Increasing Risk of Relapse after Treatment of Clostridium difficile Colitis in Quebec, Canada

Pépin, Jacques; Alary, Marie-Eve; Valiquette, Louis; Raiche, Evelyne; Ruel, Joannie; Fülöp, Katalin; Godin, D.; Bourassa, Claude

doi:10.1086/430315

Cited by 533 publications

(373 citation statements)

References 29 publications

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“…The pathophysiology underlying the association of CDI with these lesserknown yet emerging cohorts remains unclear. Other risk factors that have been linked with CDI are age greater than 65 years, proton pump inhibitor use, prolonged hospital stay, and severe comorbidities such as inflammatory bowel disease and chronic renal disease [19][20][21][22][23][24][25][26][27]. Fig.…”

Section: Clostridium Difficile Infection (Cdi)mentioning

confidence: 99%

Recurrent Clostridium difficile infection and the microbiome

2015

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The diverse and densely populated gastrointestinal microbiota is essential for the regulation of host physiology and immune function. As our knowledge of the composition and function of the intestinal microbiota continues to expand, there is new interest in using these developments to tailor fecal microbiota transplantation (FMT) and microbial ecosystem therapeutics (MET) for a variety of diseases. The potential role of FMT and MET in the treatment of Clostridium difficile infection (CDI)-currently the leading nosocomial gastrointestinal infection-has proven highly effective for recurrent CDI, and has emerged as a paradigm shift in the treatment of this disease. The current review will serve as a summary of the key aspects of CDI, and will introduce the essential framework and challenges of FMT, as is currently practiced. MET represents the progression of conventional bacteriotherapy that fundamentally capitalizes on the restorative properties of intestinal bacterial communities and may be viewed as the culmination of a rationally designed therapeutic modality. As our understanding of the composition and function of the intestinal microbiota evolves, it will likely drive next-generation microbiota therapies for a range of medical conditions, such as inflammatory bowel disease, obesity, and metabolic syndrome.

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Section: Clostridium Difficile Infection (Cdi)mentioning

confidence: 99%

Recurrent Clostridium difficile infection and the microbiome

2015

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“…Management of patients with C. difficile infection (CDI) includes withdrawal of the predisposing antimicrobial agent, if possible, and empiric therapy with metronidazole or oral vancomycin. Recent publications have reported an increasing risk of treatment failure and CDI recurrence for patients treated with metronidazole (McDonald et al, 2006;Musher et al, 2005;Pepin et al, 2005) and have discouraged the use of vancomycin to treat CDI in hospitals to minimize the risk of selection for vancomycin resistance in enterococci and staphylococci (Hospital Infection Control Practices Advisory Committee, 1995). Observed increases in morbidity and mortality have been attributed, in part, to the emergence of the North American pulsotype 1 (NAP1)/ ribotype 027 strain in Canada and elsewhere (Bourgault et al, 2006;Loo et al, 2005;Martin et al, 2008;Miller et al, 2010).…”

Section: Introductionmentioning

confidence: 99%

Multidrug-resistant North American pulsotype 2 Clostridium difficile was the predominant toxigenic hospital-acquired strain in the province of Manitoba, Canada, in 2006–2007

Karlowsky

Zhanel

Hammond

et al. 2012

Journal of Medical Microbiology

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The objective of the current study was to determine whether the antimicrobial susceptibility profile or genotype of hospital-acquired isolates of Clostridium difficile differed from isolates causing community-acquired disease. Five hundred diarrhoeal stool samples (one .2 ml sample per patient) from patients across Manitoba, Canada, in 2006-2007 that were reported as C. difficile toxin positive were cultured, resulting in 432 isolates of toxin-positive C. difficile for analysis. Of these 432 isolates, acquisition status could be determined for 235 (54.4 %); 182 (77.4 %) isolates were hospital acquired and 53 (22.6 %) were community acquired. North American pulsotype (NAP) designations based on SmaI PFGE could be defined for 52.3 % of the 432 isolates, with NAP2 (n5122) being the most common. Ninety-one per cent (71/78) of NAP2 isolates were recovered from patients with hospital-acquired C. difficile disease. Other NAP types and isolates with non-NAP-type PFGE patterns were less frequently associated with hospitalacquired disease. Community-acquired disease (35.3 % of isolates) was associated with a wide variety of NAP types. NAP2 isolates were homogeneous (85.5 % had SmaI PFGE pattern 0003) and demonstrated low susceptibility to moxifloxacin (6.6 %) and clindamycin (1.6 %) compared with non-NAP2 isolates (64.1-93.2 % moxifloxacin susceptible; 14.1-28.2 % clindamycin susceptible). All isolates of C. difficile in Manitoba were susceptible to metronidazole, piperacillin-tazobactam, amoxicillin-clavulanate and meropenem. NAP2 isolates of toxigenic C. difficile were approximately three times more common than NAP1 isolates (28.2 vs 9.1 %) in Manitoba in [2006][2007], and these isolates demonstrated high levels of clonality and multidrug resistance, and were associated with hospital acquisition.

