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Suleiman M, Tang P, Imam O, Morales P, Altrmanini D, Barr KL, Roberts JC, Pérez-López A. Use of PCR Cycle Threshold and Clinical Interventions to Aid in the Management of Pediatric Clostridioides difficile Patients. Microorganisms 2024; 12:1181. [PMID: 38930564 PMCID: PMC11205759 DOI: 10.3390/microorganisms12061181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Revised: 06/03/2024] [Accepted: 06/05/2024] [Indexed: 06/28/2024] Open
Abstract
Better diagnostic tools are needed to improve the diagnosis of Clostridioides difficile infections (CDI) and reduce the overtreatment of colonized children. In this study, we evaluated two polymerase chain reaction (PCR) assays (Cepheid GeneXpert C. difficile and the Gastroenteritis PCR Panel by QIAstat-Dx) as a standalone method in combination with the PCR cycle threshold (Ct) value in positive samples to predict the presence of free toxins. We also evaluated the clinical impact of reporting toxin production results and provided comments alongside the PCR results in our pediatric population. PCR-positive stool samples from pediatric patients (aged 2 to 18 years old) were included in our study and tested for the presence of toxins A and B using the C. difficile Quik Chek Complete kit. For the clinical intervention, the CDI treatment rates 6 months pre- and post-intervention were compared. The use of PCR Ct value showed excellent sensitivity (100%) at a Ct value cutoff of 26.1 and 27.2 using the Cepheid GeneXpert C. difficile and the Gastroenteritis PCR Panel by QIAstat-Dx, respectively, while the toxin test showed inferior sensitivity of 64% in the PCR-positive samples. In addition, CDI treatment rates were decreased by 23% post-intervention. The results of our study suggest that nucleic acid amplification test (NAAT) assays supplemented by the use of PCR Ct value for positive samples can be used as standalone tests to differentiate CDI from colonization. Furthermore, the reporting of toxin production along with the PCR results can help reduce the unnecessary treatment of colonized children.
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Affiliation(s)
- Mohammed Suleiman
- Department of Pathology, Sidra Medicine, Doha P.O. Box 26999, Qatar; (P.T.); (P.M.); (D.A.); (A.P.-L.)
| | - Patrick Tang
- Department of Pathology, Sidra Medicine, Doha P.O. Box 26999, Qatar; (P.T.); (P.M.); (D.A.); (A.P.-L.)
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine in Qatar, Doha P.O. Box 24144, Qatar
| | - Omar Imam
- Department of Infectious Diseases, Sidra Medicine, Doha P.O. Box 26999, Qatar;
| | - Princess Morales
- Department of Pathology, Sidra Medicine, Doha P.O. Box 26999, Qatar; (P.T.); (P.M.); (D.A.); (A.P.-L.)
| | - Diyna Altrmanini
- Department of Pathology, Sidra Medicine, Doha P.O. Box 26999, Qatar; (P.T.); (P.M.); (D.A.); (A.P.-L.)
| | - Kelli L. Barr
- Center for Global Health and Infectious Disease Research, University of South Florida, Tampa, FL 33612, USA; (K.L.B.); (J.C.R.)
| | - Jill C. Roberts
- Center for Global Health and Infectious Disease Research, University of South Florida, Tampa, FL 33612, USA; (K.L.B.); (J.C.R.)
| | - Andrés Pérez-López
- Department of Pathology, Sidra Medicine, Doha P.O. Box 26999, Qatar; (P.T.); (P.M.); (D.A.); (A.P.-L.)
