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Mendo-Lopez R, Alonso CD, Villafuerte-Gálvez JA. Best Practices in the Management of Clostridioides difficile Infection in Developing Nations. Trop Med Infect Dis 2024; 9:185. [PMID: 39195623 PMCID: PMC11359346 DOI: 10.3390/tropicalmed9080185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Revised: 08/13/2024] [Accepted: 08/13/2024] [Indexed: 08/29/2024] Open
Abstract
Clostridioides difficile infection (CDI) is a well-known cause of hospital-acquired infectious diarrhea in developed countries, though it has not been a top priority in the healthcare policies of developing countries. In the last decade, several studies have reported a wide range of CDI rates between 1.3% and 96% in developing nations, raising the concern that this could represent a healthcare threat for these nations. This review defines developing countries as those with a human development index (HDI) below 0.8. We aim to report the available literature on CDI epidemiology, diagnostics, management, and prevention in developing countries. We identify limitations for CDI diagnosis and management, such as limited access to CDI tests and unavailable oral vancomycin formulation, and identify opportunities to enhance CDI care, such as increased molecular test capabilities and creative solutions for CDI. We also discuss infection prevention strategies, including antimicrobial stewardship programs and opportunities emerging from the COVID-19 pandemic, which could impact CDI care.
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Affiliation(s)
- Rafael Mendo-Lopez
- Division of Infectious Disease, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA
- School of Medicine, Case Western Reserve University, Cleveland, OH 44106, USA
- Louis Stokes Cleveland VA Medical Center, Cleveland, OH 44106, USA
| | - Carolyn D. Alonso
- Division of Infectious Disease, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA;
- Harvard Medical School, Harvard University, Boston, MA 02215, USA;
| | - Javier A. Villafuerte-Gálvez
- Harvard Medical School, Harvard University, Boston, MA 02215, USA;
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
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2
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Heydari H, Iranikhah A, Ghasemi A, Mohammadbeigi A, Sadat-Mirei SA, Shams S, Kermani S. Evaluation of the prevalence of Aeromonas spp., Campylobacter spp., and Clostridioides difficile in immunocompromised children with diarrhea. BMC Infect Dis 2024; 24:512. [PMID: 38778271 PMCID: PMC11110422 DOI: 10.1186/s12879-024-09372-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 05/02/2024] [Indexed: 05/25/2024] Open
Abstract
AIM Diarrhea is a common disease in immunocompromised patients and can be associated with greater morbidity and even mortality. Therefore, the present study was designed to determine the prevalence of Aeromonas spp., Campylobacter spp., and C. difficile among immunocompromised children. METHODS This study was conducted on 130 stool samples from patients with diarrhea who had defects in the immune system and were referred to Hazrat Masoumeh Children's Hospital in Qom. Demographic information, clinical symptoms, immune status, and duration of chemotherapy were also recorded for each child. DNAs were extracted from the stool, and then direct PCR assays were done by specific primers for the detection of Aeromonas spp., Campylobacter spp., and toxigenic C. difficile, including tcdA/B and cdtA/B genes. Co-infection in patients was also evaluated. RESULTS 60.8% and 39.2% were male and female, respectively, with a m ± SD age of 56.72 ± 40.49 months. Most cases of immunocompromised states were related to Acute Lymphocytic Leukemia (77.7%) and Non-Hodgkin Lymphoma (14.6%). 93.1% of patients were undergoing chemotherapy during the study. Among patients, most clinical symptoms were related to bloody diarrhea (98.5%) and fever (92.3%). Based on PCR, 14.6, 9.2, and 1.5% were positive for Aeromonas spp., C. difficile, and C. jejuni, respectively. Among the C. difficile-positive cases, the tcdA gene was only detected in one patient. In total, three co-infections were identified, which included Aeromonas spp./C. difficile (tcdA+), C. jejuni/C. difficile, and C. jejuni/Aeromonas spp. CONCLUSIONS This is the first study in Iran to investigate the simultaneous prevalence of some pathogens in immunocompromised children with diarrhea. Because Aeromonas spp., Campylobacter spp., and C. difficile are not routinely detected in some laboratories, infections caused by them are underappreciated in the clinic. Our results showed that these pathogens are present in our region and can cause gastroenteritis in children, especially those with underlying diseases. Therefore, increasing the level of hygiene in some areas and controlling bacterial diarrheal diseases should be given more attention by health officials.
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Affiliation(s)
- Hosein Heydari
- Pediatric Medicine Research Center, Qom University of Medical Sciences, Qom, Iran
| | - Abolfazl Iranikhah
- Gastroenterology and Hepatology Diseases Research Center, Qom University of Medical Sciences, Qom, Iran
| | - Ahmad Ghasemi
- Department of Microbiology, Research Center of Reference Health Laboratories, Ministry of Health and Medical Education, Tehran, Iran
| | - Abolfazl Mohammadbeigi
- Department of Epidemiology and Biostatistics, School of Health, Qom University of Medical Sciences, Qom, Iran
| | | | - Saeed Shams
- Cellular and Molecular Research Center, Qom University of Medical Sciences, Qom, Iran.
| | - Somayeh Kermani
- Cellular and Molecular Research Center, Qom University of Medical Sciences, Qom, Iran.
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Nogueira HBR, Costa CL, Quesada-Gómez C, Pacífico DDM, Ferreira EDO, Leitão RFDC, Brito GADC. Molecular epidemiology and antimicrobial resistance in Clostridioides difficile strains isolated from children and adolescents in a tertiary referral pediatric hospital in Fortaleza, Brazil. Braz J Infect Dis 2024; 28:103767. [PMID: 38843868 PMCID: PMC11215949 DOI: 10.1016/j.bjid.2024.103767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 04/24/2024] [Accepted: 05/19/2024] [Indexed: 06/19/2024] Open
Abstract
BACKGROUND C. difficile has been increasingly reported as a cause of gastrointestinal disease in children, ranging from mild self-limiting diarrhea to severe conditions such as pseudomembranous colitis and toxic megacolon. Only two pediatric research groups reported the presence of C. difficile infection in Brazilian children, but no previous research has examined C. difficile infection among children in northeastern Brazil. This prospective cross-sectional study investigated the molecular epidemiology and antimicrobial resistance of C. difficile strains isolated from children and adolescents with diarrhea referred to a tertiary pediatric hospital in Brazil while exploring the associated risk factors. RESULTS Toxin positivity or C. difficile isolation was found in 30.4 % (17/56) samples. C. difficile was isolated from 35 % (6/17) samples. Four toxigenic strains were identified (tpi+, tcdA+, tcdB+, cdtB-, without tcdC deletions) belonging to PCR ribotypes and PFGE-pulsotypes: 046 (new pulsotype 1174), 106 (NAP11), 002 (new pulsotype 1274), 012 (new pulsotype NML-1235). Two of the six isolates belonging to ribotypes 143 and 133 were non-toxigenic. All toxigenic strains were sensitive to metronidazole and vancomycin. Regarding the clinical manifestation, diarrhea lasted an average of 11 days, ranging from 3 to 50 days and was often associated with mucus and/or blood. All six patients from whom the C. difficile was isolated had a chronic disease diagnosis, with these comorbidities as the main risk factors. CONCLUSION Our study enhances our understanding of the present epidemiological landscape of C. difficile-associated diarrhea (CDI) among children in northeastern Brazil, reveling a substantial CDI frequency of 30.4 %, with toxigenic strains detected in 76.4 % of cases, highlighting a higher prevalence compared to earlier Brazilian studies. In the globalized world, an understanding of disease-generating strains, the associated risk factors, clinical manifestation, and antimicrobial sensitivity has fundamental epidemiological importance and draws attention to preventive measures, allowing for more decisive action.