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“…Al igual que en esta investigación, diversos estudios (3,4,16,22,23) han documentado que esta enfermedad afecta a todos los grupos poblacionales sin distinción de edad ni de sexo, aunque parece presentarse con mayor frecuencia en los adultos mayores de 65 años, en quienes, además, es más agresiva (3,12,22,24).…”

Section: Discussionunclassified

“…Infortunadamente, no se pudo establecer la tasa de recaídas de la enfermedad. La recomendación general, dada la similar reacción clínica a los dos tratamientos (36,37), es tratar las formas leves a moderadas de la enfermedad con metronidazol y dejar la vancomicina para las formas graves, pues ha habido un incremento en la proporción de pacientes que no mejoran con metronidazol y que tienen mayor porcentaje de recaídas (16,17). Vale la pena anotar que en Colombia, al igual que en gran parte de América Latina, la presentación más accesible de la vancomicina es la solución inyectable (21).…”

Section: Discussionunclassified

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Clinical and demographic profile and risk factors for Clostridium difficile infection

Carvajal¹,

Pacheco²,

Jaimes³

2017

biomedica

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Contribución de los autores:Todos los autores participaron en igual medida en todos los aspectos del estudio y la redacción del manuscrito. Introducción. La enfermedad asociada a Clostridium difficile es la principal causa de diarrea infecciosa adquirida en el hospital; su creciente incidencia, las menores tasas de respuesta al tratamiento inicial y la mayor tasa de recaídas han incrementado la carga de la enfermedad. Objetivo. Determinar las características clínicas de los pacientes hospitalizados con enfermedad asociada a C. difficile. Materiales y métodos. Se hizo un estudio de casos anidado en una cohorte. Se revisaron las historias clínicas de pacientes con diarrea iniciada durante su hospitalización a quienes se les había practicado la prueba de detección de la toxina A-B de C. difficile, entre febrero de 2010 y febrero de 2012. Se definió como caso al paciente hospitalizado con diarrea y prueba de Enzyme Linked Fluorescent Assay (ELFA) positiva para la toxina y, como control, a aquel con resultado negativo para la toxina. Se recolectaron los datos demográficos y clínicos, así como la información sobre los factores asociados, la estancia hospitalaria, el tratamiento y las complicaciones. Perfil clínico y demográfico y factores de riesgo frente a la infección por Clostridium difficileResultados. Durante el periodo de seguimiento se recolectaron datos de 123 pacientes, de los cuales 30 fueron positivos para la toxina. La edad media en la población de estudio fue de 49 años y el 60 % correspondía a hombres. Los síntomas predominantes fueron el dolor abdominal (35 %) y la fiebre (34 %). Las principales complicaciones fueron la alteración electrolítica y la sepsis grave asociada con disfunción renal. La mortalidad total fue de 13 % y los factores independientes asociados con la aparición de la infección fueron el uso de inhibidores de la bomba de protones y la cirugía gastrointestinal previa. Conclusiones. El uso de inhibidores de la bomba de protonesy la cirugía gastrointestinal previa fueron factores asociados con la infección por C. difficile. Clinical and demographic profile and risk factors for Clostridium difficile infectionIntroduction: Clostridium difficile infection is the leading cause of nosocomial infectious diarrhea. The increasing incidence added to a lower rate of response to the initial treatment and higher rates of relapse has generated a higher burden of the disease. Objective: To determine the clinical characteristics of hospitalized patients with C. difficile infection. Materials and methods:We made a nested case-cohort study. We reviewed medical records of the patients with nosocomial diarrhea for whom an assay for toxin A-B of C. difficile had been requested from February, 2010, to February, 2012. We defined case as a patient with diarrhea and a positive assay for the toxin, and control as those patients with a negative assay for the toxin. We collected data on demographic and clinical characteristics, risk factors, hospital length of stay, treatment, and complications. Results: We collec...

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Increasing Risk of Relapse after Treatment of Clostridium difficile Colitis in Quebec, Canada

Abstract: In 2003-2004, there was an increase in the proportion of patients with CDAD believed, by their attending physicians, to have experienced metronidazole treatment failure, as well as an increase in the frequency of post-metronidazole therapy recurrences, especially among elderly persons.

Cited by 533 publications

References 29 publications

Recurrent Clostridium difficile infection and the microbiome

Recurrent Clostridium difficile infection and the microbiome

Multidrug-resistant North American pulsotype 2 Clostridium difficile was the predominant toxigenic hospital-acquired strain in the province of Manitoba, Canada, in 2006–2007

Clinical and demographic profile and risk factors for Clostridium difficile infection

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