scholarly journals Analysis of Routine and Integrative Data from Clostridioides difficile Infection Diagnosis and the Consequent Observations

2019 ◽  
Vol 13 (1) ◽  
pp. 343-349
Author(s):  
Gabriella Piatti ◽  
Marco Bruzzone ◽  
Vincenzo Fontana ◽  
Marcello Ceppi
Keyword(s):  
Multiple Testing ◽  
Diagnostic Algorithm ◽  
Toxin B ◽  
Clostridioides Difficile ◽  
Clostridioides Difficile Infection ◽  
Bacterial Growth Curve ◽  
Polymerase Chain ◽  
Automated Immunoassay ◽  
Low Sensitivity ◽  
Over Time

Background: Clostridioides difficile Infection (CDI) is an acute disease that needs a fast proper treatment. Unfortunately, the diagnosis, and above all the understanding of the results, remain arduous. Objective: This study analyzed routine and integrative results of all fecal samples from patients over time. Our aim was to understand the dynamics of CDI infection and the meaning of “difficult to interpret” results, to make physicians better understand the various tools they can use. Methods: We evaluated routine results obtained from 815 diarrheal stools with Enzyme Immunoassay (EIA) that detects C. difficile Glutamate Dehydrogenase (GDH) antigen and toxin B. We also reanalyzed a part of samples using integrative tests: a Real-time polymerase chain reaction (RT-PCR) for C. difficile toxin B gene (tcdB) and the automated immunoassay VIDAS C. difficile system for GDH and toxins A/B. Results: EIA GDH positivity increased through multiple testing over time, with a P value <0.001, depicting a sort of bacterial growth curve. Eighty-five percent of GDH positive/toxin B negative, i.e., discrepant, samples PCR were tcdB positive, 61.5% of discrepant tcdB positive samples were VIDAS toxins A/B positive, and 44.4% of GDH EIA negative stools were VIDAS GDH positive. Conclusion: The results confirmed the low sensitivity of the EIA system for C. difficile GDH and toxins, questioned the use of the latter for concluding any CDI diagnostic algorithm, and led us to indicate the algorithm beginning with tcdB molecular research, and continuing in positive cases with VIDAS CD GDH method, as the most effective for CDI.

scholarly journals Clostridioides difficile Infection, Still a Long Way to Go

2021 ◽  
Vol 10 (3) ◽  
pp. 389
Author(s):  
Eleftheria Kampouri ◽  
Antony Croxatto ◽  
Guy Prod’hom ◽  
Benoit Guery
Keyword(s):  
Fecal Microbiota Transplantation ◽  
Diagnostic Algorithm ◽  
Fecal Microbiota ◽  
Diagnostic Methods ◽  
Special Focus ◽  
Surveillance Systems ◽  
Main Question ◽  
Clostridioides Difficile ◽  
Clostridioides Difficile Infection ◽  
The Right

Clostridioides difficile is an increasingly common pathogen both within and outside the hospital and is responsible for a large clinical spectrum from asymptomatic carriage to complicated infection associated with a high mortality. While diagnostic methods have considerably progressed over the years, the optimal diagnostic algorithm is still debated and there is no single diagnostic test that can be used as a standalone test. More importantly, the heterogeneity in diagnostic practices between centers along with the lack of robust surveillance systems in all countries and an important degree of underdiagnosis due to lack of clinical suspicion in the community, hinder a more accurate evaluation of the burden of disease. Our improved understanding of the physiopathology of CDI has allowed some significant progress in the treatment of CDI, including a broader use of fidaxomicine, the use of fecal microbiota transplantation for multiples recurrences and newer approaches including antibodies, vaccines and new molecules, already developed or in the pipeline. However, the management of CDI recurrences and severe infections remain challenging and the main question remains: how to best target these often expensive treatments to the right population. In this review we discuss current diagnostic approaches, treatment and potential prevention strategies, with a special focus on recent advances in the field as well as areas of uncertainty and unmet needs and how to address them.

scholarly journals Kinetics of polymerase chain reaction positivity in patients with Clostridioides difficile infection

2021 ◽  
Vol 14 ◽  
pp. 175628482110504
Author(s):  
Srishti Saha ◽  
Devvrat Yadav ◽  
Ryan Pardi ◽  
Robin Patel ◽  
Sahil Khanna ◽  
...  
Keyword(s):  
Polymerase Chain Reaction ◽  
Median Time ◽  
Median Duration ◽  
Treatment Initiation ◽  
Chain Reaction ◽  
Duration Of Treatment ◽  
Clostridioides Difficile ◽  
Clostridioides Difficile Infection ◽  
Polymerase Chain ◽  
Kinetics Of

