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Drapkina OM, Lazebnik LB, Bakulin IG, Zhuravleva MS, Bakulina NV, Skazyvaeva EV, Sitkin SI, Skalinskaya MI, Solovyeva OI, Eremina EY, Tikhonov SV, Fil' TS, Pilat TL, Kuznetsova YG, Khanferyan RA, Livzan MA, Osipenko MF, Abdulganieva DI, Tarasova LV, Khavkin AI. <i>Clostridioides difficile</i> infection: diagnosis, treatment, and prevention Clinical guidelines of the Russian Scientific Medical Society of Internal Medicine, the Gastroenterological Scientific Society of Russia, and the North- West Society of Gastroenterologists and Hepatologists. EXPERIMENTAL AND CLINICAL GASTROENTEROLOGY 2023:4-32. [DOI: 10.31146/1682-8658-ecg-210-2-4-32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
Clostridioides difficile infection (CDI) is the most common cause of antibiotic-associated diarrhea, and an important cause of nosocomial infection. Since the publication of the National Guidelines (2016, 2017), new data have been accumulated on the genetic structure and pathogenic properties of the most common causative agent of severe forms of antibiotic- associated diarrhea, which has led to the reclassifi cation of the pathogen, formerly known as Clostridium diffi cile, to Clostridioides difficile. Laboratory algorithms have been developed to diagnose CDI and determine the toxigenicity of strains reliably. New data on the effectiveness of antibacterials have been published, monoclonal antibodies to toxin B (bezlotoxumab) have been introduced into clinical practice to prevent CDI recurrence, and fecal microbiota transplantation has been proposed. Over the past 5 years, many international guidelines on the management of adult patients with CDI have also been updated (USA, EU). In the last decade, including due to the COVID-19 pandemic, there has been an increase in CDI incidence. Considering therelevance of CDI, new data on the pathogen, and domestic features, the Russian Scientific Medical Society of Internal Medicine, the Gastroenterological Scientific Society of Russia, and the North-West Society of Gastroenterologists and Hepatologists developed these clinical guidelines.
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Affiliation(s)
- O. M. Drapkina
- National Medical Research Center for Therapy and Preventive Medicine
| | - L. B. Lazebnik
- A. I. Yevdokimov Moscow State University of Medicine and Dentistry
| | - I. G. Bakulin
- North-Western state medical University named after I. I. Mechnikov
| | - M. S. Zhuravleva
- North-Western state medical University named after I. I. Mechnikov
| | - N. V. Bakulina
- North-Western state medical University named after I. I. Mechnikov
| | - E. V. Skazyvaeva
- North-Western state medical University named after I. I. Mechnikov
| | - S. I. Sitkin
- North-Western state medical University named after I. I. Mechnikov; Almazov National Medical Research Centre
| | | | - O. I. Solovyeva
- North-Western state medical University named after I. I. Mechnikov
| | | | - S. V. Tikhonov
- North-Western state medical University named after I. I. Mechnikov
| | - T. S. Fil'
- North-Western state medical University named after I. I. Mechnikov
| | - T. L. Pilat
- Izmerov Research Institute of Occupational Health
| | | | | | | | | | | | | | - A. I. Khavkin
- Veltischev Research and Clinical Institute for Pediatrics and Pediatric Surgery, Pirogov Russian National Research Medical University
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Boone AW, McCoy TP, Kennedy-Malone L, Wallace DC, Yasin R. Characteristics of Hospitalized Adults 55 and Older With Clostridioides difficile Infection. Gastroenterol Nurs 2023; 46:181-196. [PMID: 37097641 DOI: 10.1097/sga.0000000000000728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 12/12/2022] [Indexed: 04/26/2023] Open
Abstract
Clostridioides difficile infection in older adults can result in severe infection, difficulty in treating, and complicated disease process, yet few studies have examined the characteristics of hospitalized older adults and recurrent Clostridioides difficile infection. A retrospective cohort study was conducted to explore the characteristics of hospitalized adults 55 years and older with initial Clostridioides difficile infection and recurrences by extracting routinely documented data in the electronic health record. A sample of 1,199 admissions on 871 patients was included, with a recurrence rate of 23.9% ( n = 208). During the first admission, there were 79 deaths (9.1%). Clostridioides difficile infection recurrence was more prevalent in patients between 55 and 64 years old, and if discharged to a skilled nursing facility or with home health services. Chronic diseases significantly more prevalent in recurrent Clostridioides difficile infection included hypertension, heart failure, and chronic kidney disease. On initial admission, no laboratory abnormalities were significantly associated with recurrent Clostridioides difficile infection. This study indicates the need for utilizing routinely captured electronic health record data during acute hospitalizations to aid in targeting care to reduce morbidity, mortality, and recurrence.
