Community-acquired Clostridium difficile: epidemiology, ribotype, risk factors, hospital and intensive care unit outcomes, and current and emerging therapies

Ofori, Emmanuel; Ramai, Daryl; Dhawan, Manish; Mustafa, Fekriya E.; Gasperino, James; Reddy, Madhavi

doi:10.1016/j.jhin.2018.01.015

Cited by 98 publications

(77 citation statements)

References 71 publications

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“…41 Many studies identified antibiotic use as a risk factor for CA-CDI, with up to three quarters of patients receiving antibiotics in the 12 weeks prior to infection, 41,42 but other studies showed either decreased exposure to antibiotics as compared with HA-CDI patients, or no association to antibiotics at all. [43][44][45] Additional risk factors for CA-CDI include hospitalization within the last year, female sex, proximity to infants, use of proton pump inhibitors (PPIs), or farm proximity. 44,46 Though CA-CDI is defined as symptom onset in the community or first 48 hours of hospital admission, many afflicted patients have prior contact with the health care system.…”

Section: Recurrent CDImentioning

confidence: 99%

“…[43][44][45] Additional risk factors for CA-CDI include hospitalization within the last year, female sex, proximity to infants, use of proton pump inhibitors (PPIs), or farm proximity. 44,46 Though CA-CDI is defined as symptom onset in the community or first 48 hours of hospital admission, many afflicted patients have prior contact with the health care system. In one study, 82% of patients with CA-CDI had exposure to health care, but not admission, in the 12 weeks prior to infection, and approximately half of those had an outpatient office visit, and the other half had a procedure, emergency department visit, inpatient care, or other "high-level" exposure to health care.…”

Section: Recurrent CDImentioning

confidence: 99%

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Clostridium difficile Infection: An Epidemiology Update

Roo

Regenbogen

2020

Clinics in Colon and Rectal Surgery

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Clostridium (reclassified as “Clostridioides”) difficile infection (CDI) is a healthcare-associated infection and significant source of potentially preventable morbidity, recurrence, and death, particularly among hospitalized older adults. Additional risk factors include antibiotic use and severe underlying illness. The increasing prevalence of community-associated CDI is gaining recognition as a novel source of morbidity in previously healthy patients. Even after recovery from initial infection, patients remain at risk for recurrence or reinfection with a new strain. Some pharmaco-epidemiologic studies have suggested an increased risk associated with proton pump inhibitors and protective effect from statins, but these findings have not been uniformly reproduced in all studies. Certain ribotypes of C. difficile, including the BI/NAP1/027, 106, and 018, are associated with increased antibiotic resistance and potential for higher morbidity and mortality. CDI remains a high-morbidity healthcare-associated infection, and better understanding of ribotypes and medication risk factors could help to target treatment, particularly for patients with high recurrence risk.

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Section: Recurrent CDImentioning

confidence: 99%

Section: Recurrent CDImentioning

confidence: 99%

Clostridium difficile Infection: An Epidemiology Update

Roo

Regenbogen

2020

Clinics in Colon and Rectal Surgery

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“…Outbreak in hospitals have resulted in ward closures and extensive infection control measures. Rapid diagnosis of C. difficile infection can lead to quick application of therapeutic and hygienic/preventive strategies [27].…”

Section: Infectious Diseasesmentioning

confidence: 99%

Application of Fecal Volatile Organic Compound Analysis in Clinical Practice: Current State and Future Perspectives

et al. 2018

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Abstract:Increasing interest is noticed in the potential of volatile organic compound (VOC) analysis as non-invasive diagnostic biomarker in clinical medical practice. The spectrum of VOCs, originating from (patho)physiological metabolic processes in the human body and detectable in bodily excrements, such as exhaled breath, urine and feces, harbors a magnificent source of information. Thus far, the majority of studies have focused on VOC analysis in exhaled breath, aiming at identification of disease-specific VOC profiles. Recently, an increasing number of studies have evaluated the usability of VOC present in the headspace of feces in the diagnostic work-up of a wide range of gastrointestinal diseases. Promising results have been demonstrated particularly in those diseases in which microbiota alterations are considered to play a significant etiological role, such as colorectal carcinoma, inflammatory bowel disease, irritable bowel syndrome, celiac disease and infectious bowel diseases. In addition, fecal VOC analysis seems to have potential as a diagnostic biomarker for extra-intestinal diseases, including bronchopulmonary dysplasia and sepsis. Different methods for VOC analysis have been used in medical studies, such as gas-chromatography mass spectrometry, selected-ion flow tube-mass spectrometry, ion-mobility spectrometry, and electronic nose devices. In this review, the available literature on the potential of fecal VOCs as diagnostic biomarker, including an overview of relevant VOC detection techniques, is discussed. In addition, future hurdles, which need to be taken prior to implementation of VOC analysis in daily clinical practice, are outlined.