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine in Qatar, Doha P.O. Box 24144, Qatar
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Xie Y, Chupina Estrada A, Nelson B, Feng H, Pothoulakis C, Chesnel L, Koon HW. ADS024, a Bacillus velezensis strain, protects human colonic epithelial cells against C. difficile toxin-mediated apoptosis. Front Microbiol 2023; 13:1072534. [PMID: 36704560 PMCID: PMC9873417 DOI: 10.3389/fmicb.2022.1072534] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 12/19/2022] [Indexed: 01/11/2023] Open
Abstract
Clostridioides difficile infection (CDI) causes intestinal injury. Toxin A and toxin B cause intestinal injury by inducing colonic epithelial cell apoptosis. ADS024 is a Bacillus velezensis strain in development as a single-strain live biotherapeutic product (SS-LBP) to prevent the recurrence of CDI following the completion of standard antibiotic treatment. We evaluated the protective effects of the sterile filtrate and ethyl acetate extract of conditioned media from ADS024 and DSM7 (control strain) against mucosal epithelial injury in toxin-treated human colonic tissues and apoptosis in toxin-treated human colonic epithelial cells. Ethyl acetate extracts were generated from conditioned culture media from DSM7 and ADS024. Toxin A and toxin B exposure caused epithelial injury in fresh human colonic explants. The sterile filtrate of ADS024, but not DSM7, prevented toxin B-mediated epithelial injury in fresh human colonic explants. Both sterile filtrate and ethyl acetate extract of ADS024 prevented toxin-mediated apoptosis in human colonic epithelial cells. The anti-apoptotic effects of ADS024 filtrate and ethyl acetate extract were dependent on the inhibition of caspase 3 cleavage. The sterile filtrate, but not ethyl acetate extract, of ADS024 partially degraded toxin B. ADS024 inhibits toxin B-mediated apoptosis in human colonic epithelial cells and colonic explants.
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Affiliation(s)
- Ying Xie
- Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA, United States,Department of Gastroenterology, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Andrea Chupina Estrada
- Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA, United States
| | - Becca Nelson
- Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA, United States
| | - Hanping Feng
- Department of Microbial Pathogenesis, School of Dentistry, University of Maryland, College Park, College Park, MD, United States
| | - Charalabos Pothoulakis
- Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA, United States
| | | | - Hon Wai Koon
- Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA, United States,*Correspondence: Hon Wai Koon,
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Viprey VF, Davis GL, Benson AD, Ewin D, Spittal W, Vernon JJ, Rupnik M, Banz A, Allantaz F, Cleuziat P, Wilcox MH, Davies KA. A point-prevalence study on community and inpatient Clostridioides difficile infections (CDI): results from Combatting Bacterial Resistance in Europe CDI (COMBACTE-CDI), July to November 2018. Euro Surveill 2022; 27:2100704. [PMID: 35775426 PMCID: PMC9248264 DOI: 10.2807/1560-7917.es.2022.27.26.2100704] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 04/05/2022] [Indexed: 11/20/2022] Open
Abstract
BackgroundThere is a paucity of data on community-based Clostridioides difficile infection (CDI) and how these compare with inpatient CDI.AimTo compare data on the populations with CDI in hospitals vs the community across 12 European countries.MethodsFor this point-prevalence study (July-November 2018), testing sites sent residual diagnostic material on sampling days to a coordinating laboratory for CDI testing and PCR ribotyping (n = 3,163). Information on whether CDI testing was requested at the original site was used to identify undiagnosed CDI. We used medical records to identify differences between healthcare settings in patient demographics and risk factors for detection of C. difficile with or without free toxin.ResultsThe CDI positivity rate was 4.4% (country range: 0-16.2) in hospital samples, and 1.3% (country range: 0-2.2%) in community samples. The highest prevalence of toxinotype IIIb (027, 181 and 176) was seen in eastern European countries (56%; 43/77), the region with the lowest testing rate (58%; 164/281). Different predisposing risk factors were observed (use of broad-spectrum penicillins in the community (OR: 8.09 (1.9-35.6), p = 0.01); fluoroquinolones/cephalosporins in hospitals (OR: 2.2 (1.2-4.3), p = 0.01; OR: 2.0 (1.1-3.7), p = 0.02)). Half of community CDI cases were undetected because of absence of clinical suspicion, accounting for three times more undiagnosed adults in the community compared with hospitals (ca 111,000 vs 37,000 cases/year in Europe).ConclusionThese findings support recommendations for improving diagnosis in patients presenting with diarrhoea in the community, to guide good practice to limit the spread of CDI.
