scholarly journals Clostridioides (Clostridium) difficile Pacemaker Infection

2020 ◽  
Vol 7 (12) ◽  
Author(s):  
Anna Berkefeld ◽  
Fabian K Berger ◽  
Barbara C Gärtner ◽  
Nina Wantia ◽  
Anatol Prinzing ◽  
...  
Keyword(s):  
Clostridium Difficile ◽  
Prosthetic Material ◽  
Oral Vancomycin ◽  
Molecular Subtyping ◽  
Documented Case ◽  
Clostridioides Difficile ◽  
Abdominal Symptoms ◽  
Intravascular Device ◽  
Nosocomial Diarrhea ◽  
Lead Infection

Abstract Clostridioides difficile is the leading cause of antibiotic-associated nosocomial diarrhea, but extra-intestinal manifestations are rare. We describe the first documented case of bacteraemia with pacemaker pocket and lead infection with the toxigenic C. difficile ribotype 014 with a lack of abdominal symptoms. The patient underwent pacemaker extraction and treatment with intravenous and oral vancomycin. Genotyping and molecular subtyping revealed clonality between pacemaker and intestinal isolates. This case illustrates the risk of intravascular device infections due to C. difficile. Even asymptomatic C. difficile colonization might pose a risk for prosthetic material infection.

scholarly journals 2386. Mortality reduction with implementation of a standardized approach of surveillance, diagnosis and treatment of Clostridioides difficile infections.

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S824-S824
Author(s):  
Aaron Molina ◽  
Alejandro Olmedo-Reneaum ◽  
Yanelly Garfias ◽  
Paulette A Carmona ◽  
Andrea Constantino ◽  
...  
Keyword(s):  
Active Surveillance ◽  
Clinical Cure ◽  
Diagnosis And Treatment ◽  
Oral Vancomycin ◽  
Traditional Treatment ◽  
Adequate Treatment ◽  
Multimodal Strategy ◽  
Clostridioides Difficile ◽  
Nosocomial Diarrhea ◽  
The Impact

Abstract Background Clostridioides difficile (C. difficile) infection is the main cause of nosocomial diarrhea in the world. In our hospital, there was no standardized protocol for diagnosis and treatment of this infection. The aim of this study was to measure the impact of implementing a multimodal strategy of active surveillance, diagnosis and treatment in the clinical outcome of patients with C. difficile infection. Methods Observational, retrospective, and analytical study that compared a multimodal strategy for the treatment of C. difficile infection against a traditional strategy, which consisted of treatment with either metronidazole or vancomycin with variable duration of therapy depending on the physician’s choice. The multimodal strategy consisted of active surveillance of cases of nosocomial diarrhea, timely diagnosis (<12 hours), and standard treatment with oral vancomycin for a minimum of 10 days (125 mg po qid in mild and moderate illness, and 250 mg qid in severe disease). Patients with a confirmed diagnosis of C. difficile infection (PCR- Gene Xpert Cepheid) and inflammatory diarrhea were included. The study was carried out in a third-level hospital, in the period between September 2017 and December 2018. Results In 15 month study period, 92 cases of C. difficile infection were documented. All cases were caused by strain NAP1 / B1 / 027. Twenty-three patients (25%) had mild disease, 28 (30.4%) moderate illness and 41 (44.56%) complicated illness. Thirty-four patients were evaluated with multimodal strategy and 58 according to the traditional treatment. Only 24 patients (41%) in the traditional treatment group received treatment with oral vancomycin. The clinical outcomes of patients in the multimodal strategy against patients with the tradional strategy were: clinical cure 85.3% vs 37.9% (P = 0.02), recurrence 2.9% vs 17.2% (p = < 0.05) and death 11.8% vs 44.8%(p = < 0.05), respectively. Conclusion Unfortunately, in our country, there are no guidelines for the management of C. difficile infection, and in many hospitals, metronidazole is the most prescribed treatment. In this study, we documented that implementing a standardized strategy of surveillance, diagnosis and adequate treatment, reduced mortality related to C. difficile infection, recurrence, and achieved greater clinical cure. Disclosures All authors: No reported disclosures.

scholarly journals 2413. Assessment of compliance with Clostridioides difficile prophylaxis guideline and its efficacy on secondary prophylaxis and reducing hospital-onset Clostridioides difficile infections.

