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Di Bella S, Sanson G, Monticelli J, Zerbato V, Principe L, Giuffrè M, Pipitone G, Luzzati R. Clostridioides difficile infection: history, epidemiology, risk factors, prevention, clinical manifestations, treatment, and future options. Clin Microbiol Rev 2024; 37:e0013523. [PMID: 38421181 PMCID: PMC11324037 DOI: 10.1128/cmr.00135-23] [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] [Indexed: 03/02/2024] Open
Abstract
SUMMARYClostridioides difficile infection (CDI) is one of the major issues in nosocomial infections. This bacterium is constantly evolving and poses complex challenges for clinicians, often encountered in real-life scenarios. In the face of CDI, we are increasingly equipped with new therapeutic strategies, such as monoclonal antibodies and live biotherapeutic products, which need to be thoroughly understood to fully harness their benefits. Moreover, interesting options are currently under study for the future, including bacteriophages, vaccines, and antibiotic inhibitors. Surveillance and prevention strategies continue to play a pivotal role in limiting the spread of the infection. In this review, we aim to provide the reader with a comprehensive overview of epidemiological aspects, predisposing factors, clinical manifestations, diagnostic tools, and current and future prophylactic and therapeutic options for C. difficile infection.
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Affiliation(s)
- Stefano Di Bella
- Clinical Department of
Medical, Surgical and Health Sciences, Trieste
University, Trieste,
Italy
| | - Gianfranco Sanson
- Clinical Department of
Medical, Surgical and Health Sciences, Trieste
University, Trieste,
Italy
| | - Jacopo Monticelli
- Infectious Diseases
Unit, Trieste University Hospital
(ASUGI), Trieste,
Italy
| | - Verena Zerbato
- Infectious Diseases
Unit, Trieste University Hospital
(ASUGI), Trieste,
Italy
| | - Luigi Principe
- Microbiology and
Virology Unit, Great Metropolitan Hospital
“Bianchi-Melacrino-Morelli”,
Reggio Calabria, Italy
| | - Mauro Giuffrè
- Clinical Department of
Medical, Surgical and Health Sciences, Trieste
University, Trieste,
Italy
- Department of Internal
Medicine (Digestive Diseases), Yale School of Medicine, Yale
University, New Haven,
Connecticut, USA
| | - Giuseppe Pipitone
- Infectious Diseases
Unit, ARNAS Civico-Di Cristina
Hospital, Palermo,
Italy
| | - Roberto Luzzati
- Clinical Department of
Medical, Surgical and Health Sciences, Trieste
University, Trieste,
Italy
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Chien MM, Chang MH, Chang KC, Ni YH, Wu JF. The incidence of Clostridium difficile infection in children with and without inflammatory bowel diseases: A single-center study in Taiwan from 2006 to 2019. J Formos Med Assoc 2024:S0929-6646(24)00206-7. [PMID: 38631957 DOI: 10.1016/j.jfma.2024.04.006] [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: 08/06/2023] [Revised: 03/18/2024] [Accepted: 04/07/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND The incidence of Clostridium difficile infection (CDI) is increasing around the world, and patients with inflammatory bowel disease (IBD) have a higher risk of obtaining CDI. The data on the incidence rate of CDI in the Asian pediatric IBD population was lacking. METHODS We retrospectively collected data from a tertiary medical center in Taipei, Taiwan. All patients aged 1-18 years old who visited the outpatient department or were admitted to our hospital between 2006 and 2019 were included. CDI was defined as positive stool C. difficile toxin or C. difficile culture results with appropriate antibiotic use within the range of 7 days prior or 14 days after the result. RESULTS We compared the average annual incidence of CDI before and after 2013. The average incidence of community-acquired CDI (CA-CDI) increased from 0.063 to 0.564 cases per 1,000 visits, with a rate ratio (RR) of 8.82 (95% CI 5.74-14.38). In patients with IBD, the rate increased from 26.738 to 278.873 cases per 1,000 visits (RR=10.12, 95% CI: 4.57-29.02). The average incidence rate increased from 0.685 to 1.874 cases per 1,000 admissions in pediatric general patients (RR = 2.72, 95% CI 1.82-4.20) and from 14.706 to 62.500 cases per 1,000 admissions in pediatric IBD patients (RR = 3.77, 95% CI 0.71-93.53). CONCLUSIONS Both CA-CDI and healthcare facility-onset CDI (HO-CDI) were increasing substantially in the pediatric population over the past decade in Taiwan. Compared to the general pediatric population, pediatric IBD patients had a much higher incidence of CDI.