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Affiliation(s)
- Hildenia Baltasar Ribeiro Nogueira
- Hospital Infantil Albert Sabin, Fortaleza, CE, Brazil; Universidade Federal do Ceará, Núcleo de Microscopia e Processamento de Imagens (NEMPI), Departamento de Morfologia Fortaleza, CE, Brazil; Universidade de Fortaleza, Fortaleza, CE, Brazil
| | - Cecília Leite Costa
- Universidade Federal do Ceará, Núcleo de Microscopia e Processamento de Imagens (NEMPI), Departamento de Morfologia Fortaleza, CE, Brazil; Centro Universitário Christus, Fortaleza, CE, Brazil
| | - Carlos Quesada-Gómez
- Facultad de Microbiología and Centro de Investigación en Enfermedades Tropicales, Universidad de Costa Rica, San José, Costa Rica
| | - Dvison de Melo Pacífico
- Universidade Federal do Ceará, Núcleo de Microscopia e Processamento de Imagens (NEMPI), Departamento de Morfologia Fortaleza, CE, Brazil
| | - Eliane de Oliveira Ferreira
- Universidade Federal do Rio de Janeiro, Instituto de Microbiologia Paulo de Góes, Laboratório de Biologia de Anaeróbios, Rio de Janeiro, RJ, Brazil
| | - Renata Ferreira de Carvalho Leitão
- Universidade Federal do Ceará, Núcleo de Microscopia e Processamento de Imagens (NEMPI), Departamento de Morfologia Fortaleza, CE, Brazil.
| | - Gerly Anne de Castro Brito
- Universidade Federal do Ceará, Núcleo de Microscopia e Processamento de Imagens (NEMPI), Departamento de Morfologia Fortaleza, CE, Brazil
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Li Z, Dong N, Hao J, Ouyang Z, Qiang C, Yang Y, Mi C, Niu Y, Yang J, Wen B, Wang L, Zhang S, Zhao J. Clostridioides difficile infection in infants: a case report and literature review. Gut Pathog 2023; 15:31. [PMID: 37386612 DOI: 10.1186/s13099-023-00552-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 05/11/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND Clostridioides difficile (C. difficile) is the major pathogen causing antibiotic-associated diarrhea. There are a variety of symptoms associated with C. difficile infection (CDI) in adults, including self-limiting diarrhea, pseudomembranous colitis, toxic megacolon, septic shock, and even death from the infection. However, the infant's intestine appears to be completely resistant to the effects of C. difficile toxins A and B with rare development of clinical symptoms. CASE PRESENTATION In this study, we reported a 1-month-old girl with CDI who was born with neonatal hypoglycemia and necrotizing enterocolitis. Her symptom of diarrhea occurred after extensive use of broad-spectrum antibiotics during hospitalization and was accompanied by elevated white blood cell, platelet, and C-reactive protein levels, and repeated routine stool examinations were abnormal. She was recovered by norvancomycin (an analogue of vancomycin) and probiotic treatment. The results of 16 S rRNA gene sequencing also demonstrated the recovery of intestinal microbiota with the enrichment of Firmicutes and Lactobacillus. CONCLUSIONS Based on the literature review and this case report, clinicians should also pay attention to diarrhea caused by C. difficile in infants and young children. More strong evidence is needed to explain the true prevalence of CDI in this population and to better understand the C. difficile-associated diarrhea in infants.
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Affiliation(s)
- Zhirong Li
- Hebei Provincial Center for Clinical Laboratories, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, Hebei, China
| | - Ning Dong
- Hebei Provincial Center for Clinical Laboratories, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, Hebei, China
| | - Jihong Hao
- Department of Clinical Laboratory, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, Hebei, China
| | - Zirou Ouyang
- Hebei Provincial Center for Clinical Laboratories, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, Hebei, China
| | - Cuixin Qiang
- Hebei Provincial Center for Clinical Laboratories, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, Hebei, China
| | - Ying Yang
- Hebei Provincial Center for Clinical Laboratories, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, Hebei, China
| | - Chaoyi Mi
- Research Center, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, Hebei, China
| | - Yanan Niu
- Hebei Provincial Center for Clinical Laboratories, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, Hebei, China
| | - Jing Yang
- Hebei Provincial Center for Clinical Laboratories, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, Hebei, China
| | - Baojiang Wen
- Hebei Provincial Center for Clinical Laboratories, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, Hebei, China
| | - Liwei Wang
- Clinical Laboratory, Shexian Hospital, Handan, 050000, Hebei, China
| | - Shaodan Zhang
- Department of Pediatrics, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, Hebei, China.
- , 215# Hepingxi road, Shijiazhuang, Hebei province, China.
| | - Jianhong Zhao
- Hebei Provincial Center for Clinical Laboratories, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, Hebei, China.
- Department of Clinical Laboratory, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, Hebei, China.
- , 215# Hepingxi road, Shijiazhuang, Hebei province, China.
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Adesoji AT, Mgbere O, Darkoh C. Pediatric diarrhea patients living in urban areas have a higher incidence of Clostridioides difficile infection. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0000477. [PMID: 36962940 PMCID: PMC10022077 DOI: 10.1371/journal.pgph.0000477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 12/19/2022] [Indexed: 01/25/2023]
Abstract
Clostridioides difficile infection (CDI) is a major cause of antibiotic-associated diarrhea and an unappreciated contributor to child mortality in low- and middle-income countries where the diagnosis may be difficult. There is little information about the prevalence of CDI among infants, children, and adolescents in Africa. Using a cross-sectional design, seventy-six samples were collected from pediatric patients presenting with diarrhea, including infants (≤ 2 years old), children (2-12 years), and adolescents (13 ≤17 years) from three hospitals between January and December 2019. Demographic data, medical history, and prior antibiotic use were recorded. Toxigenic culture and PCR were used to detect and validate the presence of C. difficile in the samples. Data obtained were analyzed using descriptive and inferential statistics. A total of 29 (38.7%), 39 (52.0%) and 7 (9.3%) samples were from infants, children, and adolescents, respectively. The average age of the patients was 4.4 years. Of these samples, 31 (41%) were positive for C. difficile by culture and were verified by PCR amplification of C. difficile-specific genes (tcdA and tcdB). The most positive cases were children (53.3%) and infants (40.0%) with the majority of them residing in urban areas. Forty-nine (66.2%) of the patients had no known antibiotics exposure, whereas 29.0% and 29.7% reported the use of over-the-counter antibiotics at 14 and 90 days, prior to the hospital visit, respectively. CDI is relatively common among children with diarrhea in Northern Nigeria. Therefore, for effective management and treatment, more attention should be given to testing for C. difficile as one of the causative agents of diarrhea.