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Affiliation(s)
- Virginie F Viprey
- Healthcare Associated Infections Research Group, Leeds Institute of Medical Research, University of Leeds, Leeds, United Kingdom
| | - Georgina L Davis
- Healthcare Associated Infections Research Group, Leeds Institute of Medical Research, University of Leeds, Leeds, United Kingdom
| | - Anthony D Benson
- Healthcare Associated Infections Research Group, Leeds Institute of Medical Research, University of Leeds, Leeds, United Kingdom
| | - Duncan Ewin
- Healthcare Associated Infections Research Group, Leeds Institute of Medical Research, University of Leeds, Leeds, United Kingdom
| | - William Spittal
- Healthcare Associated Infections Research Group, Leeds Institute of Medical Research, University of Leeds, Leeds, United Kingdom
| | - Jon J Vernon
- Healthcare Associated Infections Research Group, Leeds Institute of Medical Research, University of Leeds, Leeds, United Kingdom
| | - Maja Rupnik
- National Laboratory for Health, Environment and Food, Maribor, Slovenia
- Faculty of Medicine, University of Maribor, Maribor, Slovenia
- European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Clostridioides difficile (ESGCD)
| | | | | | | | - Mark H Wilcox
- Healthcare Associated Infections Research Group, Leeds Institute of Medical Research, University of Leeds, Leeds, United Kingdom
- European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Clostridioides difficile (ESGCD)
- Department of Microbiology, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Kerrie A Davies
- Healthcare Associated Infections Research Group, Leeds Institute of Medical Research, University of Leeds, Leeds, United Kingdom
- European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Clostridioides difficile (ESGCD)
- Department of Microbiology, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
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A Rare Case of Pseudomembranous Colitis Presenting with Pleural Effusion and Ascites with Literature Review. Case Rep Gastrointest Med 2022; 2021:6019068. [PMID: 35003814 PMCID: PMC8741396 DOI: 10.1155/2021/6019068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 12/20/2021] [Indexed: 11/25/2022] Open
Abstract
Clostridium difficile infection usually results from long-term and irregular antibiotic intake. The high-risk individuals for this infection include the patients undergoing chemotherapy due to malignancy, immunocompromised patients, and hospitalized patients receiving broad-spectrum antibiotics. The most common clinical manifestation of Clostridium difficile infection is diarrhea. However, pleural effusion and ascites have rarely been observed. As mentioned, these manifestations can be developed in a patient being treated with broad-spectrum antibiotics. Therefore, the present study reports a rare case of Clostridium difficile infection manifesting with these rare manifestations who was a 78-year-old female patient with a history of COVID-19, orthopedic surgery, and antibiotic treatment with cefixime and gentamicin.
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Davidovics ZH, Michail S, Nicholson MR, Kociolek LK, Pai N, Hansen R, Schwerd T, Maspons A, Shamir R, Szajewska H, Thapar N, de Meij T, Mosca A, Vandenplas Y, Kahn SA, Kellermayer R. Fecal Microbiota Transplantation for Recurrent Clostridium difficile Infection and Other Conditions in Children: A Joint Position Paper From the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition. J Pediatr Gastroenterol Nutr 2019; 68:130-143. [PMID: 30540704 PMCID: PMC6475090 DOI: 10.1097/mpg.0000000000002205] [Citation(s) in RCA: 76] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Fecal microbiota transplantation (FMT) is becoming part of the treatment algorithms against recurrent Clostridium difficile infection (rCDI) both in adult and pediatric gastroenterology practice. With our increasing recognition of the critical role the microbiome plays in human health and disease, FMT is also being considered as a potential therapy for other disorders, including inflammatory bowel disease (Crohn disease, ulcerative colitis), graft versus host disease, neuropsychiatric diseases, and metabolic syndrome. Controlled trials with FMT for rCDI have not been performed in children, and numerous clinical and regulatory considerations have to be considered when using this untraditional therapy. This report is intended to provide guidance for FMT in the treatment of rCDI in pediatric patients.
