bremmer
We conducted a pre-intervention/post-intervention study to assess the rate of healthcare-associated Clostridium difficile infections (HA-CDI) before and after the implementation of an antimicrobial stewardship program (ASP). Upon implementation of our ASP, the usage of targeted antimicrobials, including ceftriaxone, clindamycin, fluoroquinolones and carbapenem antibiotics, were significantly reduced. There was also a significant reduction in HA-CDI/1000 patient-days following ASP implementation (0.84 vs. 0...
July 2018: Journal of Infection Prevention
Angie M Jarrad, Mark A T Blaskovich, Anggia Prasetyoputri, Tomislav Karoli, Karl A Hansford, Matthew A Cooper
Vancomycin was bactericidal against Clostridium difficile at eightfold the minimum inhibitory concentration (MIC) using a traditional minimum bactericidal concentration (MBC) assay. However, at higher concentrations up to 64 × MIC, vancomycin displayed a paradoxical "more-drug-kills-less" Eagle effect against C. difficile . To overcome challenges associated with performing the labor-intensive agar-based MBC method under anaerobic growth conditions, we investigated an alternative more convenient ATP-bioluminescence assay to assess the Eagle effect in C...
2018: Frontiers in Microbiology
Amber Howerton, Cale O Seymour, Senthil K Murugapiran, Zhenlin Liao, Jacqueline R Phan, Alan Estrada, Adam J Wagner, Chrisabelle C Mefferd, Brian P Hedlund, Ernesto Abel-Santos
Clostridium difficile infection (CDI) is the leading cause of antibiotic-associated diarrhea and has gained worldwide notoriety due to emerging hypervirulent strains and high incidence of recurrence. We previously reported protection of mice from CDI using the anti-germinant bile salt analog CamSA. Here we describe the effects of CamSA on the hamster model of CDI. CamSA treatment of hamsters showed no toxicity and did not affect the richness or diversity of gut microbiota; however, minor changes in community composition were observed...
July 16, 2018: Antimicrobial Agents and Chemotherapy
Christopher C Battaglia, Kaye Hale
Hospital-acquired infections are a common and costly problem facing critically ill patients in the intensive care unit (ICU). Critically ill patients with cancer are a particularly vulnerable subpopulation who possesses additional, nonmodifiable risk factors for developing these infections and, in many cases, are at increased risk of death as a result. This review will describe the most common nosocomial infections patients with cancer acquire while in the ICU: ventilator-associated events, central line-associated bloodstream infection, catheter-associated urinary tract infections, and Clostridium difficile infection...
January 1, 2018: Journal of Intensive Care Medicine
Steven C Lin, Carolyn D Alonso, Alan C Moss
Clostridium difficile, an anaerobic gram-positive, spore-forming bacillus, has become the most common cause of nosocomial infectious diarrhea, and is associated with increased mortality in all populations. Patients who have received solid organ transplants (SOT) are at increased risk of Clostridium difficile infection (CDI) and CDI recurrence (rCDI). This may be related to chronic immunosuppression, frequent antibiotic exposure, and increased or prolonged hospitalizations. Increased morbidity and mortality from CDI is well described in SOT patients...
July 16, 2018: Transplant Infectious Disease: An Official Journal of the Transplantation Society
Larry K Kociolek, Eric R Purdue, Warren N Fawley, Mark H Wilcox, Dale N Gerding, Stuart Johnson
Restriction endonuclease analysis (REA) and PCR ribotyping are two typing systems that have been frequently utilized for molecular epidemiologic characterization of Clostridioides (Clostridium) difficile. To correlate typing data obtained from each method, we performed both REA and PCR ribotyping on a large and diverse set of historical and contemporary C. difficile infection clinical isolates. Eighty isolates were selected from each reference laboratory in the United States (Microbiology Reference Laboratory, Hines VA Medical Center) and United Kingdom (Clostridium difficile Network for England and Northern Ireland laboratory, University of Leeds)...
July 13, 2018: Anaerobe
Shanglei Liu, Toshiaki Suzuki, Bryce W Murray, Lisa Parry, Craig S Johnson, Santiago Horgan, Sonia Ramamoorthy, Samuel Eisenstein
BACKGROUND: Transanal minimally invasive surgery (TAMIS) offers intra-luminal full-thickness excision of rectal neoplasia. Robotic TAMIS (RT) allows for greater versatility in motion while operating in the limited space of the rectum. We present our experience with this technique in practice using the DaVinci Xi™ platform. METHOD: This is a multi-institutional retrospective analysis for patient undergoing Robotic TAMIS for resection of rectal lesions at two tertiary referral hospitals in the United States...
July 13, 2018: Surgical Endoscopy
Shiv K Sharma, Christopher Yip, Emilio Xavier Esposito, Prateek V Sharma, Matthew P Simon, Ernesto Abel-Santos, Steven M Firestine
Clostridium difficile infections (CDI), particularly those caused by the BI/NAP1/027 epidemic strains, are challenging to treat. One method to address this disease is to prevent the development of CDI by inhibiting the germination of C. difficile spores. Previous studies have identified cholic amide m-sulfonic acid, CamSA, as an inhibitor of spore germination. However, CamSA is inactive against the hypervirulent strain R20291. To circumvent this problem, a series of cholic acid amides were synthesized and tested against R20291...