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Affiliation(s)
- Ayodele T. Adesoji
- Department of Microbiology, Federal University, Dutsin-Ma, Katsina State, Nigeria
| | - Osaro Mgbere
- Disease Prevention and Control Division, Houston Health Department, Houston, Texas, United States of America
- Institute of Community Health, Texas Medical Center, University of Houston College of Pharmacy, Houston, Texas, United States of America
| | - Charles Darkoh
- Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, Center for Infectious Diseases, University of Texas Health Science Center, Houston, TX, United States of America
- MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Microbiology and Infectious Diseases Program, Houston, Texas, United States of America
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Gildner TE, Eick GN, Schneider AL, Madimenos FC, Snodgrass JJ. After Theranos: Using point-of-care testing to advance measures of health biomarkers in human biology research. Am J Hum Biol 2022; 34:e23689. [PMID: 34669210 DOI: 10.1002/ajhb.23689] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 09/21/2021] [Accepted: 09/29/2021] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVES The rise and fall of the health technology startup Theranos is emblematic of the promise and peril of point-of-care testing (POCT). Instruments that deliver immediate results from minimally invasive samples at the location of collection can provide powerful tools to deliver health data in clinical and public health contexts. Yet, POCT availability is driven largely by market interests, which limits the development of inexpensive tests for diverse health conditions that can be used in resource-limited settings. These constraints, combined with complex regulatory hurdles and substantial ethical challenges, have contributed to the underutilization of POCT in human biology research. METHODS We evaluate current POCT capabilities and limitations, discuss promising applications for POCT devices in resource-limited settings, and discuss the future of POCT. RESULTS As evidenced by publication trends, POCT platforms have rapidly advanced in recent years, gaining traction among clinicians and health researchers. We highlight POCT devices of potential interest to population-based researchers and present specific examples of POCT applications in human biology research. CONCLUSIONS Several barriers can limit POCT applications, including cost, lack of regulatory approval for non-clinical use, requirements for expensive equipment, and the dearth of validation in remote field conditions. Despite these issues, we see immense potential for emerging POCT technology capable of analyzing new sample types and used in conjunction with increasingly common technology (e.g., smart phones). We argue that the fallout from Theranos may ultimately provide an opportunity to advance POCT, leading to more ethical data collection and novel opportunities in human biology research.
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Affiliation(s)
- Theresa E Gildner
- Department of Anthropology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Geeta N Eick
- Department of Anthropology, University of Oregon, Eugene, Oregon, USA
| | - Alaina L Schneider
- Department of Anthropology, Washington University in St. Louis, St. Louis, Missouri, USA
| | | | - J Josh Snodgrass
- Department of Anthropology, University of Oregon, Eugene, Oregon, USA.,Center for Global Health, University of Oregon, Eugene, Oregon, USA
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Risk factors for Clostridioides difficile infection in children: A systematic review and meta-analysis. J Hosp Infect 2022; 130:112-121. [PMID: 36108754 DOI: 10.1016/j.jhin.2022.09.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 08/30/2022] [Accepted: 09/01/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Clostridioides difficile infection (CDI) is considered an urgent threat to human health by the US Centers for Disease Control and Prevention. In recent years, C. difficile is increasingly being reported as a cause of gastrointestinal diseases in children, and the prevalence of hospital-acquired CDI (HA-CDI) and community-acquired CDI (CA-CDI) in children is increasing. AIM To perform a systematic review and meta-analysis of risk factors for Clostridioides difficile infection (CDI) in children. METHODS MEDLINE/PubMed, EMBASE, Web of Science, Scopus, OVID, China National Knowledge Infrastructure, Wanfang (Chinese), SinoMed (Chinese), and Weipu (Chinese) databases were searched from inception through January 12, 2022. Observational studies (cohort, case-control, and cross-sectional) on CDI in children were included in the analysis. Data were pooled using a fixed or random-effects model, and odds ratios (ORs) were calculated. FINDINGS A total of 25 observational studies were included in the analysis. Prior antibiotic exposure (OR, 1.93; 95% confidence interval (CI), 1.25-2.97), prolonged hospitalization (OR, 14.68; 95% CI, 13.24-16.28), hospitalization history (OR, 3.67; 95% CI, 1.91-7.06), gastric acid suppressants (OR, 1.96; 95% CI, 1.41-2.73), male gender (OR, 1.18; 95% CI, 1.05-1.32), neoplastic disease (OR, 3.40; 95% CI, 2.85-4.07), immunodeficiency (OR, 4.18; 95% CI, 3.25-5.37), solid organ transplantation (OR, 4.56; 95% CI, 3.95-5.27) and enteral feeding (OR, 2.21; 95% CI, 1.15-4.62) were associated with an increased risk of CDI. CONCLUSION This systematic review and meta-analysis provides further evidence for the susceptibility factors of CDI to improve clinicians' awareness of CDI and effectively prevent C. difficile associated diarrhoea in children.
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Moosavian M, Keshavarzi R, Abbasi Montazeri E, Hajiani E. Loop mediated isothermal amplification of Clostridioides difficile isolates in gastrointestinal patients. AMB Express 2022; 12:42. [PMID: 35412160 PMCID: PMC9005576 DOI: 10.1186/s13568-022-01382-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 04/01/2022] [Indexed: 11/10/2022] Open
Abstract
This study investigated the prevalence of Clostridioides difficile by culture, multiplex polymerase chain reaction (M-PCR), and loop mediated isothermal amplification (LAMP) in patients with suspected C. difficile infections (CDIs). Also, the results of three methods were compared. All stool specimens collected from CDI suspected patients were cultured on selective C. difficile cycloserine-cefoxitin fructose agar and incubated in an anaerobic jar up to 7 days. The bacterial isolates were identified using standard tests. Multiplex-PCR (M-PCR) was performed for detection of tcdA, tcdB, and tpi genes. The LAMP assay was performed to detect the tcdB gene of C. difficile. C. difficile was isolated from 20.0% (n = 10/50) of samples by culture. M-PCR showed that 34.0% (n = 17/50) of the specimens were positive for C. difficile based on the presence of tpi gene. Out of the 17 C. difficile, 13 strains (76.0%) were positive for tcdB gene using M-PCR. However, the LAMP assay showed that 30.0% (15/50) of specimens were positive for the presence of tcdB gene. M-PCR and LAMP methods showed 100.0% sensitivity compared to the culture method. However, the specificity of the LAMP (87.5%) was relatively higher than the M-PCR (82.5%) compared to the culture. Based on the results of this study, the prevalence of toxigenic C. difficile strains was high in suspected CDI patients. So, the differentiation between toxigenic and non-toxigenic strains is necessary. Our data showed that the LAMP assay is a good method for direct detection of toxigenic C. difficile strains from stool specimens.
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Kullin B, Abratt VR, Reid SJ, Riley TV. Clostridioides difficile infection in Africa: A narrative review. Anaerobe 2022; 74:102549. [PMID: 35337974 DOI: 10.1016/j.anaerobe.2022.102549] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 03/13/2022] [Accepted: 03/17/2022] [Indexed: 12/12/2022]
Abstract
Clostridioides (Clostridium) difficile infection (CDI) places a burden on healthcare facilities worldwide. Most research studies have been concentrated in high-income countries in North America, Europe, Asia and Australia, where C. difficile is the leading cause of diarrhoea associated with antimicrobial use. This narrative review summarises African CDI studies, focussing on reports published in the last 20 years. Although relatively sparse, the data suggest that CDI is an important cause of diarrhoea on the continent. African CDI patient populations are often younger than in European and North American settings, probably due to the high prevalence of co-morbid conditions such as tuberculosis, particularly in sub-Saharan Africa. Strain typing data are rare and where reported generally limited to single sites and institutions. Despite challenges, including a lack of facilities and awareness, there is a need for further investigation to more accurately determine the true burden of disease caused by C. difficile in Africa.