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Affiliation(s)
- Anna W Boone
- Anna W. Boone, PhD, ANP-BC, is Adult Nurse Practitioner, Rockingham Gastroenterology Associates, Cone Health, Reidsville, North Carolina
- Thomas P. McCoy, PhD, PStat, is Statistician, Clinical Professor, University of North Carolina at Greensboro School of Nursing, Greensboro, North Carolina
- Laurie Kennedy-Malone, PhD, GNP-BC, FAANP, FGSA, FAGHE, is Professor of Nursing, University of North Carolina at Greensboro School of Nursing, Greensboro, North Carolina
- Debra C. Wallace, PhD, RN, FAAN, is Professor, University of North Carolina at Greensboro School of Nursing, Greensboro, North Carolina
- Reham Yasin, MSN, RN, is PhD Student, University of North Carolina at Greensboro School of Nursing, Greensboro, North Carolina. 233 Gilmer Street, Reidsville, NC, 27320. The Winsome Laurel Address is my personal home address and would rather not be published
| | - Thomas P McCoy
- Anna W. Boone, PhD, ANP-BC, is Adult Nurse Practitioner, Rockingham Gastroenterology Associates, Cone Health, Reidsville, North Carolina
- Thomas P. McCoy, PhD, PStat, is Statistician, Clinical Professor, University of North Carolina at Greensboro School of Nursing, Greensboro, North Carolina
- Laurie Kennedy-Malone, PhD, GNP-BC, FAANP, FGSA, FAGHE, is Professor of Nursing, University of North Carolina at Greensboro School of Nursing, Greensboro, North Carolina
- Debra C. Wallace, PhD, RN, FAAN, is Professor, University of North Carolina at Greensboro School of Nursing, Greensboro, North Carolina
- Reham Yasin, MSN, RN, is PhD Student, University of North Carolina at Greensboro School of Nursing, Greensboro, North Carolina. 233 Gilmer Street, Reidsville, NC, 27320. The Winsome Laurel Address is my personal home address and would rather not be published
| | - Laurie Kennedy-Malone
- Anna W. Boone, PhD, ANP-BC, is Adult Nurse Practitioner, Rockingham Gastroenterology Associates, Cone Health, Reidsville, North Carolina
- Thomas P. McCoy, PhD, PStat, is Statistician, Clinical Professor, University of North Carolina at Greensboro School of Nursing, Greensboro, North Carolina
- Laurie Kennedy-Malone, PhD, GNP-BC, FAANP, FGSA, FAGHE, is Professor of Nursing, University of North Carolina at Greensboro School of Nursing, Greensboro, North Carolina
- Debra C. Wallace, PhD, RN, FAAN, is Professor, University of North Carolina at Greensboro School of Nursing, Greensboro, North Carolina
- Reham Yasin, MSN, RN, is PhD Student, University of North Carolina at Greensboro School of Nursing, Greensboro, North Carolina. 233 Gilmer Street, Reidsville, NC, 27320. The Winsome Laurel Address is my personal home address and would rather not be published
| | - Debra C Wallace
- Anna W. Boone, PhD, ANP-BC, is Adult Nurse Practitioner, Rockingham Gastroenterology Associates, Cone Health, Reidsville, North Carolina
- Thomas P. McCoy, PhD, PStat, is Statistician, Clinical Professor, University of North Carolina at Greensboro School of Nursing, Greensboro, North Carolina
- Laurie Kennedy-Malone, PhD, GNP-BC, FAANP, FGSA, FAGHE, is Professor of Nursing, University of North Carolina at Greensboro School of Nursing, Greensboro, North Carolina
- Debra C. Wallace, PhD, RN, FAAN, is Professor, University of North Carolina at Greensboro School of Nursing, Greensboro, North Carolina
- Reham Yasin, MSN, RN, is PhD Student, University of North Carolina at Greensboro School of Nursing, Greensboro, North Carolina. 233 Gilmer Street, Reidsville, NC, 27320. The Winsome Laurel Address is my personal home address and would rather not be published
| | - Reham Yasin
- Anna W. Boone, PhD, ANP-BC, is Adult Nurse Practitioner, Rockingham Gastroenterology Associates, Cone Health, Reidsville, North Carolina
- Thomas P. McCoy, PhD, PStat, is Statistician, Clinical Professor, University of North Carolina at Greensboro School of Nursing, Greensboro, North Carolina
- Laurie Kennedy-Malone, PhD, GNP-BC, FAANP, FGSA, FAGHE, is Professor of Nursing, University of North Carolina at Greensboro School of Nursing, Greensboro, North Carolina
- Debra C. Wallace, PhD, RN, FAAN, is Professor, University of North Carolina at Greensboro School of Nursing, Greensboro, North Carolina
