scholarly journals Clostridium Difficile-Associated Diarrhea in 200 Canadian Children

2005 ◽  
Vol 19 (8) ◽  
pp. 497-501 ◽  
Author(s):  
Véronique Morinville ◽  
Jane McDonald
Keyword(s):  
Clostridium Difficile ◽  
Pediatric Patients ◽  
Single Agent ◽  
Hirschsprung Disease ◽  
Pediatric Hospital ◽  
Recurrence Rates ◽  
Treatment Data ◽  
Prior Literature ◽  
Clostridium Difficile Associated Diarrhea ◽  
Bloody Stools

OBJECTIVE: Clostridium difficile-associated diarrhea is a major problem in adults. The present study was conducted to assess risk factors and outcomes in children with C difficile-associated diarrhea.METHODS: Laboratory records at a university-affiliated pediatric hospital were reviewed for all C difficile toxin-positive stools (cell culture cytotoxin assay) between 2000 and 2003. Charts on identified patients were reviewed.RESULTS: Two hundred patients with a diagnosis of C difficile-associated diarrhea were identified between February 2000 and November 2003. There were 107 males and 93 females (mean age 5.4 years; median age 2.6 years). Underlying factors were identified in 19% (12 patients underwent chemotherapy; seven patients had Crohn's disease; six were transplantation recipients; seven an immunodeficiency; four with Hirschsprung disease; two diagnoses of 'other'). Of the 200 identified patients, 149 (74.5%) had documentation of antibiotics in the previous two months (32 penicillins; 38 cephalosporins; three clindamycin, nine other single-agent, 59 multiple; eight not specified), and 111 (55.5%) had been hospitalized in the previous month. The symptoms of C difficile-associated diarrhea included bloody stools in 12.5% and frequent watery stools in 79%. Hospitalization was required in 27 of 116 outpatients; stay was prolonged in seven of the 84 patients already hospitalized. Fifty-five per cent received metronidazole, 34% were not treated, and treatment data were not available for the remainder. Recurrence occurred in 31% of those treated and retreatment consisted of vancomycin (15%), probiotics (15%) and cholestyramine (6%). No colectomies were required but two deaths occurred.CONCLUSIONS: The majority of pediatric patients developing symptomatic C difficile-associated diarrhea had antibiotic exposure or hospitalization within the previous one to two months. This is higher than previously reported. One-third had spontaneous symptom resolution. For those treated, recurrence rates were high. Mortality was significantly lower than described in adults, in agreement with prior literature.

Resolution of Clostridium difficile–Associated Diarrhea in Patients With Cancer Treated With Fidaxomicin or Vancomycin

2013 ◽  
Vol 31 (19) ◽  
pp. 2493-2499 ◽  
Author(s):  
Oliver A. Cornely ◽  
Mark A. Miller ◽  
Bruno Fantin ◽  
Kathleen Mullane ◽  
Yin Kean ◽  
...  
Keyword(s):  
Clostridium Difficile ◽  
Cancer Recurrence ◽  
Patient Characteristics ◽  
Sustained Response ◽  
Recurrence Rates ◽  
Double Blind ◽  
Patients With Cancer ◽  
Increased Risk ◽  
Intent To Treat ◽  
Clostridium Difficile Associated Diarrhea

Purpose Patients with cancer are at increased risk for Clostridium difficile–associated diarrhea (CDAD). Little is known about treatment response. Patients and Methods Two double-blind trials randomly allocated 1,105 patients with CDAD to fidaxomicin or vancomycin treatment (modified intent-to-treat [mITT]), and 183 of these had cancer. Univariate and multivariate post hoc analyses compared effects of treatment and patient characteristics on cure, recurrence, and sustained response after 4 weeks. Time to resolution of diarrhea (TTROD) was also evaluated. Results Patients with cancer had a lower cure rate and longer TTROD than patients without cancer. Recurrence rates were similar. Cure was more likely with fidaxomicin than vancomycin (odds ratio [OR] 2.0; P = .065), recurrence was less likely (OR = 0.37; P = .018), and sustained response more frequent (OR = 2.56; P = .003). Under vancomycin, median TTROD was longer in patients with cancer than in those without (123 v 58 hours; log-rank P < .001). With fidaxomicin, median TTROD was not significantly affected by presence of cancer (74 v 54 hours; log-rank P = .145). In the full mITT population, age, hypoalbuminemia, and cancer were inversely associated with clinical cure by multivariate analysis. Study treatment with vancomycin was a significant predictor of recurrence (P < .001). Within the cancer population, low albumin was negatively and fidaxomicin was positively associated with improved cure. Conclusion For patients with cancer, fidaxomicin treatment was superior to vancomycin, resulting in higher cure and sustained response rates, shorter TTROD, and fewer recurrences.