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Affiliation(s)
- Brian Kullin
- Department of Molecular and Cell Biology, University of Cape Town, Cape Town, South Africa
| | - Valerie R Abratt
- Department of Molecular and Cell Biology, University of Cape Town, Cape Town, South Africa
| | - Sharon J Reid
- Department of Molecular and Cell Biology, University of Cape Town, Cape Town, South Africa
| | - Thomas V Riley
- Medical, Molecular and Forensic Sciences, Murdoch University, Murdoch, Western Australia WA, Australia; School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia; Department of Microbiology, PathWest Laboratory Medicine, Nedlands, WA, Australia; School of Biomedical Sciences, The University of Western Australia, Crawley, WA, Australia.
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Brennhofer SA, Rogawski McQuade ET, Liu J, Guerrant RL, Platts-Mills JA, Warren CA. Clostridioides difficile colonisation among very young children in resource-limited settings. Clin Microbiol Infect 2022; 28:996-1002. [PMID: 35150876 PMCID: PMC9240321 DOI: 10.1016/j.cmi.2022.01.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 01/20/2022] [Accepted: 01/24/2022] [Indexed: 12/01/2022]
Abstract
Objectives To describe the epidemiology and risk factors for Clostridioides difficile (C. difficile) colonization among young children in eight low-resource settings. Methods We tested 41 354 monthly non-diarrhoeal and diarrhoeal stools for C. difficile toxin genes (TcdA and TcdB) using quantitative PCR (qPCR) in 1715 children from birth to age two years in a multisite birth cohort study. We estimated the prevalence, cumulative incidence, and seasonality of C. difficile colonization and investigated the associations of C. difficile detection with risk factors of infection, markers of enteropathy, and growth. Results The prevalence of C. difficile detection was lower in diarrhoeal (2.2%; n = 151/6731) compared to non-diarrhoeal stools (6.1%; n = 2106/34 623). By 24 months of age, the cumulative incidence of C. difficile varied widely by site, with 17.9% (n = 44; Pakistan) to 76.3% (n = 148; Peru) of children having at least one positive stool. Only Bangladesh and Pakistan had seasonal differences in C. difficile detection. Female sex (adjusted risk ratio (aRR): 1.18; 95% CI: 1.02–1.35), cephalosporin use in the past 15 days (aRR: 1.73; 95% CI: 1.39–2.16), and treated water (aRR: 1.24; 95% CI: 1.02–1.50) were risk factors for C. difficile positivity. The presence of C. difficile was significantly associated with elevated faecal myeloperoxidase, neopterin, and α-1-antitrypsin, but no associations were found between C. difficile and child growth at 24 months of age. Discussion C. difficile colonization among children ages 0–2 years was variable across low-resource settings. Significant elevation of intestinal inflammation and barrier disruption markers associated with C. difficile detection suggests a subclinical impact of colonization.
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Affiliation(s)
- Stephanie A Brennhofer
- Division of Infectious Diseases and International Health, School of Medicine, University of Virginia, Charlottesville, VA, USA
| | | | - Jie Liu
- Division of Infectious Diseases and International Health, School of Medicine, University of Virginia, Charlottesville, VA, USA; School of Public Health, Qingdao University, Qingdao, China
| | - Richard L Guerrant
- Division of Infectious Diseases and International Health, School of Medicine, University of Virginia, Charlottesville, VA, USA
| | - James A Platts-Mills
- Division of Infectious Diseases and International Health, School of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Cirle A Warren
- Division of Infectious Diseases and International Health, School of Medicine, University of Virginia, Charlottesville, VA, USA.
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Darkoh C, Keita K, Odo C, Oyaro M, Brown EL, Arias CA, Hanson BM, DuPont HL. Emergence of Clinical Clostridioides difficile Isolates With Decreased Susceptibility to Vancomycin. Clin Infect Dis 2022; 74:120-126. [PMID: 35016207 PMCID: PMC8752249 DOI: 10.1093/cid/ciaa912] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Clostridioides difficile infection (CDI) is a leading cause of hospital-associated antibiotic-related diarrhea and deaths worldwide. Vancomycin is one of the few antibiotics recommended for both nonsevere and severe CDI cases. We sought to determine whether vancomycin nonsusceptible C. difficile strains are circulating in the patient population. METHODS Stool samples from patients with CDI were collected from 438 and 98 patients at a large university hospital in Houston, Texas, and Nairobi, Kenya, respectively. The stools were examined for the presence of vancomycin and metronidazole nonsusceptible C. difficile using broth dilution culture, Etest (BioMérieux, France), polymerase chain reaction (PCR), whole-genome sequencing, and in vivo testing in a CDI mouse model. RESULTS Of the Houston stool samples, 114/438 (26%) had vancomycin nonsusceptible C. difficile isolates and 128/438 (29%) were metronidazole nonsusceptible. Similarly, 66 out of 98 (67%) and 83/98 (85%) of the Nairobi patients harbored vancomycin and metronidazole nonsusceptible isolates, respectively. Vancomycin treatment of a CDI mouse model infected with a vancomycin nonsusceptible isolate failed to eradicate the infection. Whole-genome sequencing analyses did not identify vanA genes, suggesting a different mechanism of resistance. CONCLUSIONS C. difficile strains exhibiting reduced susceptibility to vancomycin are currently circulating in patient populations. The spread of strains resistance to vancomycin, a first-line antibiotic for CDI, poses a serious therapeutic challenge. Routine susceptibility testing may be necessary.
