A 76-Year-Old Man With Recurrent Clostridium difficile–Associated Diarrhea

Kelly, Ciarán P.

doi:10.1001/jama.2009.171

Cited by 76 publications

(103 citation statements)

References 75 publications

(140 reference statements)

Supporting

Mentioning

102

Contrasting

Order By: Relevance

“…15 In the authors' experience, the initial stool ELISA for toxins A and B identified only 54% of cases with the second, third, and fourth specimens identifying 75%, 78%, and 92% of cases, respectively. 11…”

Section: Diagnosis Of CDImentioning

confidence: 89%

Clostridium Difficile and Inflammatory Bowel Disease

Ananthakrishnan

Issa

Binion

2009

Gastroenterology Clinics of North America

View full text Add to dashboard Cite

Section: Diagnosis Of CDImentioning

confidence: 89%

Clostridium Difficile and Inflammatory Bowel Disease

Ananthakrishnan

Issa

Binion

2009

Gastroenterology Clinics of North America

View full text Add to dashboard Cite

“…Broad-spectrum antimicrobials have the potential to disrupt the balanced ecology of the stool microbiota, creating an opportunity for C. difficile spores to germinate resulting in overgrowth and attendant production of toxins, which are responsible for most of the clinical symptoms of CDI and (pseudomembraneous)-colitis. Antibiotics like clindamycin are known to impair colonisation resistance, however, second-and third-generation cephalosporins (for which all clinical isolates of C. difficile are resistant) and fluoroquinolones are frequently used in hospital infections/ patients and cause iatrogenic CDI (Kelly, 2009). Patients can keep shedding (bacteria, toxins and spores) for some weeks despite full clinical recovery.…”

Section: Discussionmentioning

confidence: 99%

“…Using gloves for avoiding direct skin contact and hand hygiene with plain soap and running water to remove spores followed by an alcoholic hand rub is preferred over alcohol-based hand rubs alone for symptomatic patients or patients with a recent known CDI-episode. To reduce the environmental burden, spores should be removed with sporicidal agents (chlorine) on surfaces adjacent to the patients, as well as for toilets and showers (Kelly 2009). Detergents based on peroxides or glutaraldehyde are also effective (TschudinSutter, 2012).…”

Section: Discussionmentioning

confidence: 99%

“…Not until 1978 was C. difficile recognised as an opportunistic pathogen for its antibiotic-associated diarrhoea and pseudomembranous colitis. CDI has rapidly increased since the 1990s with alarming rise since 2000 (1999-2007: 25% incidenceincrease per year in USA and 750% fatality rate increase in UK; Kelly, 2009) when the novel and fluoroquinolone resistant strain of PCR ribotype 027 spread and accounted for severe disease and over 40% of isolates (Islam et al, 2012). Currently, CDI incidence rates are still high, but have dropped due to rapid diagnosis, improved infection control practice, root cause analysis, isolation of cases/ patients, and restricted use of antibiotics (stewardship).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Probiotics in Clostridium difficile infection: reviewing the need for a multistrain probiotic

Hell

Bernhofer

Stalzer

et al. 2013

View full text Add to dashboard Cite

In the past two years an enormous amount of molecular, genetic, metabolomic and mechanistic data on the hostbacterium interaction, a healthy gut microbiota and a possible role for probiotics in Clostridium difficile infection (CDI) has been accumulated. Also, new hypervirulent strains of C. difficile have emerged. Yet, clinical trials in CDI have been less promising than in antibiotic associated diarrhoea in general, with more meta-analysis than primary papers on CDI-clinical-trials. The fact that C. difficile is a spore former, producing at least three different toxins has not yet been incorporated in the rational design of probiotics for (recurrent) CDI. Here we postulate that the plethora of effects of C. difficile and the vast amount of data on the role of commensal gut residents and probiotics point towards a multistrain mixture of probiotics to reduce CDI, but also to limit (nosocomial) transmission and/or endogenous reinfection. On the basis of a retrospective chart review of a series of ten CDI patients where recurrence was expected, all patients on adjunctive probiotic therapy with multistrain cocktail (Ecologic®AAD/OMNiBiOTiC® 10) showed complete clinical resolution. This result, and recent success in faecal transplants in CDI treatment, are supportive for the rational design of multistrain probiotics for CDI.

show abstract

“…Clostridium difficile (C difficile), a gram negative anaerobe first described as the causative organism for antibiotic associated pseudomembranous colitis, is an important cause of nosocomial morbidity and mortality [1][2][3][4][5][6][7][8][9] . The past two decades have seen a rising incidence of C difficile infection (CDI) with the emergence of hypervirulent strains, regional epidemics, and increasing failure rates of commonly used first-line therapies 7,[10][11][12] .…”

Section: Introductionmentioning

confidence: 99%