Clostridium difficile infection in cystic fibrosis: an uncommon but life‐threatening complication

Abstract

Adults with cystic fibrosis (CF) have significant rates of asymptomatic Clostridium difficile carriage and are frequently exposed to risk factors for C. difficile infection (CDI). Despite this, the rate of reported CDI in CF is low. We describe three cases of near fatal CDI in adults with CF and review the literature regarding presentation, management, and recurrence prevention. Early recognition is important as the clinical presentation may be atypical and the illness can be severe and even life‐threatening. Management can be complicated by respiratory and nutritional failure. CF‐related gastrointestinal dysfunction may alter the typical host–pathogen interaction between patient and C. difficile, potentially explaining the low rates of CDI and atypical presentation.

Higher mortality rates associated with Clostridioides difficile infection in hospitalized children with cystic fibrosis

“…In contrast, our study adds support to several more recent case reports and small case series describing the severe, life threatening impact of C. difficile infection in CF patients. [16][17][18][19]30 Increasing CDI among children with CF could be due to several factors, including[NO_PRINTED_FORM] exposure to newer antimicrobial agents 31 in the treatment of CF exacerbations, 32,33 and the dissemination of a more-virulent epidemic strain of C difficile, such as North American pulsed-field gel electrophoresis type 1 (NAP1) 34,35 Alternative explanations include the possibility of more frequent testing and/or documentation and coding for CDI during inpatient admissions for CF. Our findings may also be partially explained by greater detection of asymptomatic carriage of C. difficile.…”

“…In recent years however, a few case reports and small case series have described severe complicated CDI in children with CF. [16][17][18][19][20] Furthermore, an adult study indicated that patients with CF have a three-fold risk 21 of developing CDI as compared to non-CF controls and CF patients with CDI have higher mortality, colectomy rates, length of stay, and hospital charges. Less is known about the impact of CDI on outcomes of pediatric CF hospitalizations.…”

Gastrointestinal and Hepatobiliary Disease in Cystic Fibrosis

“…Patients more commonly present with abdominal pain and distention, rapidly progressing to toxic megacolon. 111,112 C. difficile colitis in CF can mimic a myriad of other conditions including DIOS, appendicitis, pancreatitis, constipation, intussusception, and IBD, among others. Timely diagnosis requires abdominal CT scan which reveals colonic distention, colonic wall thickening, fat stranding, and ascites.…”

“…Timely diagnosis requires abdominal CT scan which reveals colonic distention, colonic wall thickening, fat stranding, and ascites. 112 Blood work may show marked leukocytosis and hypoalbuminemia, and stool testing is positive for C. difficile toxin. Therapy follows the standard clinical practice guidelines for C. difficile infection and includes oral or IV metronidazole for mild to moderate cases and oral vancomycin for severe cases.…”

Antimicrobial Molecules in the Lung: Formulation Challenges and Future Directions for Innovation

“…Long term fluoroquinolone use and the accompanying reduction in microbial biodiversity in the gut can lead to an increase in the prevalence of highly-virulent, fluoroquinolone-resistant Clostridium difficile, causing potentially deadly diarrhoea [21]. Although C. difficile-associated disease is rare in CF patients, ~50% of patients are colonised with the species and in many cases fatal C. difficile colitis in CF patients are reported in the literature [22,23].…”