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Affiliation(s)
- Charles Darkoh
- University of Texas Health Science Center, School of Public Health, Department of Epidemiology, Human Genetics, and Environmental Sciences, Center for Infectious Diseases, Houston, Texas,USA
- University of Texas MD Anderson Cancer Center, UTHealth Graduate School of Biomedical Sciences, Microbiology and Infectious Diseases Program, Houston, Texas,USA
| | | | - Chioma Odo
- University of Texas MD Anderson Cancer Center, UTHealth Graduate School of Biomedical Sciences, Microbiology and Infectious Diseases Program, Houston, Texas,USA
| | - Micah Oyaro
- University of Nairobi, School of Medicine, College of Health Sciences, Nairobi, Kenya
| | - Eric L Brown
- University of Texas Health Science Center, School of Public Health, Department of Epidemiology, Human Genetics, and Environmental Sciences, Center for Infectious Diseases, Houston, Texas,USA
| | - Cesar A Arias
- University of Texas Health Science Center, School of Public Health, Department of Epidemiology, Human Genetics, and Environmental Sciences, Center for Infectious Diseases, Houston, Texas,USA
- University of Texas MD Anderson Cancer Center, UTHealth Graduate School of Biomedical Sciences, Microbiology and Infectious Diseases Program, Houston, Texas,USA
- Division of Infectious Diseases and Center for Antimicrobial Resistance and Microbial Genomics, UTHealth, McGovern School of Medicine at Houston, Houston, Texas, USA
| | - Blake M Hanson
- University of Texas Health Science Center, School of Public Health, Department of Epidemiology, Human Genetics, and Environmental Sciences, Center for Infectious Diseases, Houston, Texas,USA
- Division of Infectious Diseases and Center for Antimicrobial Resistance and Microbial Genomics, UTHealth, McGovern School of Medicine at Houston, Houston, Texas, USA
| | - Herbert L DuPont
- University of Texas Health Science Center, School of Public Health, Department of Epidemiology, Human Genetics, and Environmental Sciences, Center for Infectious Diseases, Houston, Texas,USA
- University of Texas MD Anderson Cancer Center, UTHealth Graduate School of Biomedical Sciences, Microbiology and Infectious Diseases Program, Houston, Texas,USA
- Kelsey Research Foundation, Houston, Texas, USA
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Mutai WC, Mureithi M, Anzala O, Kullin B, Ofwete R, Kyany' A C, Odoyo E, Musila L, Revathi G. Assessment of independent comorbidities and comorbidity measures in predicting healthcare facility-onset Clostridioides difficile infection in Kenya. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000090. [PMID: 36962261 PMCID: PMC10022263 DOI: 10.1371/journal.pgph.0000090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 11/04/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Clostridioides difficile is primarily associated with hospital-acquired diarrhoea. The disease burden is aggravated in patients with comorbidities due to increased likelihood of polypharmacy, extended hospital stays and compromised immunity. The study aimed to investigate comorbidity predictors of healthcare facility-onset C. difficile infection (HO-CDI) in hospitalized patients. METHODOLOGY We performed a cross sectional study of 333 patients who developed diarrhoea during hospitalization. The patients were tested for CDI. Data on demographics, admission information, medication exposure and comorbidities were collected. The comorbidities were also categorised according to Charlson Comorbidity Index (CCI) and Elixhauser Comorbidity Index (ECI). Comorbidity predictors of HO-CDI were identified using multiple logistic regression analysis. RESULTS Overall, 230/333 (69%) patients had comorbidities, with the highest proportion being in patients aged over 60 years. Among the patients diagnosed with HO-CDI, 63/71(88.7%) reported comorbidities. Pairwise comparison between HO-CDI patients and comparison group revealed significant differences in hypertension, anemia, tuberculosis, diabetes, chronic kidney disease and chronic obstructive pulmonary disease. In the multiple logistic regression model significant predictors were chronic obstructive pulmonary disease (odds ratio [OR], 9.51; 95% confidence interval [CI], 1.8-50.1), diabetes (OR, 3.56; 95% CI, 1.11-11.38), chronic kidney disease (OR, 3.88; 95% CI, 1.57-9.62), anemia (OR, 3.67; 95% CI, 1.61-8.34) and hypertension (OR, 2.47; 95% CI, 1.-6.07). Among the comorbidity scores, CCI score of 2 (OR 6.67; 95% CI, 2.07-21.48), and ECI scores of 1 (OR, 4.07; 95% CI, 1.72-9.65), 2 (OR 2.86; 95% CI, 1.03-7.89), and ≥ 3 (OR, 4.87; 95% CI, 1.40-16.92) were significantly associated with higher odds of developing HO-CDI. CONCLUSION Chronic obstructive pulmonary disease, chronic kidney disease, anemia, diabetes, and hypertension were associated with an increased risk of developing HO-CDI. Besides, ECI proved to be a better predictor for HO-CDI. Therefore, it is imperative that hospitals should capitalize on targeted preventive approaches in patients with these underlying conditions to reduce the risk of developing HO-CDI and limit potential exposure to other patients.
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Affiliation(s)
- Winnie C Mutai
- Department of Medical Microbiology, School of Medicine, University of Nairobi, Nairobi, Kenya
| | - Marianne Mureithi
- Department of Medical Microbiology, School of Medicine, University of Nairobi, Nairobi, Kenya
| | - Omu Anzala
- Department of Medical Microbiology, School of Medicine, University of Nairobi, Nairobi, Kenya
| | - Brian Kullin
- Division of Medical Virology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Robert Ofwete
- Department of Medical Microbiology, School of Medicine, University of Nairobi, Nairobi, Kenya
| | - Cecilia Kyany' A
- US Army Medical Research Directorate-Africa, Kenya, Nairobi, Kenya
| | - Erick Odoyo
- US Army Medical Research Directorate-Africa, Kenya, Nairobi, Kenya
| | - Lillian Musila
- US Army Medical Research Directorate-Africa, Kenya, Nairobi, Kenya
| | - Gunturu Revathi
- Department of Pathology, Division of Medical Microbiology, Aga Khan University Hospital, Nairobi, Kenya
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Mutai WC, Mureithi MW, Anzala O, Revathi G, Kullin B, Burugu M, Kyany'a C, Odoyo E, Otieno P, Musila L. High Prevalence of Multidrug-Resistant Clostridioides difficile Following Extensive Use of Antimicrobials in Hospitalized Patients in Kenya. Front Cell Infect Microbiol 2021; 10:604986. [PMID: 33628744 PMCID: PMC7897694 DOI: 10.3389/fcimb.2020.604986] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 12/14/2020] [Indexed: 01/02/2023] Open
Abstract
Introduction Clostridioides difficile is a neglected pathogen in many African countries as it is generally not regarded as one of the major contributors toward the diarrheal disease burden in the continent. However, several studies have suggested that C. difficile infection (CDI) may be underreported in many African settings. The aim of this study was to determine the prevalence of CDI in hospitalized patients, evaluate antimicrobial exposure, and detect toxin and antimicrobial resistance profiles of the isolated C. difficile strains. Methods In this cross-sectional study, 333 hospitalized patients with hospital-onset diarrhoea were selected. The stool samples were collected and cultured on cycloserine-cefoxitin egg yolk agar (CCEY). Isolates were presumptively identified by phenotypic characteristics and Gram stain and confirmed by singleplex real-time PCR (qPCR) assays detecting the species-specific tpi gene, toxin A (tcdA) gene, toxin B (tcdB) gene, and the binary toxin (cdtA/cdtB) genes. Confirmed C. difficile isolates were tested against a panel of eight antimicrobials (vancomycin, metronidazole, rifampicin, ciprofloxacin, tetracycline, clindamycin, erythromycin, and ceftriaxone) using E-test strips. Results C. difficile was detected in 57 (25%) of diarrheal patients over the age of two, 56 (98.2%) of whom received antimicrobials before the diarrheal episode. Amongst the 71 confirmed isolates, 69 (97.1%) harbored at least one toxin gene. More than half of the toxigenic isolates harbored a truncated tcdA gene. All isolates were sensitive to vancomycin, while three isolates (2.1%) were resistant to metronidazole (MIC >32 mg/L). High levels of resistance were observed to rifampicin (65/71, 91.5%), erythromycin (63/71, 88.7%), ciprofloxacin (59/71, 83.1%), clindamycin (57/71, 80.3%), and ceftriaxone (36/71, 50.7.8%). Among the resistant isolates, 61 (85.9%) were multidrug-resistant. Conclusion Multidrug-resistant C. difficile strains were a significant cause of healthcare facility-onset C. difficile infections in patients with prior antimicrobial exposure in this Kenyan hospital.
