Assessing the Burden of Clostridium difficile Infection in Low- and Middle-Income Countries

Roldan, Giovanni A.; Cui, Alice X; Pollock, Nira R.

doi:10.1128/jcm.01747-17

Cited by 45 publications

(38 citation statements)

References 37 publications

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“…However, there are only a few studies in Colombia about the prevalence of CDI considering the onset groups mentioned herein, especially studies focusing on CDI within community onset. In the case of Latin America, an underestimation of CDI has been done, maybe because of the low standardization of methods for C. difficile detection and because of the lack of supplies in many laboratories [18]. Despite this fact, many studies performed in some countries such as Argentina, Brazil, Puerto Rico, and Chile have focused on the determination of CDI prevalence, principally within healthcare centers.…”

Section: Descriptive Analyses Of the Population And The Four Outcome mentioning

confidence: 99%

Occurrence of Blastocystis in Patients with Clostridioides difficile Infection

et al. 2020

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Clostridiodes difficile comprises a public-health threat that has been understudied in Colombia. Hypervirulent strains of C. difficile harbor multiple toxins, can be easily spread, and can have their onset of disease within healthcare facilities (HCFO) and the community (CO). Studies have shown that a disrupted microbiota (e.g., dysbiosis) may allow C. difficile infection (CDI). It has been suggested that dysbiosis prevents colonization by the anaerobic eukaryote Blastocystis, possibly due to an increase in luminal oxygen tension. No study has found co-occurrence of CDI and Blastocystis. Therefore, we aimed to determine the frequencies of C. difficile and Blastocystis infection/colonization in 220 diarrheal fecal samples. Molecular detection by PCR for both microorganisms was performed, with descriptive analyses of four variables (CDI detection, determination of C. difficile toxigenic profiles, Blastocystis detection, and patient site of onset). We demonstrate a significant association between the presence of Blastocystis and CDI, with coinfection found in 61 patients, and show a high frequency of CDI among both HCFO and CO groups. Our results of coinfection frequencies could support hypotheses that suggest Blastocystis can adapt to dysbiosis and oxidative stress. Further, the presence of toxigenic C. difficile occurring outside healthcare facilities shown here raises the alarm for community wide spread.

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Section: Descriptive Analyses Of the Population And The Four Outcome mentioning

confidence: 99%

Occurrence of Blastocystis in Patients with Clostridioides difficile Infection

et al. 2020

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“…In developing countries, surveillance data on C. difficile infection are not readily available, likely due to limitations in awareness, laboratory capacity and capabilities, and surveillance systems [ 22 – 24 ]. A recent review of the burden of C. difficile infection in developing countries noted that patients with diarrhea are not routinely tested for this pathogen, and, when tested, it is very often with enzyme immunoassay (EIA) rather than stool culture [ 25 ]. Clinical Practice Guidelines for C. difficile note that EIA is less sensitive than stool culture and is therefore an inferior alternative [ 11 , 19 ].…”

Section: Introductionmentioning

confidence: 99%

Clostridium difficile-associated Diarrhea in Developing Countries: A Systematic Review and Meta-Analysis

Curcio¹,

Cané²,

Fernández³

et al. 2019

Infect Dis Ther

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Introduction The prevalence of Clostridium difficile infection is rapidly increasing worldwide, but prevalence is difficult to estimate in developing countries where awareness, diagnostic resources, and surveillance protocols are limited. As diarrhea is the hallmark symptom, we conducted a systematic review and meta-analysis to determine the prevalence and incidence of C. difficile infection in patients in these regions who presented with diarrhea. Methods We conducted a systematic literature search of MEDLINE/PubMed, Scopus, and Latin-American and Caribbean Health Sciences Literature databases to identify and analyze data from recent studies providing prevalence or incidence rates of C. difficile -associated diarrhea in developing countries within four regions: Africa–Middle East, developing Asia, Latin America, and China. Our objectives were to determine the current prevalence and incidence density rates of first episodes of C. difficile -associated diarrhea in developing countries. Results Within the regions included in our analysis, prevalence of C. difficile infection in patients with diarrhea was 15% (95% CI 13–17%) (including community and hospitalized patients), with no significant difference across regions. The incidence of C. difficile infection in 17 studies including this information was 8.5 per 10,000 patient-days (95% CI 5.83–12.46). Prevalence was significantly higher in hospitalized patients versus community patients ( p = 0.0227). Conclusion Our prevalence estimate of 15% is concerning; however, low awareness and inconsistent diagnostic and surveillance protocols suggest this is markedly underestimated. Enhanced awareness and management of C. difficile infection in patients with diarrhea, along with improvements in infection control and surveillance practices, should be implemented to reduce prevalence of C. difficile -associated diarrhea in developing countries. Funding Pfizer Inc. Electronic supplementary material The online version of this article (10.1007/s40121-019-0231-8) contains supplementary material, which is available to authorized users.

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“…Operative intervention is a cornerstone of therapy for severe, fulminant C. difficile infection [145]. The burden of these infections in LMICs remains poorly understood, with few national-level estimates [146,147].…”

Section: Clostridioides Difficile Colitismentioning

confidence: 99%

Surgical Infections in Low- and Middle-Income Countries: A Global Assessment of the Burden and Management Needs

Rickard

Beilman

Forrester

et al. 2020

Surgical Infections

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Background: The burden of surgical infections in low-and middle-income countries (LMICs) remains poorly defined compared with high-income countries. Although there are common infections necessitating surgery prevalent across the world, such as appendicitis and peptic ulcer disease, other conditions are more localized geographically. To date, comprehensive assessment of the burden of surgically treatable infections or sequelae of surgical infections in LMICs is lacking. Methods: We reviewed the literature to define the burden of surgical infections in LMICs and characterize the needs and challenges of addressing this issue. Results: Surgical infections comprise a broad range of diseases including intra-abdominal, skin and soft tissue, and healthcare-associated infections and other infectious processes. Treatment of surgical infections requires a functional surgical ecosystem, microbiology services, and appropriate and effective antimicrobial therapy. Systems must be developed and maintained to evaluate screening, prevention, and treatment strategies. Solutions and interventions are proposed focusing on reducing the burden of disease, improving surveillance, strengthening antibiotic stewardship, and enhancing the management of surgical infections. Conclusions: Surgical infections constitute a large burden of disease globally. Challenges to management in LMICs include a shortage of trained personnel and material resources. The increasing rate of antimicrobial drug resistance, likely related to antibiotic misuse, adds to the challenges. Development of surveillance, infection prevention, and antimicrobial stewardship programs are initial steps forward. Education is critical and should begin early in training, be an active process, and be sustained through regular programs.

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Assessing the Burden of Clostridium difficile Infection in Low- and Middle-Income Countries

Cited by 45 publications

References 37 publications

Occurrence of Blastocystis in Patients with Clostridioides difficile Infection

Occurrence of Blastocystis in Patients with Clostridioides difficile Infection

Clostridium difficile-associated Diarrhea in Developing Countries: A Systematic Review and Meta-Analysis

Surgical Infections in Low- and Middle-Income Countries: A Global Assessment of the Burden and Management Needs

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