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Affiliation(s)
- Zev H. Davidovics
- Department of Pediatric Gastroenterology, Digestive Diseases, Hepatology, and Nutrition, Connecticut Children’s Medical Center, University of Connecticut School of Medicine, Farmington, CT
| | - Sonia Michail
- Children’s Hospital Los Angeles, University of Southern California, Los Angeles, CA
| | - Maribeth R. Nicholson
- D. Brent Polk Division of Gastroenterology, Hepatology, and Nutrition, Vanderbilt University Medical Center, Nashville, TN
| | - Larry K. Kociolek
- Ann and Robert H. Lurie Children’s Hospital of Chicago, North-western University Feinberg School of Medicine, Chicago, IL
| | - Nikhil Pai
- Division of Pediatric Gastroenterology and Nutrition, McMaster Children’s Hospital, McMaster University, Hamilton, Ontario, Canada
| | - Richard Hansen
- Department of Paediatric Gastroenterology, Royal Hospital for Children, Glasgow, Scotland
| | - Tobias Schwerd
- Department of Pediatrics, Dr. von Hauner Children’s Hospital, University Hospital, LMU Munich, Munich, Germany
| | | | - Raanan Shamir
- Institute for Gastroenterology, Nutrition and Liver Disease, Schneider Children’s Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hania Szajewska
- Department of Paediatrics, The Medical University of Warsaw, Warsaw, Poland
| | - Nikhil Thapar
- Department of Paediatric Gastroenterology, Great Ormond Street Hospital NHS Foundation Trust, London, United Kingdom
| | - Tim de Meij
- Department of Paediatric Gastroenterology, VU University Medical Center, Amsterdam, The Netherlands
| | - Alexis Mosca
- Division of Pediatric Gastroenterology and Nutrition, Robert Debré Hospital (APHP)
- French Group of Fecal Transplantation, St Antoine Hospital (APHP), Paris, France
| | - Yvan Vandenplas
- KidZ Health Castle, Universitair Ziekenuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Stacy A. Kahn
- Division of Gastroetenterology and Nutrition, Inflammatory Bowel Disease Center, Boston Children’s Hospital, Harvard Medical School, 17 Boston, MA
| | - Richard Kellermayer
- Section of Pediatric Gastroenterology and Nutrition, Texas Children’s Hospital, Baylor College of Medicine, Children’s Nutrition and Research Center, Houston, TX
| | - FMT Special Interest Group of the North American Society of Pediatric Gastroenterology Hepatology, Nutrition, the European Society for Pediatric Gastroenterology Hepatology, Nutrition
- Department of Pediatric Gastroenterology, Digestive Diseases, Hepatology, and Nutrition, Connecticut Children’s Medical Center, University of Connecticut School of Medicine, Farmington, CT
- Children’s Hospital Los Angeles, University of Southern California, Los Angeles, CA
- D. Brent Polk Division of Gastroenterology, Hepatology, and Nutrition, Vanderbilt University Medical Center, Nashville, TN
- Ann and Robert H. Lurie Children’s Hospital of Chicago, North-western University Feinberg School of Medicine, Chicago, IL
- Division of Pediatric Gastroenterology and Nutrition, McMaster Children’s Hospital, McMaster University, Hamilton, Ontario, Canada
- Department of Paediatric Gastroenterology, Royal Hospital for Children, Glasgow, Scotland