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Affiliation(s)
- Winnie C Mutai
- Department of Medical Microbiology, School of Medicine, University of Nairobi, Nairobi, Kenya
| | - Marianne W Mureithi
- Department of Medical Microbiology, School of Medicine, University of Nairobi, Nairobi, Kenya
| | - Omu Anzala
- Department of Medical Microbiology, School of Medicine, University of Nairobi, Nairobi, Kenya
| | - Gunturu Revathi
- Department of Pathology, Division of Medical Microbiology, Aga Khan University Hospital, Nairobi, Kenya
| | - Brian Kullin
- Department of Molecular and Cell Biology, Faculty of Science, University of Cape Town, Cape Town, South Africa
| | - Magdaline Burugu
- Department of Medical Microbiology, School of Medicine, University of Nairobi, Nairobi, Kenya
| | | | - Erick Odoyo
- US Army Medical Research Directorate-Africa, Nairobi, Kenya
| | - Peter Otieno
- US Army Medical Research Directorate-Africa, Nairobi, Kenya
| | - Lillian Musila
- US Army Medical Research Directorate-Africa, Nairobi, Kenya
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Babatola AO, Fadare JO, Olatunya OS, Obiako R, Enwere O, Kalungia A, Ojo TO, Sunmonu TA, Desalu O, Godman B. Addressing antimicrobial resistance in Nigerian hospitals: exploring physicians prescribing behavior, knowledge, and perception of antimicrobial resistance and stewardship programs. Expert Rev Anti Infect Ther 2020; 19:537-546. [PMID: 32990480 DOI: 10.1080/14787210.2021.1829474] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
INTRODUCTION We assessed the knowledge of, attitude toward antimicrobial resistance (AMR) and practice of antimicrobial stewardship (AMS) among physicians in Nigeria to provide future guidance to the Nigerian National Action Plan for AMR. METHODS A descriptive cross-sectional questionnaire-based study explored the physicians' self-reported practice of antibiotic prescribing, knowledge, attitude, and practice of AMR and components of ASPs. RESULTS The majority (217; 67.2%) of respondents prescribed antibiotics daily in their clinical practice AMR was recognized as a global and local problem by 308 (95.4%) and 262 (81.1%) respondents, respectively. Only 91 (28.2%) of respondents have ever heard of antibiotic stewardship. The median AMR knowledge score was 40 (19-45)out of 45while that for ASP was 46.0(32-57) out of 60. There was significant statistical difference between the ASP median scores among the medical specialties category (P value <0.0001) More respondents had good knowledge of AMR than ASPs (82.7% versus 36.5%; p < 0.0001). CONCLUSION Respondents in this study were more knowledgeable about AMR than AMS and its core components.
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Affiliation(s)
- Adefunke O Babatola
- Department of Paediatrics, Ekiti State University, Ado-Ekiti, Nigeria.,Department of Paediatrics, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria
| | - Joseph O Fadare
- Department of Pharmacology and Therapeutics, Ekiti State University, Ado-Ekiti, Nigeria.,Department of Medicine, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria
| | - Oladele S Olatunya
- Department of Paediatrics, Ekiti State University, Ado-Ekiti, Nigeria.,Department of Paediatrics, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria
| | - Reginald Obiako
- Department of Clinical Pharmacology, Ahmadu Bello University, Zaria, Nigeria.,Department of Medicine, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
| | - Okezie Enwere
- Department of Medicine, Imo State University, Orlu, Nigeria
| | - Aubrey Kalungia
- Department of Pharmacy, University of Zambia, Lusaka, Zambia
| | - Temitope O Ojo
- Department of Community Medicine, Obafemi Awolowo University, Ile-Ife, Nigeria
| | | | - Olufemi Desalu
- Department of Medicine, University of Ilorin, Ilorin, Nigeria
| | - Brian Godman
- Department of Pharmacy, Faculty of Health Sciences, School of Health Care Sciences, Sefako Makgatho Health Sciences University, Pretoria, South Africa.,Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK.,Health Economics Centre, University of Liverpool Management School, Liverpool, UK.,Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital Huddinge, Stockholm, Sweden
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15
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Mantziari A, Salminen S, Szajewska H, Malagón-Rojas JN. Postbiotics against Pathogens Commonly Involved in Pediatric Infectious Diseases. Microorganisms 2020; 8:E1510. [PMID: 33008065 PMCID: PMC7601467 DOI: 10.3390/microorganisms8101510] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 09/22/2020] [Accepted: 09/29/2020] [Indexed: 02/08/2023] Open
Abstract
The Sustainable Development goals for 2020 included reducing all causes associated with infant and perinatal mortality in their priorities. The use of compounds with bioactive properties has been proposed as a therapeutic strategy due to their stimulating effect on the host's immune system. Additionally, biotherapeutic products such as postbiotics, tentatively defined as compounds produced during a fermentation process that support health and well-being, promote intestinal barrier integrity without posing considerable risks to children's health. Although this is a concept in development, there are increasing studies in the field of nutrition, chemistry, and health that aim to understand how postbiotics can help prevent different types of infections in priority populations such as minors under the age of five. The present review aims to describe the main mechanisms of action of postbiotics. In addition, it presents the available current evidence regarding the effects of postbiotics against pathogens commonly involved in pediatric infections. Postbiotics may constitute a safe alternative capable of modulating the cellular response and stimulating the host's humoral response.
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Affiliation(s)
- Anastasia Mantziari
- Functional Foods Forum, Faculty of Medicine, University of Turku, 20520 Turku, Finland;
| | - Seppo Salminen
- Functional Foods Forum, Faculty of Medicine, University of Turku, 20520 Turku, Finland;
| | - Hania Szajewska
- Department of Paediatrics at the Medical University of Warsaw, 02091 Warsaw, Poland;
| | - Jeadran Nevardo Malagón-Rojas
- Facultad de Medicina, Universidad El Bosque, 110121 Bogotá, Colombia;
- Instituto Nacional de Salud de Colombia, 111321 Bogotá, Colombia
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16
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Odoyo E, Kyanya C, Mutai W, Musila L. High levels of toxigenic Clostridioides difficile contamination of hospital environments: a hidden threat in hospital-acquired infections in Kenya. Access Microbiol 2020; 2:acmi000171. [PMID: 33490867 PMCID: PMC7818243 DOI: 10.1099/acmi.0.000171] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 09/10/2020] [Indexed: 01/05/2023] Open
Abstract
Introduction The contribution of Clostridioides difficile (formerly Clostridium difficile) to the burden of hospital-associated infections (HAIs) remains undetermined in many African countries. Aim This study aimed to identify a sensitive and readily adaptable C. difficile detection assay and to evaluate the C. difficile HAI risk in Kenya. Methodology Sterile swabs in neutralizing buffer were used to sample equipment or surfaces that patients and clinical staff touched frequently. These swabs were either plated directly on chromogenic agar or cultured in an enrichment broth before plating. The swab suspensions, enrichment broth and plate cultures were screened by quantitative PCR (qPCR) to determine the most efficient detection method. The HAI risk was evaluated by testing the C. difficile-positive samples by qPCR for the A, B and binary toxins. Results C. difficile was detected on 4/57 (7.0 %) equipment and surfaces by direct culture. The additional enrichment step increased the detection rate 10-fold to 43/57 (75.4 %). In total, 51/57 (89.5 %) environmental samples were positive for C. difficile detected through either culture or qPCR. The genes encoding the primary toxins, tcdA and tcdB, were detected on six surfaces, while the genes encoding the binary toxins, cdtA and cdtB, were detected on 2/57 (3.5 %) and 3/57 (5.3 %) surfaces, respectively. Different C. difficile toxin gene profiles were detected: the tcdA+/tcdB− gene profile on 4/10 (40 %) high-touch surfaces, tcdA−/tcdB+ on 3/10 (30 %) surfaces, tcdA+/tcdB+/cdtA+/cdtB+ on 2/10 (20 %) surfaces and tcdA−/tcdB+/cdtB+ on one high-touch surface. Conclusion The widespread contamination of hospital environments by toxigenic C. difficile gives a strong indication of the high risk of C. difficile infections (CDIs). The two-step culture process described can easily be adapted for monitoring hospital environment contamination by C. difficile.
