<i>Clostridium difficile</i>infection: new approaches to prevention, non-antimicrobial treatment, and stewardship

Cataldo, Maria Adriana; Granata, Guido; Petrosillo, Nicola

doi:10.1080/14787210.2017.1387535

Cited by 19 publications

(11 citation statements)

References 122 publications

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“…Measures to control CDI have focused primarily on hospitals. In that setting, C. difficile spore transmission and overall CDI rates can be significantly reduced through stringent infection control, deep environmental cleaning, appropriate hand hygiene and antimicrobial stewardship [52]. Although analogous interventions have been successfully employed in the veterinary hospital setting with a significant reduction in animal CDI [53], rapid diagnostic tests for animals are still lacking and assays developed for the diagnosis of human CDI, such as enzyme immunoassays and real-time PCR, perform poorly in animals [54].…”

Section: Discussionmentioning

confidence: 99%

Clostridium difficile and One Health

Lim

Knight

Riley

2020

Clinical Microbiology and Infection

110

101

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Background: For over four decades, Clostridium difficile has been a significant enteric pathogen of humans. It is associated with the use of antimicrobials that generally disrupt the microbiota of the gastrointestinal tract. Previously, it was thought that C. difficile was primarily a hospital-acquired infection; however, with the emergence of community-associated cases, and whole-genome sequencing suggesting the majority of the hospital C. difficile infection (CDI) cases are genetically distinct from one another, there is compelling evidence that sources/reservoirs of C. difficile outside hospitals play a significant role in the transmission of CDI. Objectives: To review the 'One Health' aspects of CDI, focusing on how community sources/reservoirs might be acting as a conduit in the transfer of C. difficile between animals and humans. The importance of a One Health approach in managing CDI is discussed. Sources: A literature search was performed on PubMed and Web of Science for relevant papers published from 1 January 2000 to 10 July 2019. Content: We present evidence that demonstrates transmission of C. difficile in hospitals from asymptomatic carriers to symptomatic CDI patients. The source of colonization is most probably community reservoirs, such as foods and the environment, where toxigenic C. difficile strains have frequently been isolated. With high-resolution genomic sequencing, the transmission of C. difficile between animals and humans can be demonstrated, despite a clear epidemiological link often being absent. The ways in which C. difficile from animals and humans can disseminate through foods and the environment are discussed, and an interconnected transmission pathway for C. difficile involving food animals, humans and the environment is presented. Implications: Clostridium difficile is a well-established pathogen of both humans and animals that contaminates foods and the environment. To manage CDI, a One Health approach with the collaboration of clinicians, veterinarians, environmentalists and policy-makers is paramount.

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Section: Discussionmentioning

confidence: 99%

Clostridium difficile and One Health

Lim

Knight

Riley

2020

Clinical Microbiology and Infection

110

101

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“…Minimizing antibiotic use is important for prevention of rCDI. Antimicrobial stewardship is recommended 13,79. Avoidance of gastric acid suppressants also helps prevent rCDI.…”

Section: Prevention Of Rcdimentioning

confidence: 99%

RecurrentClostridium difficileInfection: Risk Factors, Treatment, and Prevention

2019

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The most common cause of antibiotic-associated diarrhea is Clostridium difficile infection (CDI). Recurrent C. difficile infection (rCDI) often occurs after successful treatment of CDI. Due to the increased incidence and the difficulty in treating rCDI, it is becoming an important clinical issue. Identifying risk factors is helpful for early detection, treatment, and prevention of rCDI. Advanced age, use of antibiotics, gastric acid suppression, and infection with a hypervirulent strain are currently regarded as the major risk factors for rCDI. Several treatment modalities, including vancomycin, fidaxomicin, and fecal microbiota transplant (FMT), are suggested for rCDI treatment. However, there is currently no definitive treatment method with sufficient evidence for rCDI. Recent studies have focused on FMT and have shown positive results for rCDI. Prevention of rCDI by measures such as hand washing and isolation of patients is very important. However, these preventive measures are often overlooked in clinical practice. Here, we review the risk factors, treatment, and prevention of rCDI.

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“…Monoclonal antibodies present the advantage to bind to highly specific bacterial targets, and this peculiar mechanism of action confers appealing features [141]. Monoclonal antibodies do not cause disruption of the gut flora; therefore, differently from traditional broad-spectrum antimicrobials, do not contribute to gut dysbiosis and to develop C. difficile infection [141,142]. Moreover, these compounds do not cause antibiotic resistance [141].…”

Section: Non-traditional Approaches Against Mdr K Pneumoniae Futumentioning

confidence: 99%

Treatment Options for Colistin Resistant Klebsiella pneumoniae: Present and Future

Petrosillo

Taglietti

Granata

2019

JCM

104

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Multidrug-resistant (MDR) Klebsiella pneumoniae represents an increasing threat to human health, causing difficult-to-treat infections with a high mortality rate. Since colistin is one of the few treatment options for carbapenem-resistant K. pneumoniae infections, colistin resistance represents a challenge due to the limited range of potentially available effective antimicrobials, including tigecycline, gentamicin, fosfomycin and ceftazidime/avibactam. Moreover, the choice of these antimicrobials depends on their pharmacokinetics/pharmacodynamics properties, the site of infection and the susceptibility profile of the isolated strain, and is sometimes hampered by side effects. This review describes the features of colistin resistance in K. pneumoniae and the characteristics of the currently available antimicrobials for colistin-resistant MDR K. pneumoniae, as well as the characteristics of novel antimicrobial options, such as the soon-to-be commercially available plazomicin and cefiderocol. Finally, we consider the future use of innovative therapeutic strategies in development, including bacteriophages therapy and monoclonal antibodies.

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Clostridium difficileinfection: new approaches to prevention, non-antimicrobial treatment, and stewardship

Cited by 19 publications

References 122 publications

Clostridium difficile and One Health

Clostridium difficile and One Health

RecurrentClostridium difficileInfection: Risk Factors, Treatment, and Prevention

Treatment Options for Colistin Resistant Klebsiella pneumoniae: Present and Future

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