Background: Polymerase chain reaction (PCR) is a sensitive test for diagnosing Clostridioides difficile infection (CDI) and could remain positive following resolution of CDI. The kinetics of PCR positivity following antibiotics for CDI is unknown. We studied this and whether it predicted CDI recurrence. Methods: Adults with CDI from October 2009 to May 2017 were included. Serial stool samples within 60 days of treatment were collected. Recurrent CDI was defined as diarrhea after interim symptom resolution with positive stool PCR within 56 or 90 days of treatment completion. Contingency table analysis was used to assess the risk of recurrence. Results: Fifty patients were included [median age: 51 (range = 20–86) years, 66% women]. Treatment given was metronidazole, 50% (25); vancomycin, 44% (22); both, 4% (2); and fidaxomicin, 2% (1). Median duration of treatment for all 50 patients was 14 (range = 8–60) days. The median duration of treatment in patients who got prolonged therapy (>14 days) ( n = 10) was 47 (range = 18–60) days. Median time to negative PCR was 9 (95% CI, 7–14) days from treatment initiation, which did not differ by antibiotics given ( p = 0.5). A positive PCR during or after treatment was associated with a higher risk of recurrence at 56 days ( p = 0.02) and at 90 days ( p = 0.009). Conclusion: The median time to negative PCR in CDI was 9 days from treatment initiation. The PCR positivity during or after treatment may be useful for recurrence prediction; larger studies are needed to validate these results.

scholarly journals Impact of a training program on the surveillance of Clostridioides difficile infection

2019 ◽  
Vol 147 ◽  
Author(s):  
N. Sopena ◽  
N. Freixas ◽  
F. Bella ◽  
J. Pérez ◽  
A. Hornero ◽  
...  
Keyword(s):  
Training Program ◽  
Diagnostic Algorithm ◽  
Significant Rise ◽  
Diagnostic Methods ◽  
Training Strategy ◽  
Face To Face ◽  
Clostridioides Difficile ◽  
Clostridioides Difficile Infection ◽  
Multimodal Training ◽  
Hospital Acquired

Abstract A high degree of vigilance and appropriate diagnostic methods are required to detect Clostridioides difficile infection (CDI). We studied the effectiveness of a multimodal training program for improving CDI surveillance and prevention. Between 2011 and 2016, this program was made available to healthcare staff of acute care hospitals in Catalonia. The program included an online course, two face-to-face workshops and dissemination of recommendations on prevention and diagnosis. Adherence to the recommendations was evaluated through surveys administered to the infection control teams at the 38 participating hospitals. The incidence of CDI increased from 2.20 cases/10 000 patient-days in 2011 to 3.41 in 2016 (P < 0.001). The number of hospitals that applied an optimal diagnostic algorithm rose from 32.0% to 71.1% (P = 0.002). Hospitals that applied an optimal diagnostic algorithm reported a higher overall incidence of CDI (3.62 vs. 1.92, P < 0.001), and hospitals that were more active in searching for cases reported higher rates of hospital-acquired CDI (1.76 vs. 0.84, P < 0.001). The results suggest that the application of a multimodal training strategy was associated with a significant rise in the reporting of CDI, as well as with an increase in the application of the optimal diagnostic algorithm.

scholarly journals Successful use of early, repeat fecal microbiota transplantation for initial treatment of severe, refractory Clostridioides difficile colitis

2021 ◽  
Author(s):  
Catherine M Cappetto
Keyword(s):  
Stool Sample ◽  
Fecal Microbiota Transplantation ◽  
Fecal Microbiota ◽  
Community Dwelling ◽  
Nutrition Status ◽  
Vancomycin Therapy ◽  
Clostridioides Difficile ◽  
Clostridioides Difficile Infection ◽  
Polymerase Chain ◽  
Initial Episode