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Affiliation(s)
- Erick Odoyo
- United States Army Medical Research Directorate - Africa, PO Box 606-00621, Nairobi, Kenya
| | - Cecilia Kyanya
- United States Army Medical Research Directorate - Africa, PO Box 606-00621, Nairobi, Kenya
| | - Winnie Mutai
- University of Nairobi, PO Box 30197-00200, Nairobi, Kenya
| | - Lillian Musila
- United States Army Medical Research Directorate - Africa, PO Box 606-00621, Nairobi, Kenya
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17
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Djuikoue IC, Tambo E, Tazemda G, Njajou O, Makoudjou D, Sokeng V, Wandji M, Tomi C, Nanfack A, Dayomo A, Lacmago S, Tassadjo F, Sipowo RT, Kakam C, Djoko AB, Assob CN, Andremont A, Barbut F. Evaluation of inpatients Clostridium difficile prevalence and risk factors in Cameroon. Infect Dis Poverty 2020; 9:122. [PMID: 32867842 PMCID: PMC7457802 DOI: 10.1186/s40249-020-00738-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 08/11/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Clostridium difficile, rarely found in hospitals, is a bacterium responsible for post-antibiotic diarrhea and Pseudomembranous Colitis (CPM). C. difficile selective pressure represents potential public health problem due to the production of toxins A and B serious pathologies effects/consequences. A transversal and analytic study was to assess the risk factors of C. difficile infection and to determine the prevalence of C. difficile in patients received in randomly selected five hospitals in Yaoundé, Cameroon. METHODS A total of 300 stool samples were collected from consented patients using a transversal and analytic study conducted from 10th July to 10th November 2018 in five hospitals in Cameroon. The detection or diagnostic kit was CerTest C. difficile Glutamate Dehydrogenase + Toxin A + Toxin B based on immuno-chromatographic assay. A univariate and multivariate analysis allowed us to highlight the associated factors. RESULTS The results showed a prevalence of C. difficile of 27.33% (82/300 stool patients'samples taken). Of these 27.33%, the production of Toxin A and Toxin B were 37.80 and 7.31% respectively. In univariate analysis, hospitalization was a significant (P = 0.01) risk factor favoring C. difficile infection. In multivariate analysis, corticosteroids and quinolones use/administration were significantly (adjusted Odd Ratio, aOR = 14.09, 95% CI: 1.62-122.54, P = 0.02 and aOR = 3.39, 95% CI: 1.00-11.34, P = 0.05 respectively) risk factor for this infection. CONCLUSION The prevalence of C. difficile infections (CDI) remain high in these settings and may be related not only to permanent steroids and antibiotics. Promoting education to both medical staff and patients on the prevalence and public health impact of C. difficile can be core inimproving rationale prescription of steroids and antibiotics to patients and promote human health and exponential growth in Cameroon.
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Affiliation(s)
- Ingrid Cécile Djuikoue
- Département de Microbiologie de la Faculté des Sciences de la Santé de l’Université des Montagnes, Bangangte, Cameroon
- Prevention and Control Foundation, Bangangte, Cameroon
| | - Ernest Tambo
- Département de Microbiologie de la Faculté des Sciences de la Santé de l’Université des Montagnes, Bangangte, Cameroon
- Prevention and Control Foundation, Bangangte, Cameroon
| | - Gildas Tazemda
- Département de Microbiologie de la Faculté des Sciences de la Santé de l’Université des Montagnes, Bangangte, Cameroon
| | - Omer Njajou
- Prevention and Control Foundation, Bangangte, Cameroon
| | - Denise Makoudjou
- Département de Microbiologie de la Faculté des Sciences de la Santé de l’Université des Montagnes, Bangangte, Cameroon
| | - Vanessa Sokeng
- Département de Microbiologie de la Faculté des Sciences de la Santé de l’Université des Montagnes, Bangangte, Cameroon
| | - Morelle Wandji
- Département de Microbiologie de la Faculté des Sciences de la Santé de l’Université des Montagnes, Bangangte, Cameroon
| | - Charlène Tomi
- Département de Microbiologie de la Faculté des Sciences de la Santé de l’Université des Montagnes, Bangangte, Cameroon
| | | | - Audrey Dayomo
- Département de Microbiologie de la Faculté des Sciences de la Santé de l’Université des Montagnes, Bangangte, Cameroon
| | - Suzie Lacmago
- Département de Microbiologie de la Faculté des Sciences de la Santé de l’Université des Montagnes, Bangangte, Cameroon
| | - Falubert Tassadjo
- Laboratoire de Bactériologie du Centre Pasteur du Cameroun, Yaounde, Cameroon
| | - Raissa Talla Sipowo
- Département de Microbiologie de la Faculté des Sciences de la Santé de l’Université des Montagnes, Bangangte, Cameroon
| | | | - Aicha Bibiane Djoko
- Département de Microbiologie de la Faculté des Sciences de la Santé de l’Université des Montagnes, Bangangte, Cameroon
| | | | - Antoine Andremont
- Faculty of Medicine, Xavier-Bichat Campus, University of Paris VII – Denis Diderot, Paris, France
| | - Frédéric Barbut
- Faculty of Pharmacy, Paris – University of Paris Descartes, Paris, France
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18
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Molecular epidemiology and antimicrobial resistance of Clostridioides difficile detected in chicken, soil and human samples from Zimbabwe. Int J Infect Dis 2020; 96:82-87. [DOI: 10.1016/j.ijid.2020.04.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 04/06/2020] [Accepted: 04/07/2020] [Indexed: 01/05/2023] Open
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Bitilinyu-Bangoh J, Voskuijl W, Thitiri J, Menting S, Verhaar N, Mwalekwa L, de Jong DB, van Loenen M, Mens PF, Berkley JA, Bandsma RHJ, Schallig HDFH. Performance of three rapid diagnostic tests for the detection of Cryptosporidium spp. and Giardia duodenalis in children with severe acute malnutrition and diarrhoea. Infect Dis Poverty 2019; 8:96. [PMID: 31775877 PMCID: PMC6882336 DOI: 10.1186/s40249-019-0609-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 11/14/2019] [Indexed: 02/01/2023] Open
Abstract
Background There is significant need for accurate diagnostic tools for Cryptosporidium spp. and Giardia duodenalis infections in resource limited countries where diarrhoeal disease caused by these parasites is often prevalent. The present study assessed the diagnostic performance of three commercially available rapid diagnostic tests (RDTs) based on faecal-antigen detection for Cryptosporidium spp. and/or G. duodenalis infections in stool samples of children admitted with severe acute malnutrition (SAM) and diarrhoea. An established multiplex PCR was used as reference test. Methods Stool samples from children with SAM and diarrhoea enrolled in a randomized controlled trial (registered at clinicaltrials.gov/ct2/show/NCT02246296) in Malawi (n = 175) and Kenya (n = 120) between December 2014 and December 2015 were analysed by a multiplex PCR for the presence of Cryptosporidium spp., G. duodenalis or Entamoeba histolytica parasite DNA. Cryptosporidium-positive samples were species typed using restriction fragment length polymorphism analysis. A sub-sample of the stool specimens (n = 236) was used for testing with three different RDTs. Diagnostic accuracy of the tests under evaluation was assessed using the results of PCR as reference standard using MedCalc software. Pearson Chi-square test and Fisher’s exact test were used to determine (significant) difference between the number of cryptosporidiosis or giardiasis cases found by PCR in Malawi and Kenya. The overall diagnostic accuracy of each RDT was calculated by plotting a receiver operating characteristic (ROC) curve for each test and to determine the area under the curve (AUC) using SPSS8 software. Results Prevalence of Cryptosporidium spp. by PCR was 20.0 and 21.7% in Malawi and Kenya respectively, mostly C. hominis. G. duodenalis prevalence was 23.4 and 5.8% in Malawi and Kenya respectively. E. histolytica was not detected by PCR. RDT testing followed the same pattern of prevalence. RDT sensitivities ranged for cryptosporidiosis from 42.9 to 76.9% and for G. duodenalis from 48.2 to 85.7%. RDT specificities ranged from 88.4 to 100% for Cryptosporidium spp. and from 91.2 to 99.2% for G. duodenalis infections. Based on the estimated area under the curve (AUC) values, all tests under evaluation had an acceptable overall diagnostic accuracy (> 0.7), with the exception of one RDT for Cryptosporidium spp. in Malawi. Conclusions All three RDTs for Cryptosporidium spp. and Giardia duodenalis evaluated in this study have a moderate sensitivity, but sufficient specificity. The main value of the RDTs is within their rapidness and their usefulness as screening assays in surveys for diarrhoea.
