scholarly journals 1496. Bezlotoxumab Administered at the End of a Suppressive Drug Regimen for Patients with Multiply Recurrent Clostridioides difficile Infection

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S545-S545
Author(s):  
Xing Tan ◽  
Larry H Danziger ◽  
Dale N Gerding
Keyword(s):  
Treatment Regimen ◽  
Initial Response ◽  
Drug Regimen ◽  
Retrospective Case ◽  
Public Health Burden ◽  
Clostridioides Difficile ◽  
Positive Stool ◽  
Clostridioides Difficile Infection ◽  
Effective Therapeutic Strategy ◽  
Irritable Bowel

Abstract Background Recurrent Clostridioides difficile infection (CDI) remains a public health burden, affecting as many as 35% of patients with primary CDI. Bezlotoxumab, a monoclonal anti-toxin B antibody, was the first FDA-approved agent indicated for the prevention of recurrent CDI, but real-world experience is limited, particularly in patients with multiple CDI recurrences. Methods We conducted a retrospective case study of patients with multiple CDI recurrences who failed prior treatments with pulsed and tapered vancomycin and fidaxomicin regimens. Six patients in a single CDI specialty outpatient clinic received a single iv infusion of bezlotoxumab at the end of a suppressive vancomycin or fidaxomicin treatment regimen. The suppressive treatment was stopped immediately after the bezlotoxumab infusion and the patients were followed closely for recurrent symptoms and need for additional CDI treatment. Results Four of 6 patients who received bezlotoxumab at the end of a suppressive treatment regimen did not require subsequent CDI treatment and have been followed for 2 weeks to 1.5 years to date. These four patients experienced a single, self-limited episode of diarrhea within 2 weeks of the infusion, and did not require subsequent CDI treatment. Two patients had recurrent symptoms and positive stool C. difficile tests one month after infusion and were re-started on CDI treatment. One of the patients had longstanding underlying irritable bowel syndrome and variable initial response to re-starting vancomycin. The other patient responded to re-starting fidaxomicin. Conclusion Bezlotoxumab at the end of a prolonged suppressive treatment regimen may be an effective therapeutic strategy in preventing recurrent CDI in complicated, multiply recurrent CDI patients. Disclosures All authors: No reported disclosures.

scholarly journals Risk Factors for BI/NAP1/027 Clostridioides difficile Infections and Clinical Outcomes Compared With Non-NAP1 Strains

2019 ◽  
Vol 6 (12) ◽  
Author(s):  
Nandita S Mani ◽  
John B Lynch ◽  
Ferric C Fang ◽  
Jeannie D Chan
Keyword(s):  
Risk Factors ◽  
Proton Pump Inhibitor ◽  
Clinical Outcomes ◽  
Case Control ◽  
Nursing Facilities ◽  
Single Center ◽  
Retrospective Case ◽  
Skilled Nursing ◽  
Clostridioides Difficile ◽  
Clostridioides Difficile Infection

Abstract We aim to describe the characteristics, risk factors, and clinical outcomes associated with NAP1 strain Clostridioides difficile infection (CDI) in this single-center, retrospective, case–control (1:1) study. We found that the NAP1 strain accounted for 19.7% of CDI, and risk factors for acquisition included residence in skilled nursing facilities, previous CDI, and proton pump inhibitor use.

scholarly journals Clinical Application and Potential of Fecal Microbiota Transplantation

2019 ◽  
Vol 70 (1) ◽  
pp. 335-351 ◽  
Author(s):  
R.E. Ooijevaar ◽  
E.M. Terveer ◽  
H.W. Verspaget ◽  
E.J. Kuijper ◽  
J.J. Keller
Keyword(s):  
Fecal Microbiota Transplantation ◽  
Multidrug Resistant ◽  
Fecal Microbiota ◽  
Graft Versus Host ◽  
Clostridioides Difficile ◽  
Current State ◽  
Randomized Controlled Studies ◽  
Clostridioides Difficile Infection ◽  
New Treatment ◽  
Irritable Bowel

Fecal microbiota transplantation (FMT) is a well-established treatment for recurrent Clostridioides difficile infection. FMT has become a more readily available and useful new treatment option as a result of stool banks. The current state of knowledge indicates that dysbiosis of the gut microbiota is implicated in several disorders in addition to C. difficile infection. Randomized controlled studies have shown FMT to be somewhat effective in treating ulcerative colitis, irritable bowel syndrome, and hepatic encephalopathy. In addition, FMT has been beneficial in treating several other conditions, such as the eradication of multidrug-resistant organisms and graft-versus-host disease. We expect that FMT will soon be implemented as a treatment strategy for several new indications, although further studies are needed.

scholarly journals Potential for the current National Healthcare Safety Network (NHSN) >3 days after admission definition of laboratory-identified, healthcare-facility–onset, Clostridioides difficile infection (HO-CDI) to overestimate rates