- Department of Pediatrics, Dr. von Hauner Children’s Hospital, University Hospital, LMU Munich, Munich, Germany
- VeMiDoc, LLC, El Paso, TX
- Institute for Gastroenterology, Nutrition and Liver Disease, Schneider Children’s Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Paediatrics, The Medical University of Warsaw, Warsaw, Poland
- Department of Paediatric Gastroenterology, Great Ormond Street Hospital NHS Foundation Trust, London, United Kingdom
- Department of Paediatric Gastroenterology, VU University Medical Center, Amsterdam, The Netherlands
- Division of Pediatric Gastroenterology and Nutrition, Robert Debré Hospital (APHP)
- French Group of Fecal Transplantation, St Antoine Hospital (APHP), Paris, France
- KidZ Health Castle, Universitair Ziekenuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
- Division of Gastroetenterology and Nutrition, Inflammatory Bowel Disease Center, Boston Children’s Hospital, Harvard Medical School, 17 Boston, MA
- Section of Pediatric Gastroenterology and Nutrition, Texas Children’s Hospital, Baylor College of Medicine, Children’s Nutrition and Research Center, Houston, TX
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Cobo J, Merino E, Martínez C, Cózar-Llistó A, Shaw E, Marrodán T, Calbo E, Bereciartúa E, Sánchez-Muñoz LA, Salavert M, Pérez-Rodríguez MT, García-Rosado D, Bravo-Ferrer JM, Gálvez-Acebal J, Henríquez-Camacho C, Cuquet J, Pino-Calm B, Torres L, Sánchez-Porto A, Fernández-Félix BM. Prediction of recurrent clostridium difficile infection at the bedside: the GEIH-CDI score. Int J Antimicrob Agents 2017; 51:393-398. [PMID: 28939450 DOI: 10.1016/j.ijantimicag.2017.09.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 09/01/2017] [Accepted: 09/12/2017] [Indexed: 01/05/2023]
Abstract
Recurrence of Clostridium difficile infection (CDI) has major consequences for both patients and the health system. The ability to predict which patients are at increased risk of recurrent CDI makes it possible to select candidates for treatment with new drugs and therapies (including fecal microbiota transplantation) that have proven to reduce the incidence of recurrence of CDI. Our objective was to develop a clinical prediction tool, the GEIH-CDI score, to determine the risk of recurrence of CDI. Predictors of recurrence of CDI were investigated using logistic regression in a prospective cohort of 274 patients diagnosed with CDI. The model was calibrated using the Hosmer-Lemeshow test. The tool comprises four factors: age (70-79 years and ≥80 years), history of CDI during the previous year, direct detection of toxin in stool, and persistence of diarrhea on the fifth day of treatment. The functioning of the GEIH-CDI score was validated in a prospective cohort of 183 patients. The area under the ROC curve was 0.72 (0.65-0.79). Application of the tool makes it possible to select patients at high risk (>50%) of recurrence and patients at low risk (<10%) of recurrence. GEIH-CDI score may be useful for clinicians treating patients with CDI.
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Affiliation(s)
- Javier Cobo
- Servicio de Enfermedades Infecciosas, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain.