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Affiliation(s)
- Joseph Bitilinyu-Bangoh
- Academic Medical Centre, Department of Medical Microbiology, Parasitology Unit, Amsterdam University Medical Centres, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands.,Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Wieger Voskuijl
- College of Medicine, Department of Paediatrics and Child Health, University of Malawi, Blantyre, Malawi.,Global Child Health Group, Emma Children's Hospital, Amsterdam University Medical Centres, Amsterdam, The Netherlands.,The Childhood Acute Illness and Nutrition Network (CHAIN), Nairobi, Kenya
| | - Johnstone Thitiri
- The Childhood Acute Illness and Nutrition Network (CHAIN), Nairobi, Kenya.,KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
| | - Sandra Menting
- Academic Medical Centre, Department of Medical Microbiology, Parasitology Unit, Amsterdam University Medical Centres, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands
| | - Nienke Verhaar
- Academic Medical Centre, Department of Medical Microbiology, Parasitology Unit, Amsterdam University Medical Centres, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands
| | | | - Daisy B de Jong
- Academic Medical Centre, Department of Medical Microbiology, Parasitology Unit, Amsterdam University Medical Centres, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands
| | - Merlin van Loenen
- Academic Medical Centre, Department of Medical Microbiology, Parasitology Unit, Amsterdam University Medical Centres, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands
| | - Petra F Mens
- Academic Medical Centre, Department of Medical Microbiology, Parasitology Unit, Amsterdam University Medical Centres, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands
| | - James A Berkley
- The Childhood Acute Illness and Nutrition Network (CHAIN), Nairobi, Kenya.,KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
| | - Robert H J Bandsma
- The Childhood Acute Illness and Nutrition Network (CHAIN), Nairobi, Kenya.,Translational Medicine Program, Hospital for Sick Children, Toronto, Canada
| | - Henk D F H Schallig
- Academic Medical Centre, Department of Medical Microbiology, Parasitology Unit, Amsterdam University Medical Centres, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands.
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Darkoh C, Plants-Paris K, Bishoff D, DuPont HL. Clostridium difficile Modulates the Gut Microbiota by Inducing the Production of Indole, an Interkingdom Signaling and Antimicrobial Molecule. mSystems 2019; 4:e00346-18. [PMID: 30944877 PMCID: PMC6426650 DOI: 10.1128/msystems.00346-18] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 02/27/2019] [Indexed: 02/07/2023] Open
Abstract
Clostridium (Clostridioides) difficile infection (CDI) is associated with dysbiosis. C. difficile has a characteristic propensity to persist and recur 1 to 4 weeks after treatment, but the mechanism is unknown. We hypothesized that C. difficile may persist by manipulating the intestinal microenvironment, thereby hampering gut microbiota reconstitution following antibiotic-mediated dysbiosis. By screening stools from CDI patients for unique markers, a metabolite identified to be indole by mass spectrometry and Fourier transform infrared spectroscopy was identified. The average fecal indole concentration detected in CDI patients (n = 216; mean, 1,684.0 ± 84.4 µM) was significantly higher than in stools of patients with non-C. difficile diarrhea (n = 204; mean, 762.8 ± 53.8 µM). Certain intestinal bacteria, but not C. difficile, produce indole, a potent antimicrobial antioxidant. Remarkably, C. difficile induced other indole-producing gut microbes to produce increasing amounts of indole. Furthermore, a C. difficile accessory gene regulator 1 quorum sensing system mutant cannot induce indole, but complementation of the mutant strain with the wild-type gene restored its ability to induce indole production. Indole tolerance assays indicated that the amount of indole required to inhibit growth of most gut-protective bacteria was within the range detected in the CDI stools. We think that a high indole level limits the growth of beneficial indole-sensitive bacteria in the colon and alters colonization resistance and this might allow C. difficile to proliferate and persist. Together, these results reveal a unique mechanism of C. difficile persistence and provide insight into complex interactions and chemical warfare among the gut microbiota. IMPORTANCE Clostridium difficile infection is the leading cause of hospital-acquired and antibiotic-associated diarrhea worldwide. C. difficile flourishes in the colon after the diversity of the beneficial and protective gut microbiota have been altered by antibiotic therapy. C. difficile tends to persist, as does dysbiosis, encouraging recurrence a few days to weeks after treatment, and this further complicates treatment options. Here, we show that C. difficile might persist by manipulating the indigenous microbiota to produce indole, a bioactive molecule that inhibits the growth and reconstitution of the protective gut microbiota during infection. This discovery may explain a unique strategy C. difficile uses to control other bacteria in the colon and provide insight into the complex interactions and chemical warfare among the gut microbiota.
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Affiliation(s)
- Charles Darkoh
- University of Texas Health Science Center, School of Public Health, Department of Epidemiology, Human Genetics, and Environmental Sciences, Center For Infectious Diseases, Houston, Texas, USA
- Microbiology and Infectious Diseases Program, UTHealth Graduate School of Biomedical Sciences, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Kimberly Plants-Paris
- University of Texas Health Science Center, School of Public Health, Department of Epidemiology, Human Genetics, and Environmental Sciences, Center For Infectious Diseases, Houston, Texas, USA
| | - Dayna Bishoff
- University of Texas Health Science Center, School of Public Health, Department of Epidemiology, Human Genetics, and Environmental Sciences, Center For Infectious Diseases, Houston, Texas, USA
| | - Herbert L. DuPont
- University of Texas Health Science Center, School of Public Health, Department of Epidemiology, Human Genetics, and Environmental Sciences, Center For Infectious Diseases, Houston, Texas, USA
- Microbiology and Infectious Diseases Program, UTHealth Graduate School of Biomedical Sciences, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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