2020 ◽  
Vol 41 (4) ◽  
pp. 467-468
Author(s):  
Shruti Puri ◽  
Heather Y. Hughes ◽  
Monica D. McCrackin ◽  
Robert Williford ◽  
Mulugeta Gebregziabher ◽  
...  
Keyword(s):  
Healthcare Facility ◽  
National Healthcare ◽  
Clostridioides Difficile ◽  
National Healthcare Safety Network ◽  
Positive Stool ◽  
Clostridioides Difficile Infection ◽  
Stool Samples ◽  
Definition Of

AbstractHealthcare-facility–onset C.difficile LabID events are defined as positive stool samples collected >3 days after hospitalization. Using a definition of >72 hours, we found that 84 of 1013 cases (8.3%) identified as C. difficile LabID events were collected between 48 and 72 hours after admission.

Fecal microbiota transplantation in gastrointestinal and extraintestinal disorders

2020 ◽  
Vol 15 (12) ◽  
pp. 1173-1183
Author(s):  
Gianluca Ianiro ◽  
Jonathan P Segal ◽  
Benjamin H Mullish ◽  
Mohammed N Quraishi ◽  
Serena Porcari ◽  
...  
Keyword(s):  
Fecal Microbiota Transplantation ◽  
Multidrug Resistant ◽  
Fecal Microbiota ◽  
Current Evidence ◽  
Resistant Bacteria ◽  
Clostridioides Difficile ◽  
Clostridioides Difficile Infection ◽  
Inflammatory Bowel ◽  
Irritable Bowel

Fecal microbiota transplantation (FMT) is the infusion of feces from a healthy donor into the gut of a recipient to treat a dysbiosis-related disease. FMT has been proven to be a safe and effective treatment for Clostridioides difficile infection, but increasing evidence supports the role of FMT in other gastrointestinal and extraintestinal diseases. The aim of this review is to paint the landscape of current evidence of FMT in different fields of application (including irritable bowel syndrome, inflammatory bowel disease, liver disorders, decolonization of multidrug-resistant bacteria, metabolic disorders and neurological disorders), as well as to discuss the current regulatory scenario of FMT, and hypothesize future directions of FMT.

scholarly journals 2404. Molecular Epidemiology of Clostridioides difficile in the United States, 2017

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S830-S830 ◽  
Author(s):  
Ashley Paulick ◽  
Michelle Adamczyk ◽  
Lauren C Korhonen ◽  
Alice Guh ◽  
Amy Gargis ◽  
...  
Keyword(s):  
United States ◽  
Molecular Epidemiology ◽  
The United States ◽  
Emerging Infections ◽  
Convenience Sample ◽  
Clostridioides Difficile ◽  
Positive Stool ◽  
Control And Prevention ◽  
Clostridioides Difficile Infection ◽  
Healthcare Associated

Abstract Background In 2009, the Centers for Disease Control and Prevention (CDC) implemented Clostridioides difficile infection (CDI) surveillance through the Emerging Infections Program (EIP) to monitor the incidence and evolving epidemiology of CDI in the United States. Since 2012, ribotypes (RTs) 027, 106, 002, 014, and 020 have constituted the top five strain types among both US community- and healthcare-associated isolates. Here we describe the changes in molecular epidemiology of C. difficile isolates collected in the United States in 2017. Methods In 2017, CDI surveillance was conducted at 10 EIP sites (CA, CO, CT, GA, MD, MN, NM, NY, OR, and TN). A convenience sample of clinical laboratories across EIP sites submitted C. difficile-positive stool specimens to the MN Department of Health Public Health Laboratory and Hines VA Hospital (IL) for culture. Isolates were forwarded to CDC and characterized by capillary-based PCR-ribotyping and PCR detection of tcdA, tcdB, cdtA, cdtB, and deletions in tcdC. Results In 2017, 1,051 C. difficile isolates were submitted; the total number of isolates received from each site ranged from 11 to 286 with a median of 85.5. In total, 143 RTs were observed, with the majority of isolates harboring toxin genes tcdA and tcdB (95%) and a wild-type tcdC sequence (71%). Among 556 healthcare-associated isolates, RT 027 was the most prevalent and the top RT at 5 sites (CA, GA, MD, NM, TN). Ribotype 106 was the most prevalent among 495 community-associated CA isolates and the top RT at 6 sites (CO, CT, GA, MD, MN, TN). Ribotype 027 significantly decreased from 2012 to 2017 among both healthcare-associated (21% vs 15%; p = 0.02) and community-associated isolates (17% vs 6%; P < 0.0001). Among healthcare-associated isolates, RT 076, which was observed in 8 EIP sites, increased from 2% in 2016 to 5% in 2017 (p = 0.05) and replaced RT 020 as one of the top 5 healthcare-associated RTs in 2017. Conclusion Despite an overall decline since 2012, RT 027 remained the most prevalent RT among healthcare-associated isolates submitted in 2017. The increased frequency of RT 076 among healthcare-associated isolates submitted in 2017 highlights the evolving molecular epidemiology of C. difficile and the need for continued surveillance to monitor potential emerging strains. Disclosures All authors: No reported disclosures.

