How to: diagnose infection caused by Clostridium difficile

Gateau, Cécile; Couturier, Jeanne; Coia, John; Barbut, Frédéric

doi:10.1016/j.cmi.2017.12.005

Cited by 82 publications

(100 citation statements)

References 44 publications

(42 reference statements)

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“…The diagnosis of CDI and rCDI can be made using numerous assays, whose availability vary across institutions . The gold standard for detecting toxins A/B or a toxigenic C. difficile strain is stool cytotoxicity assay (CTA) and toxigenic culture (TC), respectively . However, the time to result for these tests are 48‐72 hours to 7 days respectively .…”

Section: Review Of Literature On the Epidemiology Of CDI In Patients mentioning

confidence: 99%

“…The testing can also be positive in asymptomatic carriers . The introduction of widespread NAAT testing for CDI has led to an increase in incidence, with occasional inappropriate treatment of CDI in carriers whose diarrhea is not caused by C. difficile . For this reason, CDI testing is only recommended in symptomatic patients .…”

Section: Review Of Literature On the Epidemiology Of CDI In Patients mentioning

confidence: 99%

“…11,12 The gold standard for detecting toxins A/B or a toxigenic C. difficile strain is stool cytotoxicity assay (CTA) and toxigenic culture (TC), respectively. 6,12 However, the time to result for these tests are 48-72 hours to 7 days respectively. 25 Most clinical settings now use the rapid and highly sensitive nucleic acid amplification test (NAAT) to detect tcdA/tcdB or tcdC gene as a marker of the presence of toxigenic C. difficile.…”

Section: Diagnostic Considerationsmentioning

confidence: 99%

“…12 The introduction of widespread NAAT testing for CDI has led to an increase in incidence, with occasional inappropriate treatment of CDI in carriers whose diarrhea is not caused by C. difficile. 6 For this reason, CDI testing is only recommended in symptomatic patients. 12 In populations with co-morbid conditions that cause diarrhea-such as IBD, antibiotic or medication-associated diarrhea-testing for CDI is a challenge.…”

Section: Diagnostic Considerationsmentioning

confidence: 99%

“…Factors behind increasing CDI incidence and mortality include increased antibiotic use, an aging population, and the emergence of virulent strains such as the BI/NAP1/027/toxinotype III strain. 5,6 Among patients receiving solid organ transplantation (SOT) and hematopoietic stem cell transplantation, CDI rates also increased. 7 Factors contributing to increased pathogenicity of C. difficile in this population include iatrogenic immunosuppression, antibiotic use, and prolonged or frequent hospitalizations.…”

mentioning

confidence: 99%

See 4 more Smart Citations

Fecal microbiota transplantation for recurrent Clostridium difficile infection in patients with solid organ transplants: an institutional experience and review of the literature

Lin

Alonso

Moss

2018

Transplant Infectious Dis

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Clostridium difficile, an anaerobic gram-positive, spore-forming bacillus, has become the most common cause of nosocomial infectious diarrhea, and is associated with increased mortality in all populations. Patients who have received solid organ transplants (SOT) are at increased risk of Clostridium difficile infection (CDI) and CDI recurrence (rCDI). This may be related to chronic immunosuppression, frequent antibiotic exposure, and increased or prolonged hospitalizations. Increased morbidity and mortality from CDI is well-described in SOT patients. Conventional treatments for index and recurrent CDI include vancomycin and fidaxomicin. Fecal microbiota transplantation has emerged as an effective and safe alternative for treating rCDI in the general population. Reports of its safety in certain immunocompromised populations, such as those with inflammatory bowel disease, appear reassuring, but outcomes among SOT patients are less well known. Here, we summarize the experiences published to date on the treatment of rCDI with FMT in SOT patient, and also describe our detailed FMT protocol and experience in treating a series of SOT patients with rCDI. In addition to reporting the safety and efficacy of our FMT experience, we also discuss the diagnostic challenges and considerations in this population of solid organ transplant recipients.

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Section: Review Of Literature On the Epidemiology Of CDI In Patients mentioning

confidence: 99%

Section: Review Of Literature On the Epidemiology Of CDI In Patients mentioning

confidence: 99%