July 13, 2018: Journal of Medicinal Chemistry
Ruth K Dudek-Wicher, Adam Junka, Marzenna Bartoszewicz
The gut microbiota acts as a real organ. It exerts important metabolic functions, and regulates the inflammatory response by stimulating the immune system. Gut microbial imbalance (dysbiosis) has been linked to important human diseases and inflammation-related disorders. The symbiotic interactions between resident microorganisms and the gastrointestinal tract significantly contribute to maintaining gut homeostasis. The present review summarizes our knowledge regarding the impact of different antibiotics causing such long-term consequences as decreased microbial diversity, modulation of the Bacteroidetes/Firmicutes ratio, Clostridium difficile overgrowth , and increased expansion of the opportunistic pathogens Salmonella typhimurium , Escherichia spp...
2018: Przegla̜d Gastroenterologiczny
Jordan E Axelrad, Benjamin Lebwohl, Edward Cuaresma, Ken Cadwell, Peter H R Green, Daniel E Freedberg
Background: Gut colonization with vancomycin-resistant Enterococcus (VRE) is associated with poor outcomes. This study evaluated the impact of VRE colonization on subsequent acquisition of enteric pathogens. Methods: We performed a retrospective cohort study of adults admitted to an ICU from 2012 to 2017 who were screened for VRE colonization and subsequently underwent stool testing with a gastrointestinal pathogen PCR panel (GI PCR) with or without PCR testing for Clostridium difficile ...
2018: Gut Pathogens
Kiyoshi Kinoshita
Clostridium difficile (C. difficile), an enterobacteria, flourishes and produces potent toxins, toxin A (TcdA) and toxin B (TcdB), after the disruption of the normal colonic microbiota by antibiotic therapy. C. difficile infection (CDI) may induce life-threatening complications such as fulminant colitis through damage of the intestinal wall by the toxins, therefore the prevention of CDI recurrence is the most important in CDI treatment. Bezlotoxumab is a human monoclonal antibody that neutralizes the activity of TcdB directly...
2018: Nihon Yakurigaku Zasshi. Folia Pharmacologica Japonica
Katherine Schultz, Emily Sickbert-Bennett, Ashley Marx, David J Weber, Lauren M DiBiase, Stacy Campbell-Bright, Lauren E Bode, Mike Baker, Tom Belhorn, Mark Buchanan, Sherie Goldbach, Jacci Harden, Emily Hoke, Beth Huenniger, Jonathan J Juliano, Michael Langston, Heather Ritchie, William A Rutala, Jason Smith, Shelley Summerlin-Long, Lisa Teal, Peter Gilligan
Healthcare facility-onset Clostridium difficile infections (HO-CDI) are an important national problem, causing increased morbidity and mortality, with longer and more costly hospital stays. HO-CDI is an important metric for the Center for Medicare and Medicaid Service's (CMS) performance measures. Hospitals that fall into the worst-performing quartile in preventing hospital acquired infections, including HO-CDI, may lose millions of dollars in reimbursement. Under pressure to reduce CDI and without a clear optimal method for C...
July 11, 2018: Journal of Clinical Microbiology
Jacky Shui Ho Chan, Amelia Chien Wei Chao, Vincent Chi Ho Cheung, Sophia Sau Kuen Wong, Whitney Tang, Justin Che Yuen Wu, Henry Lik Yuen Chan, Francis Ka Leung Chan, Joseph Jao Yiu Sung, Siew Chien Ng
BACKGROUND AND AIM: Gastrointestinal (GI) diseases account for substantial morbidity, mortality and health care utilization. This public hospital based study assessed the incidence and time trend of hospitalization and mortality of major GI diseases over one decade. METHODS: We conducted an observational study using population-wide database managed by the Hong Kong Hospital Authority with a principal diagnosis of GI diseases defined by ICD-9-CM coding. We measured age-standardized incidence of hospitalization, emergency admissions, multiple admissions and in-hospital mortality from 2005 to 2014 using Poisson regression...
July 11, 2018: Journal of Gastroenterology and Hepatology
F Prechter, A Stallmach
Clostridium difficile infections (CDI) are encountered in about 1-2% of patients in the intensive care unit (ICU) and pose a special challenge to those who provide care. Only little data regarding severity and management of CDI in ICU patients in Europe are available. Extrapolation of results from one patient population to another is often difficult. The comorbidities of those patients often limit the application of general recommendations concerning diagnosis and therapy. In addition, there are a relevant percentage of patients (10-20%) with asymptomatic C...
July 11, 2018: Medizinische Klinik, Intensivmedizin und Notfallmedizin
Aaron Fisher, Pradeep Khanal, Ewa Gniado, Leila Khaddour, Molly Orosey, Ismail Hader, Siddhartha Yadav, Alexandra Halalau
Background: Clostridium difficile infection (CDI) is the leading cause of hospital-associated gastrointestinal illness. Previous studies reported that patients with active malignancy are at high risk for CDIs, and yet they are still classified as nonsevere CDI and initially treated with metronidazole. Our aim is to investigate the need for the escalation of antibiotic therapy in patients with CDI and active cancer treated with oral metronidazole versus oral vancomycin. Methods: This is a retrospective study of adult patients admitted with CDI and any underlying active malignancy at Beaumont Hospital, Royal Oak, Michigan, from January 2008 to December 2014...
2018: Gastroenterology Research and Practice
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