scholarly journals Invisible steps for a global endemy: molecular strategies adopted by Clostridioides difficile

2021 ◽  
Vol 14 ◽  
pp. 175628482110327
Author(s):  
Katia Fettucciari ◽  
Pierfrancesco Marconi ◽  
Andrea Marchegiani ◽  
Alessandro Fruganti ◽  
Andrea Spaterna ◽  
...  
Keyword(s):  
Epidemiological Data ◽  
Interferon Γ ◽  
Effective Vaccine ◽  
Clostridioides Difficile ◽  
Clostridioides Difficile Infection ◽  
Irritable Bowel ◽  
Factor Α ◽  
Selective Therapy ◽  
Enteric Glial Cell ◽  
Necrosis Factor

Clostridioides difficile infection (CDI) is on the rise worldwide and is associated with an increase in deaths and socio-health burden. C. difficile has become ubiquitous in anthropized environments because of the extreme resistance of its spores. Based on the epidemiological data and knowledge of molecular pathogenesis of C. difficile, it is possible to predict its progressive colonization of the human population for the following reasons: first, its global spread is unstoppable; second, the toxins (Tcds) produced by C. difficile, TcdA and TcdB, mainly cause cell death by apoptosis, but the surviving cells acquire a senescence state that favours persistence of C. difficile in the intestine; third, proinflammatory cytokines, tumour necrosis factor-α and interferon-γ, induced during CDI, enhance the cytotoxicity of Tcds and can increase the survival of senescent cells; fourth, Tcds block mobility and induce apoptosis in immune cells recruited at the infection site; and finally, after remission from primary infection or relapse, C. difficile causes functional abnormalities in the enteric glial cell (EGC) network that can result in irritable bowel syndrome, characterized by a latent inflammatory response that contributes to C. difficile survival and enhances the cytotoxic activity of low doses of TcdB, thus favouring further relapses. Since a ‘global endemy’ of C. difficile seems inevitable, it is necessary to develop an effective vaccine against Tcds for at-risk individuals, and to perform a prophylaxis/selective therapy with bacteriophages highly specific for C. difficile. We must be aware that CDI will become a global health problem in the forthcoming years, and we must be prepared to face this menace.

Postinfection Irritable Bowel Syndrome Following Clostridioides difficile Infection

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Srishti Saha ◽  
Kanika Sehgal ◽  
Sumitabh Singh ◽  
Madhusudan Grover ◽  
Darrell Pardi ◽  
...  
Keyword(s):  
Irritable Bowel Syndrome ◽  
Clostridioides Difficile ◽  
Clostridioides Difficile Infection ◽  
Irritable Bowel

scholarly journals The Burden of Clostridioides Difficile Infection during the COVID-19 Pandemic: A Retrospective Case-Control Study in Italian Hospitals (CloVid)

2020 ◽  
Vol 9 (12) ◽  
pp. 3855
Author(s):  
Guido Granata ◽  
Alessandro Bartoloni ◽  
Mauro Codeluppi ◽  
Ilaria Contadini ◽  
Francesco Cristini ◽  
...  
Keyword(s):  
Risk Factors ◽  
Bacterial Infections ◽  
Infection Prevention And Control ◽  
Retrospective Case ◽  
Clostridioides Difficile ◽  
Clostridioides Difficile Infection ◽  
Hospital Stays ◽  
Healthcare Associated ◽  
Hospital Acquired ◽  
And Control

Data on the burden of Clostridioides difficile infection (CDI) in Coronavirus Disease 2019 (COVID-19) patients are scant. We conducted an observational, retrospective, multicenter, 1:3 case (COVID-19 patients with CDI)-control (COVID-19 patients without CDI) study in Italy to assess incidence and outcomes, and to identify risk factors for CDI in COVID-19 patients. From February through July 2020, 8402 COVID-19 patients were admitted to eight Italian hospitals; 38 CDI cases were identified, including 32 hospital-onset-CDI (HO-CDI) and 6 community-onset, healthcare-associated-CDI (CO-HCA-CDI). HO-CDI incidence was 4.4 × 10,000 patient-days. The percentage of cases recovering without complications at discharge (i.e., pressure ulcers, chronic heart decompensation) was lower than among controls (p = 0.01); in-hospital stays was longer among cases, 35.0 versus 19.4 days (p = 0.0007). The presence of a previous hospitalisation (p = 0.001), previous steroid administration (p = 0.008) and the administration of antibiotics during the stay (p = 0.004) were risk factors associated with CDI. In conclusions, CDI complicates COVID-19, mainly in patients with co-morbidities and previous healthcare exposures. Its association with antibiotic usage and hospital acquired bacterial infections should lead to strengthen antimicrobial stewardship programmes and infection prevention and control activities.

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