Prediction of poor outcome in Clostridioides difficile infection: A multicentre external validation of the toxin B amplification cycle

Reigadas, Elena; Alcalá, Luís; Marı́n, Mercedes; Martín, A.; Muñóz, Patricia; Bouza, Emilio; Sánchez-Arroyo, Rafael J.; Gutiérrez, José; García-García, Concepción; Fernández-Caso, Belén; García-Blanco, Alicia; Fernández-Pittol, Mariana; Álvarez-Martínez, Míriam J.; Miguel, Mendes; Nuño, Enrique; Álvarez-Paredes, Ledicia; Megías, Gregoria; López-Medrano, Ramiro; Foz, Carlos Fuster; Leiva, José; Fernández-Alonso, Mirian; Vega, Silvia de la; Hernando, Susana; Frutos, Mónica de; Eiros, José María; Trujillo, Gloria; López, Joan; Diego, Araceli N. Molina de; Hontangas, José Luis López; Guerrero-Vadillo, María

doi:10.1016/j.anaerobe.2019.102079

Cited by 2 publications

(3 citation statements)

References 30 publications

(25 reference statements)

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“…A few other studies have identified a significant association between lower Ct values and poor outcomes, which included recurrent CDI. 13,15,16 However, all of the aforementioned studies included very few patients with recurrence, and the recurrence rates were higher than the 10% recurrence rate in our study, which may explain some of the differences. Therefore, despite some evidence that PCR Ct is able to predict disease recurrence of C. difficile, larger, prospective studies are needed to confirm its potential utility.…”

Section: Discussioncontrasting

confidence: 58%

“…Reigadas et al, 15 in a study involving 129 patients, found that PCR Ct was independently associated with poor-outcome CDI, with 8 of 43 poor outcomes attributed to development of severe CDI. Reigadas et al 16 performed a subsequent external validation study across 14 hospitals with 223 patients and reported similar results. However, neither study reported specific analyses regarding the association of PCR Ct with C. difficile disease severity.…”

Section: Discussionmentioning

confidence: 69%

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Real-time polymerase chain reaction (PCR) cycle threshold and Clostridioides difficile infection outcomes

Choi

Wong

Dunn

et al. 2021

Infect. Control Hosp. Epidemiol.

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Objective: Clostridioides difficile infection (CDI) causes significant morbidity and mortality; however, the diagnosis of CDI remains controversial. The primary aim of our study was to evaluate the association of polymerase chain reaction (PCR) cycle threshold (Ct) values with CDI disease severity, recurrence, and mortality among adult patients with CDI. Design: Retrospective cohort study. Setting: Single tertiary-care hospital. Patients: Adult patients diagnosed with hospital-onset, healthcare facility–associated CDI from June 2014 to September 2015. Methods: We performed a retrospective chart review of included patients. Univariate and multivariable logistic regression methods were used to evaluate the association between Ct values and CDI severity, 8-week recurrence, and 30-day mortality. Results: Among 318 included patients, 51% were male and the mean age was 62 years; ~32% of the patients developed severe CDI and 11% developed severe–complicated CDI. The 30-day all-cause mortality rate was 11% and the 8-week recurrence rate was 9.5%. The overall mean Ct value was 32.9 (range, 23–40). Multivariable analyses showed that lower values of PCR Ct were associated with increased odds of 30-day morality (odds ratio [OR] 0.83; 95% confidence interval [CI], 0.72–0.96) but were not independently associated with CDI severity (OR, 0.99; 95% CI, 0.90–1.09) or recurrence (OR, 0.88; 95% CI, 0.77–1.00). Conclusions: Our findings suggest that PCR Ct values at the time of diagnosis may have a limited predictive value and utility in clinical decision making for inpatients with CDI. Larger, prospective studies across different patient populations are needed to confirm our findings.

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Section: Discussioncontrasting

confidence: 58%

Section: Discussionmentioning

confidence: 69%

Real-time polymerase chain reaction (PCR) cycle threshold and Clostridioides difficile infection outcomes

Choi

Wong

Dunn

et al. 2021

Infect. Control Hosp. Epidemiol.

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“…� Clostridium Clostridium innocuous has recently been identified as the pathogen of antibiotic associated diarrhea in humans [31].…”

Section: Group Y2mentioning

confidence: 99%

Relationship between gut microbiome characteristics and the effect of nutritional therapy on glycemic control in pregnant women with gestational diabetes mellitus

Chen

Yang

et al. 2022

PLoS ONE

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The purpose of this study was to explore the relationship between the characteristics of gut microbiome and the effect of medical nutrition therapy (MNT) on glycemic control in pregnant women with gestational diabetes mellitus (GDM). Seventy-four pregnant women newly diagnosed with GDM received MNT for one-week. The effect of glycemic control was evaluated by fasting and 2-hour postprandial blood glucose; and stool samples of pregnant women were collected to detect the gut microbiome before and after MNT. We used a nested case-control study design, with pregnant women with GDM who did not meet glycemic standards after MNT as the ineffective group and those with an age difference of ≤5 years, matched for pre-pregnancy body mass index (BMI) 1:1, and meeting glycemic control criteria as the effective group. Comparison of the gut microbiome characteristics before MNT showed that the ineffective group was enriched in Desulfovibrio, Aeromonadales, Leuconostocaceae, Weissella, Prevotella, Bacillales_Incertae Sedis XI, Gemella and Bacillales, while the effective group was enriched in Roseburia, Clostridium, Bifidobacterium, Bifidobacteriales, Bifidobacteriaceae, Holdemania and Proteus. After treatment, the effective group was enriched in Bifidobacterium and Actinomycete, while the ineffective group was enriched in Holdemania, Proteus, Carnobacteriaceae and Granulicatella. In conclusion, the decrease in the abundance of characteristic gut microbiome positively correlated with blood glucose may be a factor influencing the poor hypoglycemic effect of MNT in pregnant women with GDM. Abundance of more characteristic gut microbiome negatively correlated with blood glucose could help control blood glucose in pregnant women with GDM.

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Prediction of poor outcome in Clostridioides difficile infection: A multicentre external validation of the toxin B amplification cycle

Cited by 2 publications

References 30 publications

Real-time polymerase chain reaction (PCR) cycle threshold and Clostridioides difficile infection outcomes

Real-time polymerase chain reaction (PCR) cycle threshold and Clostridioides difficile infection outcomes

Relationship between gut microbiome characteristics and the effect of nutritional therapy on glycemic control in pregnant women with gestational diabetes mellitus

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