The risk for Clostridium difficile colitis during hospitalization in asymptomatic carriers

Kagan, Steven; Wiener-Well, Yonit; Ben‐Chetrit, Eli; Kashat, Livnat; Aouizerats, J.; Bdolah‐Abram, Tali; Yinnon, Amos M.; Assous, Marc V.

doi:10.1016/j.jhin.2017.01.013

Cited by 11 publications

(7 citation statements)

References 8 publications

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“…Our previous study and other reports have shown that carriers of C. difficile are significantly more likely to develop diarrhoea during hospitalisation than non-carriers [31, 33]. Asymptomatic carriage identified at admission was a decisive risk factor for symptomatic infection during hospital stay, accounting for about 25% of the patients (26 of 104) who developed CDI during the study.…”

Section: Discussionmentioning

confidence: 54%

Longitudinal investigation of carriage rates and genotypes of toxigenicClostridium difficilein hepatic cirrhosis patients

Chen

et al. 2019

Epidemiol. Infect.

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Toxigenic Clostridium difficile (C. difficile) carriers represent an important source in the transmission of C. difficile infection (CDI) during hospitalisation, but its prevalence and mode in patients with hepatic cirrhosis are not well established. We investigated longitudinal changes in carriage rates and strain types of toxigenic C. difficile from admission to discharge among hepatic cirrhosis patients. Toxigenic C. difficile was detected in 104 (19.8%) of 526 hepatic cirrhosis patients on admission, and the carriage status changed in a portion of patients during hospitalisation. Approximately 56% (58/104) of patients lost the colonisation during their hospital stay. Among the remaining 48 patients who remained positive for toxigenic C. difficile, the numbers of patients who were positive at one, two, three and four isolations were 10 (55.6%), three (16.7%), two (11.1%) and three (16.7%), respectively. Twenty-eight patients retained a particular monophyletic strain at multiple isolations. The genotype most frequently identified was the same as that frequently identified in symptomatic CDI patients. A total of 25% (26/104) of patients were diagnosed with CDI during their hospital stay. Conclusions: Colonisation with toxigenic C. difficile strains occurs frequently in cirrhosis patients and is a risk factor for CDI.

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Section: Discussionmentioning

confidence: 54%

Longitudinal investigation of carriage rates and genotypes of toxigenicClostridium difficilein hepatic cirrhosis patients

Chen

et al. 2019

Epidemiol. Infect.

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“…In addition, neither ST1 nor ST11, which were epidemic in western countries [48], were detected in China. Our map showing the temporospatial relationships between strains indicated that C. difficile dispersed among normal colonized patients is likely to be a potential source of infection and transmission to clinical patients leading to CDC and CDI [31,49].…”

Section: Discussionmentioning

confidence: 96%

Risk factors for Clostridium difficile infection and colonization among patients admitted to intensive care units in Shanghai, China

Cui

Zhang

Dong

et al. 2019

Preprint

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Background : Clostridium difficile is considered to be the main pathogen responsible for hospital-acquired infections in western countries, but few studies on C. difficile have been carried out in China. This study performed a prospective study to describe the prevalence, molecular epidemiological characteristics and risk factors of Clostridium difficile infection (CDI) and Clostridium difficile colonization (CDC) among patients in intensive care units (ICUs), with the aim of providing strategies for efficient CD prevention and control.Methods: Stool samples were collected from adult patients on admission to an 18-bed ICU department, and were anaerobically cultured for C. difficile . The identified isolates were tested for toxin genes, followed by multilocus sequence typing to analyze the genotypes. Patients were divided into CDI, CDC and control groups according to clinical features. The medical records of these groups were collected and further analyzed using logistic regression to investigate the risk factors.Results: Of the 800 patients included in the study, 33 (4.12%) and 25 (3.12%) patients were identified with CDI and CDC, respectively. An association was found between CDI patients and having a fever (OR=13.993) or metabolic disorder (OR=7.972), and treatment with fluoroquinolone (OR=42.696) or a combination of antibiotics (OR=2.856). CDC patients were characterized by longer hospital stays (OR=1.137), an increased number of comorbidities (OR=36.509), respiratory diseases (OR=0.043) and treatment with vancomycin (OR=18.168). However, treatment with metronidazole was simultaneously found to be a protective factor in the two groups (OR=0.042; OR=0.013). Eighteen sequence types (STs) were identified. Among the CDI group, the isolates were predominantly toxin A- and toxin B-positive (A+B+) strains and genotype ST-2 was the epidemic clone. In the CDC group, the dominant strains were A+B+ and ST-81 was the epidemic clone.Conclusions: The prevalence of C. difficile colonization and infection in our ICU patients was relatively high, suggesting the importance of routine screening to detect the acquisition of this pathogen. Future prevention and treatment strategies for C. difficile -related disease should take into consideration the duration of hospital stays, enteral nutrition, underlying comorbidities, as well as the use of combined antibiotics. Moreover, metronidazole could be a protective factor for both CDI and CDC.

