Risk Factors for Recurrence of Clostridioides difficile in Hospitalized Patients

Alrahmany, Diaa; Ereshefsky, Benjamin; Nekidy, Wasim S. El; Harb, Gehan; Pontiggia, Laura; Ghazi, Islam M.

doi:10.1016/j.jiph.2021.09.016

Cited by 12 publications

(11 citation statements)

References 46 publications

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“…We propose an early prediction model for R-CDI based on clinical and analytical data such as age, sex, immunosuppression, creatinine level, calprotectin level and C. difficile PCR toxin B gene cycle, which can be assessed using commercially available PCR methods found in many microbiology laboratories. Our R-CDI prediction model included variables already known to be risk factors for R-CDI or poor outcome of CDI, such as advanced age, female sex, creatinine levels >1mg/dL, C. difficile PCR toxin B gene cycle threshold <23, immunosuppression and faecal calprotectin levels ( Hu et al., 2009 ; Eyre et al., 2012 ; Lupse et al., 2013 ; Miller et al., 2013 ; Reigadas et al., 2016 ; Origüen et al., 2019 ; Alrahmany et al., 2021 ).…”

Section: Discussionmentioning

confidence: 99%

“…We propose an early prediction model for R-CDI based on clinical and analytical data such as age, sex, immunosuppression, creatinine level, calprotectin level and C. difficile PCR toxin B gene cycle, which can be assessed using commercially available PCR methods found in many microbiology laboratories. Our R-CDI prediction model included variables already known to be risk factors for R-CDI or poor outcome of CDI, such as advanced age, (Hu et al, 2009;Eyre et al, 2012;Lupse et al, 2013;Miller et al, 2013;Reigadas et al, 2016;Origüen et al, 2019;Alrahmany et al, 2021). Hence, the data on which the model is based are easy to obtain at the time of diagnosis of the primary CDI episode, with a reasonable AUC (0.783).…”

Section: Figurementioning

confidence: 99%

“…The main risk factors associated with R-CDI include advanced age, hospital exposure, treatment with proton pump inhibitors, prior antibiotic treatment and initial disease severity ( Eyre et al., 2012 ; Lupse et al., 2013 ; Alrahmany et al., 2021 ).…”

Section: Introductionmentioning

confidence: 99%

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Microbiome profile and calprotectin levels as markers of risk of recurrent Clostridioides difficile infection

Vázquez-Cuesta,

Lozano García,

Fernández

et al. 2023

Front. Cell. Infect. Microbiol.

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IntroductionClostridioides difficile infection (CDI) is the main cause of nosocomial diarrhoea in developed countries. Recurrent CDI (R-CDI), which affects 20%-30% of patients and significantly increases hospital stay and associated costs, is a key challenge. The main objective of this study was to explore the role of the microbiome and calprotectin levels as predictive biomarkers of R-CDI.MethodsWe prospectively (2019-2021) included patients with a primary episode of CDI. Clinical data and faecal samples were collected. The microbiome was analysed by sequencing the hypervariable V4 region of the 16S rRNA gene on an Illumina Miseq platform.ResultsWe enrolled 200 patients with primary CDI, of whom 54 developed R-CDI and 146 did not. We analysed 200 primary samples and found that Fusobacterium increased in abundance, while Collinsella, Senegalimassilia, Prevotella and Ruminococcus decreased in patients with recurrent versus non-recurrent disease. Elevated calprotectin levels correlated significantly with R-CDI (p=0.01). We built a risk index for R-CDI, including as prognostic factors age, sex, immunosuppression, toxin B amplification cycle, creatinine levels and faecal calprotectin levels (overall accuracy of 79%).DiscussionCalprotectin levels and abundance of microbial genera such as Fusobacterium and Prevotella in primary episodes could be useful as early markers of R-CDI. We propose a readily available model for prediction of R-CDI that can be applied at the initial CDI episode. The use of this tool could help to better tailor treatments according to the risk of R-CDI.

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Section: Discussionmentioning

confidence: 99%

“…We propose an early prediction model for R-CDI based on clinical and analytical data such as age, sex, immunosuppression, creatinine level, calprotectin level and C. difficile PCR toxin B gene cycle, which can be assessed using commercially available PCR methods found in many microbiology laboratories. Our R-CDI prediction model included variables already known to be risk factors for R-CDI or poor outcome of CDI, such as advanced age, (Hu et al, 2009;Eyre et al, 2012;Lupse et al, 2013;Miller et al, 2013;Reigadas et al, 2016;Origüen et al, 2019;Alrahmany et al, 2021). Hence, the data on which the model is based are easy to obtain at the time of diagnosis of the primary CDI episode, with a reasonable AUC (0.783).…”

Section: Figurementioning

confidence: 99%

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Microbiome profile and calprotectin levels as markers of risk of recurrent Clostridioides difficile infection

Vázquez-Cuesta,

Lozano García,

Fernández

et al. 2023

Front. Cell. Infect. Microbiol.