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S833-S833
Author(s):  
Nikunj M Vyas ◽  
Cindy Hou ◽  
Todd P Levin
Keyword(s):  
Clostridium Difficile ◽  
Broad Spectrum ◽  
Secondary Prophylaxis ◽  
Primary Objective ◽  
Control Group ◽  
Inpatient Mortality ◽  
Oral Vancomycin ◽  
Clostridioides Difficile ◽  
Stewardship Program ◽  
Prophylaxis Guideline

Abstract Background One of the complications of Clostridium difficile infection (CDI) is the risk of recurrence, particularly in high-risk patients who are exposed to broad-spectrum antibiotics (BSA). Antimicrobial stewardship program at our institution developed Clostridium difficile prophylaxis (CDP) guidelines. Purpose of this study was to evaluate the compliance to this guideline and evaluate the efficacy of it preventing recurrent CDI. Methods This was an IRB approved retrospective study performed at a 607-bed community health system between 2014–2016. Patients were included if they were ≥18 years old and admitted for > 24 hours on BSA with history of CDI in last 6 months. CDI prophylaxis was provided with oral vancomycin 125 PO BID. Patients were excluded if they had active CDI receiving metronidazole or treatment doses of oral vancomycin. Patients were compared in two cohorts: Study group which was patients in CDP group which were matched to control group. The primary objective of the study was to evaluate the compliance of CDP guidelines and incidence of hospital-onset CDI (HO-CDI) between CDP group and control group. The secondary objective focused on all-cause inpatient mortality and 30-day readmission between two groups. Results There were total of 72 patients reviewed and 47 patients met the inclusion criteria for CDP group which were matched with control group. Most common type of infection and BSA were pnuemonia (26%) and broad-spectrum cephalosporins (31%), respectively. CDP guidelines compliance was measured at 65%. The incidence of HO-CDI/10000 patient-days during the admission was lower in CDP group compared with control group (2.02 vs 5.4 per 10,000 PD, P = 0.03). No differences were seen in all-cause inpatient mortality and 30-day readmission between two groups. Forty-five percent of patients suffered from CDI < 3 months prior to admission. The most common dose of oral vancomycin was 125 mg PO BID. Conclusion Patients in CDP group had a lower incidence of developing HO-CDI compared with control group. Overall compliance with CDP guidelines was higher than expected. No difference was seen in all-cause inpatient mortality and 30-day readmission between two groups. Oral vancomycin 125 mg PO BID shows promising results as a secondary prophylaxis in patients receiving BSA. Disclosures All authors: No reported disclosures.

scholarly journals Probiotics in Pediatrics. A Review and Practical Guide

Nutrients ◽  
2021 ◽  
Vol 13 (7) ◽  
pp. 2176
Author(s):  
Leontien Depoorter ◽  
Yvan Vandenplas
Keyword(s):  
Health Benefit ◽  
Beneficial Effects ◽  
Treatment Regimens ◽  
Clostridioides Difficile ◽  
Nosocomial Diarrhea ◽  
Infectious Gastroenteritis ◽  
Study Heterogeneity ◽  
Probiotic Strains ◽  
Prophylactic Use ◽  
Meta Analyses