- Reham Yasin, MSN, RN, is PhD Student, University of North Carolina at Greensboro School of Nursing, Greensboro, North Carolina. 233 Gilmer Street, Reidsville, NC, 27320. The Winsome Laurel Address is my personal home address and would rather not be published
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Varga A, Kocsis B, Sipos D, Kása P, Vigvári S, Pál S, Dembrovszky F, Farkas K, Péterfi Z. How to Apply FMT More Effectively, Conveniently and Flexible - A Comparison of FMT Methods. Front Cell Infect Microbiol 2021; 11:657320. [PMID: 34150673 PMCID: PMC8213398 DOI: 10.3389/fcimb.2021.657320] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 05/18/2021] [Indexed: 01/02/2023] Open
Abstract
Purpose Metronidazol and vancomycin were long the two best options against Clostridioides (formerly Clostridium) difficile infections (CDI). Now, the cost of new drugs such as fidaxomicin directs us towards alternative treatment options, such as faecal microbiota transplant (FMT). Its effectiveness is similar to fidaxomicin. There are questions regarding its safety, but the biggest challenges are prejudice and inconvenience. Most protocols refer to FMT applied in the form of a solution. We investigated different modalities of FMT. Methods Instead of using nasoenteric tubes or colonoscopy, we place frozen or lyophilised stool in non-coated, size “00”, hard gelatine capsules or enterosolvent, size “0” capsules. Results We found that non-coated, size “00”, hard gelatine capsules are appropriate for conducting FMT. Capsules containing lyophilised supernatant with a low number of bacteria have been proven to be non-inferior to other FMT modalities. The primary cure rate in the supernatant group was 93.75%, and 66.67% in the sediment group. The overall cure rate was 82.14%. Depending on the protocol, 4–7 capsules are sufficient per patient. Capsules can be stored for up to one year at -20°C. Conclusions FMT is a feasible alternative to antibiotic treatments in CDI. Our method makes the process flexible and less inconvenient to patients. Long storage time allows a consistent supply of capsules, while small volume and formulation make the procedure tolerable.
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Affiliation(s)
- Adorján Varga
- Department of Medical Microbiology and Immunology, University of Pécs Clinical Centre, Pécs, Hungary
| | - Béla Kocsis
- Department of Medical Microbiology and Immunology, University of Pécs Clinical Centre, Pécs, Hungary
| | - Dávid Sipos
- 1stDepartment of Internal Medicine - Department of Infectology, University of Pécs Clinical Centre, Pécs, Hungary
| | - Péter Kása
- Institute of Pharmaceutical Technology and Biopharmacy, University of Pécs Faculty of Pharmacy, Pécs, Hungary
| | - Szabolcs Vigvári
- 1stDepartment of Internal Medicine - Department of Infectology, University of Pécs Clinical Centre, Pécs, Hungary
| | - Szilárd Pál
- Institute of Pharmaceutical Technology and Biopharmacy, University of Pécs Faculty of Pharmacy, Pécs, Hungary
| | - Fanni Dembrovszky
- Institute for Translational Medicine, University of Pécs Medical School, Pécs, Hungary
| | - Kornélia Farkas
- Institute of Bioanalysis, University of Pécs Medical School, Pécs, Hungary
| | - Zoltán Péterfi
- 1stDepartment of Internal Medicine - Department of Infectology, University of Pécs Clinical Centre, Pécs, Hungary
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Ma KGL, Lertpiriyapong K, Piersigilli A, Dobtsis I, Wipf JRK, Littmann ER, Leiner I, Pamer EG, Ricart Arbona RJ, Lipman NS. Outbreaks of Typhlocolitis Caused by Hypervirulent Group ST1 Clostridioides difficile in Highly Immunocompromised Strains of Mice. Comp Med 2020; 70:277-290. [PMID: 32404234 PMCID: PMC7287380 DOI: 10.30802/aalas-cm-19-000109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 12/15/2019] [Accepted: 01/13/2020] [Indexed: 12/17/2022]
Abstract