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“…Additionally, females accounted for a larger proportion than males in all reports (51.49% vs. 36.85%). This result suggests that females may be more susceptible to AAD than males, potentially due to differences in gut flora between genders [ 29 ]. These findings are consistent with recent research in the relevant literature [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

Antibiotics and antibiotic-associated diarrhea: a real-world disproportionality study of the FDA adverse event reporting system from 2004 to 2022

Huang,

Li,

et al. 2023

BMC Pharmacol Toxicol

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Background Our study aimed to assess the risk signals of antibiotic-associated diarrhea (AAD) caused by various antibiotics using real-world data and provide references for safe clinical applications. Methods We analyzed data extracted from the FDA Adverse Event Reporting System (FAERS) database, covering the period from the first quarter of 2004 to the third quarter of 2022. We computed the reporting odds ratio (ROR) for each antibiotic or antibiotic class to compare the signal difference. Furthermore, we also examined the differences in the onset times and outcomes of AAD caused by various antibiotics. Results A total of 5,397 reports met the inclusion requirements. Almost all antibiotics, except tobramycin and minocycline (ROR 0.98; 95%CI: 0.64–1.51 and 0.42; 95%CI: 0.16–1.11, respectively), showed a significant correlation with AAD. The analysis of the correlation between different classes of antibiotics and AAD revealed that lincomycins (ROR 29.19; 95%CI: 27.06–31.50), third-generation cephalosporins (ROR 15.96; 95%CI: 14.58–17.47), and first/second generation cephalosporins (ROR 15.29; 95%CI: 13.74–17.01) ranked the top three. The ROR values for antibiotics from the same class of antibiotics also varied greatly, with the ROR values for third-generation cephalosporins ranging from 9.97 to 58.59. There were also differences in ROR values between β-lactamase inhibitors and their corresponding β-lactamase drugs, such as amoxicillin-clavulanate (ROR = 13.31; 95%CI: 12.09–14.65) and amoxicillin (ROR = 6.50; 95%CI: 5.69–7.44). 91.35% of antibiotics have an onset time of less than four weeks. Conclusions There is a significant correlation between almost all antibiotics and AAD, particularly lincomycins and β-lactam antibiotics, as well as a different correlation within the same class. These findings offer valuable evidence for selecting antibiotics appropriately.

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“…One of the most common problems with CDI is recurrent CDI, which is generally associated with poor clinical outcomes. Some of the risk factors for recurrent CDI, recently described by Alrahmany et al [ 29 ], are over 76 years of age, the total length of hospital stay (>7 days), previous exposure to clindamycin, and concomitant use of aztreonam.…”

Section: Introductionmentioning

confidence: 99%

Make It Less difficile: Understanding Genetic Evolution and Global Spread of Clostridioides difficile

Mengoli

Barone

Fabbrini

et al. 2022

Genes

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Clostridioides difficile is an obligate anaerobic pathogen among the most common causes of healthcare-associated infections. It poses a global threat due to the clinical outcomes of infection and resistance to antibiotics recommended by international guidelines for its eradication. In particular, C. difficile infection can lead to fulminant colitis associated with shock, hypotension, megacolon, and, in severe cases, death. It is therefore of the utmost urgency to fully characterize this pathogen and better understand its spread, in order to reduce infection rates and improve therapy success. This review aims to provide a state-of-the-art overview of the genetic variation of C. difficile, with particular regard to pathogenic genes and the correlation with clinical issues of its infection. We also summarize the current typing techniques and, based on them, the global distribution of the most common ribotypes. Finally, we discuss genomic surveillance actions and new genetic engineering strategies as future perspectives to make it less difficile.

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Risk Factors for Recurrence of Clostridioides difficile in Hospitalized Patients

Cited by 12 publications

References 46 publications

Microbiome profile and calprotectin levels as markers of risk of recurrent Clostridioides difficile infection

Microbiome profile and calprotectin levels as markers of risk of recurrent Clostridioides difficile infection

Antibiotics and antibiotic-associated diarrhea: a real-world disproportionality study of the FDA adverse event reporting system from 2004 to 2022

Make It Less difficile: Understanding Genetic Evolution and Global Spread of Clostridioides difficile

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