The potential benefit of the administration of probiotics in children has been studied in many settings globally. Probiotics products contain viable micro-organisms that confer a health benefit on the host. Beneficial effects of selected probiotic strains for the management or prevention of selected pediatric conditions have been demonstrated. The purpose of this paper is to provide an overview of current available evidence on the efficacy of specific probiotics in selected conditions to guide pediatricians in decision-making on the therapeutic or prophylactic use of probiotic strains in children. Evidence to support the use of certain probiotics in selected pediatric conditions is often available. In addition, the administration of probiotics is associated with a low risk of adverse events and is generally well tolerated. The best documented efficacy of certain probiotics is for treatment of infectious gastroenteritis, and prevention of antibiotic-associated, Clostridioides difficile-associated and nosocomial diarrhea. Unfortunately, due to study heterogeneity and in some cases high risk of bias in published studies, a broad consensus is lacking for specific probiotic strains, doses and treatment regimens for some pediatric indications. The current available evidence thus limits the systematic administration of probiotics. The most recent meta-analyses and reviews highlight the need for more well-designed, properly powered, strain-specific and dedicated-dose response studies.

scholarly journals Effectiveness of fidaxomicin versus oral vancomycin in the treatment of recurrent clostridioides difficile

2021 ◽  
Author(s):  
Alyssa Rinaldi ◽  
Erica E. Reed ◽  
Kurt B. Stevenson ◽  
Kelci Coe ◽  
Jessica M. Smith
Keyword(s):  
Oral Vancomycin ◽  
Clostridioides Difficile

scholarly journals 1376. Oral Vancomycin as Secondary Prophylaxis Against Clostridioides difficile Infection in Pediatric Patients

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S698-S698
Author(s):  
Hongkai Bao ◽  
Yanina Dubrovskaya ◽  
John Papadopoulos ◽  
Justin Siegfried ◽  
Cristian Merchan ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Odds Ratio ◽  
Protective Factor ◽  
Pediatric Patients ◽  
Antibiotic Exposure ◽  
Oral Vancomycin ◽  
Clostridioides Difficile ◽  
Clostridioides Difficile Infection ◽  
History Of ◽  
Systemic Antibiotics

Abstract Background Secondary oral vancomycin prophylaxis (OVP) has been utilized in adults with a history of Clostridioides difficile infection (CDI) while receiving systemic antibiotics to prevent CDI recurrence. However, this practice is poorly described in pediatric patients. Rates of CDI recurrence in pediatric patients range from 10-40% and is associated with morbidity and mortality. This study assessed the efficacy and safety of secondary OVP in pediatric patients with subsequent antibiotic exposure. Methods This retrospective study evaluated pediatric patients ≤18 years with any history of clinical CDI and receiving systemic antibiotics in a subsequent encounter during the time period of 2013-2019. Patients who received OVP 10 mg/kg (up to 125 mg per dose) every 12 hours during concomitant antibiotics were compared to those who did not. The primary outcome was CDI recurrence within 8 weeks following antibiotic exposure. Secondary outcomes included time to recurrence, severity of recurrence, and isolation of vancomycin-resistant enterococci (VRE) from any site. Risk factors for CDI recurrence were assessed using logistic regression. Results A total of 153 patients were screened for inclusion, of which 32 and 47 patients were assigned to the OVP and no OVP group, respectively. Median age was 8.6 years and the most common comorbidities were malignancy (47%) and immunosuppression (46%). Median time since last CDI to study inclusion was 64.5 days in the OVP group and 90 days in the no OVP group, P=0.320. Compared to the no OVP group, OVP patients had longer hospital stays (5 vs 14 days, P=0.001) and more concomitant antibiotic exposure (8 vs 12.5 days, P=0.001). Median duration of OVP was 12 days. CDI recurrence occurred in 12 patients and was significantly lower in the OVP vs no OVP group (3.1% vs 23.4%; odds ratio, 0.106; 95% confidence interval, 0.013-0.864; P=0.022). VRE was not isolated in any patients. After adjustment in a multivariate analysis, only secondary OVP remained as a protective factor against recurrence (odds ratio, 0.082; 95% confidence interval, 0.009-0.748; P=0.027). Conclusion Secondary OVP effectively reduces the risk of recurrent CDI in pediatric patients with a history of CDI while receiving systemic antibiotics. Future prospective studies should validate these findings. Disclosures Cristian Merchan, PharMD, BCCCP, abbive (Speaker’s Bureau)