Clostridioides difficile is an enteric pathogen that can cause significant clinical disease in both humans and animals. However, clinical disease arises most commonly after treatment with broad-spectrum antibiotics. The organism's ability to cause naturally occurring disease in mice is rare, and little is known about its clinical significance in highly immunocompromised mice. We report on 2 outbreaks of diarrhea associated with C. difficile in mice. In outbreak 1, 182 of approximately 2, 400 NOD.Cg-Prkdcscid Il2rgtm1Wjl/SzJ (NSG) and related strains of mice became clinically ill after cessation of a 14-d course of 0.12% amoxicillin feed to control an increase in clinical signs associated with Corynebacterium bovis infection. Most mice had been engrafted with human tumors; the remainder were experimentally naïve. Affected animals exhibited 1 of 3 clinical syndromes: 1) peracute death; 2) severe diarrhea leading to euthanasia or death; or 3) mild to moderate diarrhea followed by recovery. A given cage could contain both affected and unaffected mice. Outbreak 2 involved a small breeding colony (approximately 50 mice) of NOD. CB17-Prkdcscid/NCrCrl (NOD-scid) mice that had not received antibiotics or experimental manipulations. In both outbreaks, C. difficile was isolated, and toxins A and B were detected in intestinal content or feces. Histopathologic lesions highly suggestive of C. difficile enterotoxemia included fibrinonecrotizing and neutrophilic typhlocolitis with characteristic 'volcano' erosions or pseudomembrane formation. Genomic analysis of 4 isolates (3 from outbreak 1 and 1 from outbreak 2) revealed that these isolates were closely related to a pathogenic human isolate, CD 196. To our knowledge, this report is the first to describe naturally occurring outbreaks of C. difficile-associated typhlocolitis with significant morbidity and mortality in highly immunocompromised strains of mice.
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Affiliation(s)
- Kathleen G L Ma
- Tri-Institutional Training Program in Laboratory Animal Medicine and Science, Memorial Sloan-Kettering Cancer Center, Weill Cornell Medicine, and The Rockefeller University, New York, New York
| | - Kvin Lertpiriyapong
- Tri-Institutional Training Program in Laboratory Animal Medicine and Science, Memorial Sloan-Kettering Cancer Center, Weill Cornell Medicine, and The Rockefeller University, New York, New York; Center for Comparative Medicine and Pathology, Memorial Sloan-Kettering Cancer Center and Weill Cornell Medicine, New York, New York
| | - Alessandra Piersigilli
- Tri-Institutional Training Program in Laboratory Animal Medicine and Science, Memorial Sloan-Kettering Cancer Center, Weill Cornell Medicine, and The Rockefeller University, New York, New York; Center for Comparative Medicine and Pathology, Memorial Sloan-Kettering Cancer Center and Weill Cornell Medicine, New York, New York; Laboratory for Comparative Pathology, Memorial Sloan-Kettering Cancer Center, Weill Cornell Medical College, and The Rockefeller University, New York, New York
| | - Irina Dobtsis
- Laboratory for Comparative Pathology, Memorial Sloan-Kettering Cancer Center, Weill Cornell Medical College, and The Rockefeller University, New York, New York
| | - Juliette R K Wipf
- Tri-Institutional Training Program in Laboratory Animal Medicine and Science, Memorial Sloan-Kettering Cancer Center, Weill Cornell Medicine, and The Rockefeller University, New York, New York; Center for Comparative Medicine and Pathology, Memorial Sloan-Kettering Cancer Center and Weill Cornell Medicine, New York, New York; Laboratory for Comparative Pathology, Memorial Sloan-Kettering Cancer Center, Weill Cornell Medical College, and The Rockefeller University, New York, New York
| | - Eric R Littmann
- Infectious Diseases Service, Department of Medicine, Immunology Program, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Ingrid Leiner
- Infectious Diseases Service, Department of Medicine, Immunology Program, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Eric G Pamer
- Infectious Diseases Service, Department of Medicine, Immunology Program, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Rodolfo J Ricart Arbona
- Tri-Institutional Training Program in Laboratory Animal Medicine and Science, Memorial Sloan-Kettering Cancer Center, Weill Cornell Medicine, and The Rockefeller University, New York, New York; Center for Comparative Medicine and Pathology, Memorial Sloan-Kettering Cancer Center and Weill Cornell Medicine, New York, New York
| | - Neil S Lipman
- Tri-Institutional Training Program in Laboratory Animal Medicine and Science, Memorial Sloan-Kettering Cancer Center, Weill Cornell Medicine, and The Rockefeller University, New York, New York; Center for Comparative Medicine and Pathology, Memorial Sloan-Kettering Cancer Center and Weill Cornell Medicine, New York, New York;,
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