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“…For example, of the 28 statements in the European consensus document, 19 (68%) have only weak supporting evidence, 5 (18%) moderate supporting evidence and only 4 (14%) have strong evidence [ 29 ]. This lack of clear evidence-based guidelines has been suggested as a barrier to the more widespread adoption of FMT as a treatment modality in the UK and other countries [ 48 – 50 ].…”

Section: Discussionmentioning

confidence: 99%

Comparison of Different Strategies for Providing Fecal Microbiota Transplantation to Treat Patients with Recurrent Clostridium difficile Infection in Two English Hospitals: A Review

et al. 2018

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Fecal microbiota transplant (FMT) has emerged as a highly efficacious treatment for difficult cases of refractory and/or recurrent Clostridium difficile infection (CDI). There have been many well-conducted randomized controlled trials and thousands of patients reported in case series that describe success rates of approximately 90% following one or more FMT. Although the exact mechanisms of FMT have yet to be fully elucidated, replacement or restoration of a ‘normal’ microbiota (or at least a microbiota resembling those who have never had CDI) appears to have a positive effect on the gut dysbiosis that is thought to exist in these patients. Furthermore, despite being aesthetically unappealing, this ‘ultimate probiotic’ is a particularly attractive solution to a difficult problem that avoids repeated courses of antibiotics. The lack of clarity about the exact mechanism of action and the ‘active ingredient’ of FMT (e.g., individual or communities of bacteria, bacteriophage, or bioactive molecules such as bile acids) has hindered the ability to produce a standardized and well-characterized FMT product. There is no standard method to produce material for FMT, and there are a multitude of factors that can vary between institutions that offer this therapy. Only a few studies have directly compared clinical efficacy in groups of patients who have been treated with FMT prepared differently (e.g., fresh vs. frozen) or administered by different route (e.g., by nasojejunal tube, colonoscopy or by oral administration of encapsulated product). More of these studies should be undertaken to clarify the superiority or otherwise of these variables. This review describes the methods and protocols that two English NHS hospitals independently adopted over the same time period to provide FMT for patients with recurrent CDI. There are several fundamental differences in the methods used, including selection and testing of donors, procedures for preparation and storage of material, and route of administration. These methods are described in detail in this review highlighting differing practice. Despite these significant methodological variations, clinical outcomes in terms of cure rate appear to be remarkably similar for both FMT providers. Although both hospitals have treated only modest numbers of patients, these findings suggest that many of the described differences may not be critical factors in influencing the success of the procedure. As FMT is increasingly being proposed for a number of conditions other than CDI, harmonization of methods and techniques may be more critical to the success of FMT, and thus it will be important to standardize these as far as practically possible.

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The risk for Clostridium difficile colitis during hospitalization in asymptomatic carriers

Cited by 11 publications

References 8 publications

Longitudinal investigation of carriage rates and genotypes of toxigenicClostridium difficilein hepatic cirrhosis patients

Longitudinal investigation of carriage rates and genotypes of toxigenicClostridium difficilein hepatic cirrhosis patients

Risk factors for Clostridium difficile infection and colonization among patients admitted to intensive care units in Shanghai, China

Comparison of Different Strategies for Providing Fecal Microbiota Transplantation to Treat Patients with Recurrent Clostridium difficile Infection in Two English Hospitals: A Review

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