Clostridium difficile—Associated Diarrhea, an Emerging Epidemic: Therapeutic Options

2007 ◽  
Vol 20 (4) ◽  
pp. 347-353
Author(s):  
Christopher R. Emerson
Keyword(s):  
Clostridium Difficile ◽  
Hospital Admissions ◽  
Treatment Options ◽  
Infectious Diarrhea ◽  
First Line ◽  
Oral Vancomycin ◽  
Considerable Morbidity ◽  
Clostridium Difficile Associated Diarrhea ◽  
Pharmacologic Agents ◽  
Oral Metronidazole

Clostridum difficile—associated disease (CDAD) is the leading cause of infectious diarrhea and is associated with considerable morbidity and mortality. The incidence is estimated to range from 3.4 to 8.4 cases per 1000 hospital admissions, and it has become a growing problem at many institutions. Treatment options for CDAD are limited due to a paucity of new pharmacologic agents and studies examining other potential treatments. Historically oral metronidazole and oral vancomycin have been used as first-line agents in the treating CDAD, however recent reports of treatment failure and recurrence with these agents have surfaced. These reports illustrate a need for novel pharmacologic agents and a thorough review of currently available agents that may have activity against C difficile. Available data on the treatment of CDAD were extracted and reviewed to outline the appropriate management of CDAD.

scholarly journals Function of the CRISPR-Cas System of the Human Pathogen Clostridium difficile

mBio ◽  
2015 ◽  
Vol 6 (5) ◽  
Author(s):  
Pierre Boudry ◽  
Ekaterina Semenova ◽  
Marc Monot ◽  
Kirill A. Datsenko ◽  
Anna Lopatina ◽  
...  
Keyword(s):  
Clostridium Difficile ◽  
Type I ◽  
Human Pathogen ◽  
Range Analysis ◽  
Data Set ◽  
Content Type ◽  
Crispr System ◽  
Nosocomial Diarrhea ◽  
Active Expression ◽  
Foreign Dna

ABSTRACT Clostridium difficile is the cause of most frequently occurring nosocomial diarrhea worldwide. As an enteropathogen, C. difficile must be exposed to multiple exogenous genetic elements in bacteriophage-rich gut communities. CRISPR (clustered regularly interspaced short palindromic repeats)-Cas (CRISPR-associated) systems allow bacteria to adapt to foreign genetic invaders. Our recent data revealed active expression and processing of CRISPR RNAs from multiple type I-B CRISPR arrays in C. difficile reference strain 630. Here, we demonstrate active expression of CRISPR arrays in strain R20291, an epidemic C. difficile strain. Through genome sequencing and host range analysis of several new C. difficile phages and plasmid conjugation experiments, we provide evidence of defensive function of the CRISPR-Cas system in both C. difficile strains. We further demonstrate that C. difficile Cas proteins are capable of interference in a heterologous host, Escherichia coli. These data set the stage for mechanistic and physiological analyses of CRISPR-Cas-mediated interactions of important global human pathogen with its genetic parasites. IMPORTANCE Clostridium difficile is the major cause of nosocomial infections associated with antibiotic therapy worldwide. To survive in bacteriophage-rich gut communities, enteropathogens must develop efficient systems for defense against foreign DNA elements. CRISPR-Cas systems have recently taken center stage among various anti-invader bacterial defense systems. We provide experimental evidence for the function of the C. difficile CRISPR system against plasmid DNA and bacteriophages. These data demonstrate the original features of active C. difficile CRISPR system and bring important insights into the interactions of this major enteropathogen with foreign DNA invaders during its infection cycle.

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