scholarly journals Detailed methodological recommendations for the treatment of Clostridium difficile-associated diarrhea with faecal transplantation

2013 ◽  
Vol 154 (1) ◽  
pp. 10-19 ◽  
Author(s):  
Gergely György Nagy ◽  
Csaba Várvölgyi ◽  
Zoltán Balogh ◽  
Piroska Orosi ◽  
György Paragh
Keyword(s):  
Clostridium Difficile ◽  
Therapeutic Strategies ◽  
Routine Clinical Practice ◽  
Cure Rate ◽  
Recurrence Rates ◽  
Professional Societies ◽  
Significant Interest ◽  
Clostridium Difficile Associated Diarrhea ◽  
Methodological Guidelines ◽  
High Treatment

The incidence of Clostridium difficile associated enteral disease shows dramatic increase worldwide, with appallingly high treatment costs, mortality figures, recurrence rates and treatment refractoriness. It is not surprising, that there is significant interest in the development and introduction of alternative therapeutic strategies. Among these only stool transplantation (or faecal bacteriotherapy) is gaining international acceptance due to its excellent cure rate (≈92%), low recurrence rate (≈6%), safety and cost-effectiveness. Unfortunately faecal transplantation is not available for most patients, although based on promising international results, its introduction into the routine clinical practice is well justified and widely expected. The authors would like to facilitate this process, by presenting a detailed faecal transplantation protocol prepared in their Institution based on the available literature and clinical rationality. Officially accepted national methodological guidelines will need to be issued in the future, founded on the expert opinion of relevant professional societies and upcoming advances in this field. Orv. Hetil., 2013, 154, 10–19.

scholarly journals Fidaxomicin Compared With Oral Vancomycin for the Treatment of Severe Clostridium difficile–Associated Diarrhea: A Retrospective Review

2019 ◽  
Vol 55 (4) ◽  
pp. 268-272
Author(s):  
Bryant B. Summers ◽  
Mary Yates ◽  
Kerry O. Cleveland ◽  
Michael S. Gelfand ◽  
Justin Usery
Keyword(s):  
Clostridium Difficile ◽  
Length Of Stay ◽  
Medical Center ◽  
Academic Medical Center ◽  
Recurrence Time ◽  
Financial Benefit ◽  
Oral Vancomycin ◽  
Recurrence Rates ◽  
Time To Recurrence ◽  
Clostridium Difficile Associated Diarrhea

Purpose: The most recent published guidelines on Clostridium difficile–associated diarrhea (CDAD) developed by the Infectious Diseases Society of America (IDSA) were released in 2017 and outline its treatment based on severity of the disease and recurrence; however, a clear first-line agent has not been recommended specifically for severe CDAD. Methods: This retrospective chart review was approved by the institutional review board and consisted of three community hospitals and one academic medical center. To be included, patients need to meet criteria for severe CDAD and receive at least 72 hours of therapy. Patients received either oral vancomycin or fidaxomicin, in addition to other therapies for CDAD, and differences in outcomes such as cost obtained from a common charge center, rates of recurrence, time to recurrence as measured at time of positive to negative polymerase chain reaction (PCR) test, and mortality were assessed. Results: Of the 147 patients, 74 patients received fidaxomicin and 73 patients received oral vancomycin. The average hospitalization cost for patients receiving fidaxomicin was $129,338.69 and for patients receiving vancomycin was $153,563.81 ( P = .26). Recurrence rates were lower with fidaxomicin compared with vancomycin (6.8% vs 17.6%; P = .047), and time to recurrence was longer with fidaxomicin versus vancomycin, but not statistically significant (96.8 ± 45.9 days vs 63.2 ± 66.9 days; P = .321). Mortality, length of stay in the intensive care unit, and overall length of stay were similar between the two therapies. Conclusions: In the treatment of severe CDAD, recurrence rates were lower and time to recurrence was higher with fidaxomicin compared with oral vancomycin. A clear financial benefit has yet to translate from these known findings.