Abstract Disclaimer In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose There is a paucity of literature surrounding the use of early fecal microbiota transplantation (FMT) for patients presenting with an initial episode of severe, refractory Clostridioides difficile infection (CDI). Information on optimal antibiotic dosing and therapy duration surrounding FMT during an acute, initial episode of CDI is also limited. Described here is a case of successful treatment of CDI after 4 FMTs during an acute, initial episode of severe, refractory Clostridioides difficile colitis. Summary A 69-year-old community-dwelling, Caucasian male presented after 48 hours of vomiting and diarrhea. A stool sample tested positive via stool sample by both polymerase chain reaction and enzme-linked immunosorbent assays for Clostridioides difficile. The patient was treated with several days of oral and rectal vancomycin therapy in addition to intravenous metronidazole, but those treatments failed. His clinical and nutrition status deteriorated over the course of several days until salvage therapy was ordered, with administration of 1 inpatient nasogastric FMT and 1 inpatient colonoscopic FMT followed by outpatient colonoscopic FMTs on 2 consecutive days within 2 weeks of hospital discharge. Conclusion This case suggests a role for early, repeat FMT during an initial presentation of a severe Clostridioides difficile colitis episode refractory to pharmacologic antimicrobial therapy. It also adds to emerging literature regarding the timing of antibiotic cessation surrounding FMT.

scholarly journals Role of Cycle Threshold in Clostridioides difficile Polymerase Chain Reaction Testing as a Predictor of Clinical Outcomes in Patients With Inflammatory Bowel Disease

2019 ◽  
Vol 1 (3) ◽  
Author(s):  
Emily R Jonica ◽  
Carol A Sulis ◽  
Kanupriya Soni ◽  
Michelle Hughes ◽  
Eric Jones ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Severe Infection ◽  
Chain Reaction ◽  
Cycle Threshold ◽  
Clostridioides Difficile ◽  
Clostridioides Difficile Infection ◽  
Inflammatory Bowel ◽  
Polymerase Chain

Abstract Background Distinguishing Clostridioides difficile infection from colonization is challenging in patients with Inflammatory Bowel Disease (IBD). Cycle threshold (Ct), the cutoff for PCR positivity, has been investigated in non-IBD patients. Methods Patients with positive C. difficile PCR (25 IBD, 51 non-IBD) were identified retrospectively. Fifteen-day outcomes were assessed. Results Ct correlated with diarrheal days in non-IBD (P = 0.048), but not IBD patients (P = 0.769). IBD patients had shorter LOS and less severe infection, but more diarrheal days (P &lt; 0.05). Conclusions IBD patients had a milder course but Ct results were not significant. Larger studies are needed to clarify utility of Ct in IBD.

Temporal change of risk factors in hospital-acquired Clostridioides difficile infection using time-trend analysis

2020 ◽  
Vol 41 (9) ◽  
pp. 1048-1057 ◽  
Author(s):  
Jiyoun Song ◽  
Bevin Cohen ◽  
Philip Zachariah ◽  
Jianfang Liu ◽  
Elaine L. Larson
Keyword(s):  
Risk Factors ◽  
New York ◽  
Kendall Test ◽  
Incidence Density ◽  
Care Community ◽  
Clostridioides Difficile ◽  
Clostridioides Difficile Infection ◽  
Ongoing Surveillance ◽  
Hospital Acquired ◽  
Over Time

AbstractObjective:Given recent changes in the epidemiology of Clostridioides difficile infection (CDI) and prevention efforts, we investigated temporal changes over a period of 11 years (2006–2016) in incidence and risk factors for CDI.Design:Retrospective matched case-control study.Setting/Patients:Pediatric and adult inpatients (n = 694,849) discharged from 3 hospitals (tertiary and quaternary care, community, and pediatric) in a large, academic health center in New York City.Methods:Risk factors were identified in cases and controls matched by length of stay at a ratio of 1:4. A Cochran–Armitage or Mann-Kendall test was used to investigate trends of incidence and risk factors.Results:Of 694,849 inpatients, 6,038 (0.87%) had CDI: 44% of these cases were hospital acquired (HA-CDI) and 56% were community acquired (CA-CDI). We observed temporal downward trends in HA-CDI (−0.03% per year) and upward trends in CA-CDI (+0.04% per year). Over time, antibiotics were administered to more patients (+3% per year); the use of high-risk antibiotics declined (–1.2% per year); and antibiotic duration increased in patients with HA-CDI (+4.4% per year). Fewer proton-pump inhibitors and more histamine-2 blockers were used (−3.8% and +7.3% per year, respectively; all Ptrend <.05).Conclusions:Although the incidence of HA-CDI decreased over time, CA-CDI simultaneously increased. Continued efforts to assure judicious use of antibiotics in inpatient and community settings is clearly vital. Measuring the actual the level of exposure of an antibiotic (incidence density) should be used for ongoing surveillance and assessment.

Sign in / Sign up

Export Citation Format

Share Document