scholarly journals Management of Clostridioides difficile colitis: insights for the gastroenterologist

2019 ◽  
Vol 12 ◽  
pp. 175628481984765 ◽  
Author(s):  
Srishti Saha ◽  
Sahil Khanna
Keyword(s):  
Clinical Trials ◽  
Infectious Diseases ◽  
European Society ◽  
Clinical Microbiology ◽  
Treatment Guidelines ◽  
Narrative Review ◽  
Common Cause ◽  
Clostridioides Difficile ◽  
Clostridioides Difficile Infection ◽  
Outpatient Settings

Clostridioides difficile infection (CDI) is a common cause of diarrhea in both inpatient and outpatient settings. The last few years have seen major changes in the treatment spectrum of CDI, most notably, recommendations against using metronidazole for initial CDI, the addition of fidaxomicin and bezlotoxumab, and emergence of microbial replacement therapies. Several other therapies are undergoing clinical trials. This narrative review focuses on the treatment of CDI with a summary of literature on the newer modalities and the treatment guidelines issued by Infectious Diseases Society of America and European Society of Clinical Microbiology and Infectious Diseases.

Antifungal treatment guidelines

2017 ◽  
Author(s):  
Laura Cottom ◽  
Brian L. Jones
Keyword(s):  
Infectious Diseases ◽  
Fungal Infection ◽  
Invasive Fungal Infection ◽  
Scientific Knowledge ◽  
European Society ◽  
Clinical Microbiology ◽  
Treatment Guidelines ◽  
Published Data ◽  
High Quality ◽  
Relative Paucity

The management of invasive fungal infection remains challenging. Given the ever-expanding body of published data and advances to scientific knowledge and technology, clinical guidance plays a greater role in supporting clinicians in making patient-centred treatment decisions, and it is essential that the guidance has been subject to rigorous scrutiny to ensure that the recommendations are based upon sound evidence. Numerous guidelines on the treatment of invasive fungal infection are available; however, differences in their recommendations exist. The relative paucity of high-quality trials is a likely contributing factor, and analysis and interpretation of clinical data have also led to conflicting conclusions. The differences in guideline remit and methodology often make direct comparison of guidance impractical. The chapter aims to present and evaluate the main recommendations set out in the Infectious Diseases Society of America (IDSA) and European Society of Clinical Microbiology and Infectious Diseases (ESCMID) guidelines.

scholarly journals Real-World Experience with Bezlotoxumab for Prevention of Recurrence of Clostridioides difficile Infection

2020 ◽  
Vol 10 (1) ◽  
pp. 2
Author(s):  
Rosa Escudero-Sánchez ◽  
María Ruíz-Ruizgómez ◽  
Jorge Fernández-Fradejas ◽  
Sergio García Fernández ◽  
María Olmedo Samperio ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Real World ◽  
Recurrence Rates ◽  
Factors Associated ◽  
Clostridioides Difficile ◽  
Multicentre Cohort Study ◽  
Clostridioides Difficile Infection ◽  
Prevention Of Recurrence ◽  
Multicentre Cohort

Bezlotoxumab is marketed for the prevention of recurrent Clostridioides difficile infection (rCDI). Its high cost could be determining its prescription to a different population than that represented in clinical trials. The objective of the study was to verify the effectiveness and safety of bezlotoxumab in preventing rCDI and to investigate factors related to bezlotoxumab failure in the real world. A retrospective, multicentre cohort study of patients treated with bezlotoxumab in Spain was conducted. We compared the characteristics of cohort patients with those of patients treated with bezlotoxumab in the pivotal MODIFY trials. We assessed recurrence rates 12 weeks after completion of treatment against C. difficile, and we analysed the factors associated with bezlotoxumab failure. Ninety-one patients were included in the study. The cohort presented with more risk factors for rCDI than the patients included in the MODIFY trials. Thirteen (14.2%) developed rCDI at 12 weeks of follow-up, and rCDI rates were numerically higher in patients with two or more previous episodes (25%) than in those who had fewer than two previous episodes of C. difficile infection (CDI) (10.4%); p = 0.09. There were no adverse effects attributable to bezlotoxumab. Despite being used in a more compromised population than that represented in clinical trials, we confirm the effectiveness of bezlotoxumab for the prevention of rCDI.

scholarly journals Predictive Factors for the First Recurrence of Clostridioides difficile Infection in the Elderly from Western Romania

Medicina ◽  
2020 ◽  
Vol 56 (9) ◽  
pp. 439
Author(s):  
Iosif Marincu ◽  
Felix Bratosin ◽  
Iulia Vidican ◽  
Bianca Cerbu ◽  
Mirela Turaiche ◽  
...  
Keyword(s):  
Infectious Diseases ◽  
Predictive Factors ◽  
Gastrointestinal Disease ◽  
National Health System ◽  
Public Health Problem ◽  
The Elderly ◽  
Control Group ◽  
The European Union ◽  
Clostridioides Difficile ◽  
Clostridioides Difficile Infection

Background and objectives: At present, Romania and parts of the European Union are facing an increasingly challenging public health problem consisting of nosocomial Clostridioides difficile infection (CDI), mostly in the elderly. Relapse cases have become more frequent, which present higher morbidity and mortality rates than the initial CDI infection. The aim of this study is to determine the predictive factors for recurrence, with the purpose of reducing the exposure of patients diagnosed with CDI, as well as aiming to initiate early treatment. Materials and Methods: In this retrospective descriptive study, we analyze a database from the First Department of Infectious Diseases at the Dr. Victor Babes Clinical Hospital for Infectious Diseases and Pulmonology in Timisoara, looking for patient history of CDI recurrences. We analyzed CDI recurrence in patients aged ≥65 years from 1 January 2016 to 31 December 2019, identifying 77 cases of CDI recurrence. The determination of predictive factors for recurrence involved the formation of a randomized control group, consisting of 74 patients aged ≥65 years who were diagnosed with C. difficile enterocolitis, but did not suffer a recurrence and survived ≥2 weeks after symptom onset. Results: Immunocompromised status, pre-existing gastrointestinal disease, and fever on initial hospitalization for CDI were all found to be significant independent positive predictive factors for the condition recurring in elderly Romanian patients. Conclusions: As the geriatric population in Romania grows, the national health system becomes increasingly overburdened, both from a financial standpoint and a human resources perspective. The analysis of factors predictive for CDI recurrence is, thus, of the utmost importance, particularly for the early identification of patients most at risk of CDI recurrence. Our findings could help physicians to identify recurrence early, consequently benefitting patients by a rapid intervention with a potential decrease in the associated complications and mortality.

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