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“…These infections lead to the death of 29,000 patients in the United States annually, most of whom are elderly (1, 2). While typically regarded a hospital acquired entity, the epidemiology of CDI has shifted in the past decade and half the cases are now community acquired among low risk populations (3). Another particular challenge in recent years is the high rate of recurrent CDI, up to 20-35% within eight weeks of the primary infection (4).…”

Section: Introductionmentioning

confidence: 99%

Novel Immunoassay for Diagnosis of Ongoing Clostridioides difficile Infections Using Serum and Medium Enriched for Newly Synthesized Antibodies (MENSA)

Haddad¹,

Nozick²,

Kim³

et al. 2020

Preprint

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47BACKGROUND. Clostridioides difficile infections (CDI) have been a challenging and 48 increasing serious concern in recent years. While early and accurate diagnosis is crucial, available assays 49 have frustrating limitations 50 51 OBJECTIVE. Develop a simple, blood-based immunoassay to accurately diagnose patients 52 suffering from active CDI. 53 54 MATERIALS AND METHODS. Uninfected controls (n=95) and CDI patients (n=167) were 55 recruited from Atlanta area hospitals. Blood samples were collected from patients within twelve days of a 56 positive CDI test and processed to yield serum and PBMCs cultured to yield medium enriched for newly 57 synthesized antibodies (MENSA). Multiplex immunoassays measured Ig responses to ten recombinant C. 58 difficile antigens. 59 60 RESULTS. Sixty-six percent of CDI patients produced measurable responses to C. difficile 61 antigens in their serum or MENSA within twelve days of a positive CDI test. Fifty-two of the 167 CDI 62 patients (31%) were detectable in both serum and MENSA, but 32/167 (19%) were detectable only in 63 MENSA, and 27/167 (16%) were detectable only in serum. 64 65 DISCUSSION. We describe the results of a multiplex immunoassay for the diagnosis of ongoing 66 CDI in hospitalized patients. Our assay resolved patients into four categories: MENSA-positive only, 67 serum-positive only, MENSA-and serum-positive, and MENSA-and serum-negative. The MENSA 68 positive-only patients accounted for 30% and may be attributed to nascent antibody secretion in MENSA 69 prior to seroconversion. Conversely, the serum positive-only subset may have been more advanced in 70 5 5 their disease course. Immunocompromise and misdiagnosis may have contributed to the 34% of CDI 71 patients who were not identified using MENSA or serum immunoassays. 72 73 IMPORTANCE. While there was considerable overlap between patients identified through 74 MENSA and serum, both methods detected additional, unique patients. The combined use of both 75 MENSA and serum to detect CDI patients resulted in the greatest identification of CDI patients. Together, 76 longitudinal analysis of MENSA and serum will provide a more accurate evaluation of successful host 77 humoral immune responses in CDI patients. 78In this observational investigation, we present the results of a pilot study validating the use of a 127 multi-antigen immunoassay and its ability to measure antibody secretion reflecting ongoing CDI in 128 MENSA samples from a complex hospital population and compare its performance with results from sera. 129 130 RESULTS 131

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Community-acquired Clostridium difficile: epidemiology, ribotype, risk factors, hospital and intensive care unit outcomes, and current and emerging therapies

Cited by 98 publications

References 71 publications

Clostridium difficile Infection: An Epidemiology Update

Clostridium difficile Infection: An Epidemiology Update

Application of Fecal Volatile Organic Compound Analysis in Clinical Practice: Current State and Future Perspectives

Novel Immunoassay for Diagnosis of Ongoing Clostridioides difficile Infections Using Serum and Medium Enriched for Newly Synthesized Antibodies (MENSA)

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