Branchial Anomalies in the Pediatric Population

2007 ◽  
Vol 137 (2) ◽  
pp. 289-295 ◽  
Author(s):  
James W. Schroeder ◽  
Nadia Mohyuddin ◽  
John Maddalozzo
Keyword(s):  
Retrospective Study ◽  
Surgical Treatment ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Tertiary Care ◽  
Epithelial Lining ◽  
Pediatric Hospital ◽  
Recurrence Rates ◽  
Branchial Anomalies

OBJECTIVE: We sought to review the presentation, evaluation, and treatment of branchial anomalies in the pediatric population and to relate these findings to recurrences and complications. STUDY DESIGN AND SETTING: We conducted a retrospective study at a tertiary care pediatric hospital. PATIENTS: Ninety-seven pediatric patients who were treated for branchial anomalies over a 10-year period were reviewed. Patients were studied if they underwent surgical treatment for the branchial anomaly and had 1 year of postoperative follow-up; 67 children met criteria, and 74 anomalies were studied. RESULTS: Patients with cysts presented at a later age than did those with branchial anomaly fistulas or sinus branchial anomalies. 32% of branchial anomalies were previously infected. Of these, 71% had more than one preoperative infection. 18% of the BA were first arch derivatives, 69% were second arch derivatives and 7% were third arch derivatives. There were 22 branchial cysts, 31 branchial sinusies and 16 branchial fistulas. The preoperative and postoperative diagnoses differed in 17 cases. None of the excised specimens that contained a cystic lining recurred; all five recurrences had multiple preoperative infections. CONCLUSIONS: Recurrence rates are increased when there are multiple preoperative infections and when there is no epithelial lining identified in the specimen.

Monotherapy for fever and neutropenia in cancer patients: a randomized comparison of ceftazidime versus imipenem.

1995 ◽  
Vol 13 (1) ◽  
pp. 165-176 ◽  
Author(s):  
A G Freifeld ◽  
T Walsh ◽  
D Marshall ◽  
J Gress ◽  
S M Steinberg ◽  
...  
Keyword(s):  
Clostridium Difficile ◽  
Pediatric Patients ◽  
Gastrointestinal Toxicity ◽  
Antibiotic Regimen ◽  
Open Label ◽  
Antimicrobial Spectrum ◽  
Unexplained Fever ◽  
Clostridium Difficile Associated Diarrhea ◽  
To Receive ◽  
Made In

PURPOSE To compare the efficacy of ceftazidime and imipenem monotherapy for fever and neutropenia, and to determine whether fewer antimicrobial modifications (additions or changes) are required by the broader-spectrum agent, imipenem. PATIENTS AND METHODS Adult and pediatric patients undergoing chemotherapy for solid tumors, leukemias, or lymphomas were randomized to receive open-label ceftazidime or imipenem on presentation with fever and neutropenia. Success with or without modifications of the initial antibiotic was defined as survival through neutropenia; failure was death due to infection. Comparisons were based on numbers of modifications made to each monotherapy during the course of neutropenia, in patients stratified as having unexplained fever or a documented infection. RESULTS Among 204 ceftazidime and 195 imipenem recipients, the overall success rate with or without modification was more than 98%, regardless of initial antibiotic regimen. Modifications occurred in half of all episodes, primarily in patients with documented infections on either monotherapy. Antianaerobic agents were more frequently added to ceftazidime (P < .001), but addition of other antibiotics, including vancomycin and aminoglycosides, was similar between the two monotherapy groups. Imipenem therapy was associated with significantly greater toxicity, manifested by Clostridium difficile-associated diarrhea and by nausea and vomiting, which required discontinuation of imipenem in 10% of recipients. CONCLUSION Ceftazidime and imipenem are both effective in the management of fever and chemotherapy-related neutropenia, provided that modifications are made in response to clinical and microbiologic data that emerge during the course of neutropenia. Imipenem, despite its broader antimicrobial spectrum, does not significantly decrease the overall need for antibiotic modifications and is more often complicated by gastrointestinal toxicity.

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