| | - Esperanza Merino
- Unidad de Enfermedades Infecciosas, Hospital General Universitario de Alicante, ISABIAL-FISABIO, Alicante, Spain
| | - Cristina Martínez
- Servicio de Enfermedades Infecciosas, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Alberto Cózar-Llistó
- Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Evelyn Shaw
- Servicio de Enfermedades infecciosas, Hospital Universitario de Bellvitge, IDIBELL, Barcelona, Spain
| | - Teresa Marrodán
- Servicio de Microbiología Clínica, Hospital de León, León, Spain
| | - Esther Calbo
- Servicio de Medicina Interna, Unidad de Control de la Infección, Hospital Universitario MútuaTerrasssa, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Elena Bereciartúa
- Unidad de Enfermedades infecciosas, Hospital Universitario Cruces, Bilbao, Spain
| | - Luis A Sánchez-Muñoz
- Servicio de Medicina Interna, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Miguel Salavert
- Unidad de Enfermedades infecciosas, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - M Teresa Pérez-Rodríguez
- Unidad de Patología Infecciosa, Servicio de Medicina Interna, Complejo Hospitalario Universitario de Vigo, Vigo, Spain
| | - Dácil García-Rosado
- Sección de Infecciones, Servicio de Medicina Interna Hospital universitario de Canarias, Vigo, Tenerife, Spain
| | | | - Juan Gálvez-Acebal
- Instituto de Biomedicina de Sevilla, IBiS/Hospital universitario Virgen Macarena/Unidad de Enfermedades infecciosas/CSIC/Universidad de Sevilla, Sevilla, Spain
| | | | - Jordi Cuquet
- Proceso de Infecciones, Servicio de Medicina Interna, Hospital General de Granollers, Barcelona, Spain
| | - Berta Pino-Calm
- Servicio de Microbiología, Hospital Nuestra Señora de Candelaria, Sta, Cruz de Tenerife, Spain
| | - Luis Torres
- Servicio de Microbiología, Hospital San Jorge de Huesca, Huesca, Spain
| | - Antonio Sánchez-Porto
- Unidad de Enfermedades infecciosas y Microbiología, Hospital del SAS de La Línea de la Concepción, Cádiz, Spain
| | - Borja M Fernández-Félix
- Unidad de Bioestadística Clínica, Hospital Universitario Ramón y Cajal, Madrid, Spain; IRYCIS, CIBER Epidemiología y Salud Pública (CIBERESP)
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Epidemiology of Clostridium difficile in a County Level Hospital in China. Jundishapur J Microbiol 2017. [DOI: 10.5812/jjm.14376] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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Esteban-Vasallo MD, Naval Pellicer S, Domínguez-Berjón MF, Cantero Caballero M, Asensio Á, Saravia G, Astray-Mochales J. Age and gender differences in Clostridium difficile-related hospitalization trends in Madrid (Spain) over a 12-year period. Eur J Clin Microbiol Infect Dis 2016; 35:1037-44. [PMID: 27056555 DOI: 10.1007/s10096-016-2635-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 03/21/2016] [Indexed: 02/08/2023]
Abstract
This study aimed to analyze temporal trends by gender and age in Clostridium difficile infection (CDI)-related hospitalization rates in the Autonomous Community of Madrid (Spain) over a 12-year period. A population-based cross-sectional study of all hospital admissions with a CDI diagnosis from 2003 to 2014 was carried out. Annual age-specific hospitalization rates were calculated by gender. All the analyses were performed separately for total hospitalizations and hospitalizations with CDI as the primary diagnosis. Joinpoint regression models were used to analyze time trends. A total of 13,526 hospital discharges were identified (26.8 % with CDI as the primary diagnosis). In both sexes, a gradient in age-specific rates was observed, ranging in 2014 from 5.92 hospitalizations per 100,000 person-years in patients <15 years of age to 378.96 in patients ≥85 years of age. Since 2009, in the age group of 15-44 years, both men and women presented an increasing trend of around 18 %. A significantly increasing trend was detected in women of age 45-84 years, with an estimated annual percentage of change of 7.6 % in the age group of 45-64 years, and rounding with 4.5 % in the age group of 65-84 years. In men of age 45-64 years, the average annual percentage of increase was 4.7 %, and it was 21.1 % between 2010 and 2014 in the age group of 65-74 years. No trends were identified in the 85 years and over age group. Surveillance methods to assess trends by age group should be implemented. Preventive and therapeutic initiatives should remain a priority.
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Affiliation(s)
- M D Esteban-Vasallo
- Public Health Directorate, Madrid Regional Health Authority, San Martín de Porres, 6, 28035, Madrid, Spain.
| | - S Naval Pellicer
- Public Health Directorate, Madrid Regional Health Authority, San Martín de Porres, 6, 28035, Madrid, Spain
| | - M F Domínguez-Berjón
- Public Health Directorate, Madrid Regional Health Authority, San Martín de Porres, 6, 28035, Madrid, Spain
| | - M Cantero Caballero
- Preventive Medicine Service, Puerta de Hierro-Majadahonda Hospital, Manuel de Falla, 1, 28222, Majadahonda, Madrid, Spain
| | - Á Asensio
- Preventive Medicine Service, Puerta de Hierro-Majadahonda Hospital, Manuel de Falla, 1, 28222, Majadahonda, Madrid, Spain
| | - G Saravia
- Public Health Directorate, Madrid Regional Health Authority, San Martín de Porres, 6, 28035, Madrid, Spain
| | - J Astray-Mochales
- Public Health Directorate, Madrid Regional Health Authority, San Martín de Porres, 6, 28035, Madrid, Spain
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Chilton CH, Crowther GS, Śpiewak K, Brindell M, Singh G, Wilcox MH, Monaghan TM. Potential of lactoferrin to prevent antibiotic-induced Clostridium difficile infection. J Antimicrob Chemother 2016; 71:975-85. [PMID: 26759363 PMCID: PMC4790624 DOI: 10.1093/jac/dkv452] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Accepted: 11/24/2015] [Indexed: 12/15/2022] Open
Abstract
Objectives Clostridium difficile infection (CDI) is a global healthcare problem. Recent evidence suggests that the availability of iron may be important for C. difficile growth. This study evaluated the comparative effects of iron-depleted (1% Fe3+ saturated) bovine apo-lactoferrin (apo-bLf) and iron-saturated (85% Fe3+ saturated) bovine holo-lactoferrin (holo-bLf) in a human in vitro gut model that simulates CDI. Methods Two parallel triple-stage chemostat gut models were inoculated with pooled human faeces and spiked with C. difficile spores (strain 027 210, PCR ribotype 027). Holo- or apo-bLf was instilled (5 mg/mL, once daily) for 35 days. After 7 days, clindamycin was instilled (33.9 mg/L, four times daily) to induce simulated CDI. Indigenous microflora populations, C. difficile total counts and spores, cytotoxin titres, short chain fatty acid concentrations, biometal concentrations, lactoferrin concentration and iron content of lactoferrin were monitored daily. Results In the apo-bLf model, germination of C. difficile spores occurred 6 days post instillation of clindamycin, followed by rapid vegetative cell proliferation and detectable toxin production. By contrast, in the holo-bLf model, only a modest vegetative cell population was observed until 16 days post antibiotic administration. Notably, no toxin was detected in this model. In separate batch culture experiments, holo-bLf prevented C. difficile vegetative cell growth and toxin production, whereas apo-bLf and iron alone did not. Conclusions Holo-bLf, but not apo-bLf, delayed C. difficile growth and prevented toxin production in a human gut model of CDI. This inhibitory effect may be iron independent. These observations suggest that bLf in its iron-saturated state could be used as a novel preventative or treatment strategy for CDI.
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Affiliation(s)
- C H Chilton
- Leeds Institute for Molecular Medicine, University of Leeds, Leeds, UK
| | - G S Crowther
- Leeds Institute for Molecular Medicine, University of Leeds, Leeds, UK
| | - K Śpiewak
- Department of Inorganic Chemistry, Jagiellonian University, Krakow, Poland
| | - M Brindell
- Department of Inorganic Chemistry, Jagiellonian University, Krakow, Poland
| | - G Singh
- NIHR Biomedical Research Unit in Gastrointestinal and Liver Diseases at Nottingham University Hospitals NHS Trust and The University of Nottingham, Nottingham, UK
| | - M H Wilcox
- Leeds Institute for Molecular Medicine, University of Leeds, Leeds, UK
| | - T M Monaghan
- NIHR Biomedical Research Unit in Gastrointestinal and Liver Diseases at Nottingham University Hospitals NHS Trust and The University of Nottingham, Nottingham, UK
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