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Affiliation(s)
- Mu-Ming Chien
- Department of Pediatrics, Taipei Medical University Hospital, Taipei City, Taiwan; Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei City, Taiwan; Taipei Medical University Research Center for Digestive Medicine, Taipei Medical University, Taipei City, Taiwan; Department of Pediatrics, National Taiwan University Hospital, Taipei City, Taiwan
| | - Mei-Hwei Chang
- Department of Pediatrics, National Taiwan University Hospital, Taipei City, Taiwan; College of Medicine, National Taiwan University Hospital, Taipei City, Taiwan
| | - Kai-Chi Chang
- Department of Pediatrics, National Taiwan University Hospital, Taipei City, Taiwan
| | - Yen-Hsuan Ni
- Department of Pediatrics, National Taiwan University Hospital, Taipei City, Taiwan; College of Medicine, National Taiwan University Hospital, Taipei City, Taiwan
| | - Jia-Feng Wu
- Department of Pediatrics, National Taiwan University Hospital, Taipei City, Taiwan; College of Medicine, National Taiwan University Hospital, Taipei City, Taiwan.
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Lo Vecchio A, Quitadamo P, Poeta M, Buccigrossi V, Siani P, Cioffi V, Ercolini D, Guarino A. Aetiology, risk factors and microbiota composition in children with prolonged diarrhoea: A prospective case-controlled cohort study. Acta Paediatr 2024; 113:598-605. [PMID: 38129967 DOI: 10.1111/apa.17073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 11/15/2023] [Accepted: 12/12/2023] [Indexed: 12/23/2023]
Abstract
AIM Prolonged diarrhoea (ProD) refers to acute-onset diarrhoea that persists for longer than 1 week. As the aetiology, risk factors and management are poorly defined, we prospectively enrolled children hospitalised in a high-income setting to assess these outcomes and investigate the potential role of gut microbiota. METHODS All children aged 30 days to 14 years admitted for acute-onset diarrhoea lasting 7-14 days were included. Children consecutively admitted in the same period for acute diarrhoea (AD) served as controls. High-throughput sequencing of 16S rRNA gene amplicons was used to analyse stool samples from a subset of patients and healthy controls. RESULTS Sixty-eight with ProD and 104 with AD were enrolled. Intestinal infections were the main aetiology of diarrhoea in both groups (ProD 92.9% vs. AD 97.8%). ProD children showed a higher prevalence of bacterial infections compared to AD (30.8% vs. 8.9%, p = 0.024). Neither age, host-related factors, nor microbiome alterations were specifically linked to ProD. However, ProD children had a more severe initial clinical presentation than AD. CONCLUSION ProD is often the result of an unusually severe intestinal infection that runs a course longer than expected but generally resolves without further problems. No specific management or therapies should be undertaken in most cases.
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Affiliation(s)
- Andrea Lo Vecchio
- Department of Translational Medical Science-Section of Pediatrics, University of Naples Federico II, Naples, Italy
| | - Paolo Quitadamo
- Pediatric Gastroenterology and Hepatology Unit, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Marco Poeta
- Department of Translational Medical Science-Section of Pediatrics, University of Naples Federico II, Naples, Italy
| | - Vittoria Buccigrossi
- Department of Translational Medical Science-Section of Pediatrics, University of Naples Federico II, Naples, Italy
| | - Paolo Siani
- Department of Pediatrics, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Valentina Cioffi
- Department of Translational Medical Science-Section of Pediatrics, University of Naples Federico II, Naples, Italy
| | - Danilo Ercolini
- Department of Agricultural Sciences, University of Naples Federico II, Portici, Italy
| | - Alfredo Guarino
- Department of Translational Medical Science-Section of Pediatrics, University of Naples Federico II, Naples, Italy
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Cotter JM, Stokes CL, Tong S, Birkholz M, Child J, Cost C, Coughlin R, Cox S, Dolan SA, Dorris K, Hazleton KZ, Lugo V, Norcross M, Pearce K, Dominguez SR. A Multimodal Intervention to Reduce C. difficile Infections and Stool Testing. Pediatrics 2024; 153:e2023061981. [PMID: 38352983 PMCID: PMC11360068 DOI: 10.1542/peds.2023-061981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/13/2023] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND AND OBJECTIVES The introduction of multiplex gastrointestinal panels at our institution resulted in increased Clostridioides difficile (C. difficile) detection and stool test utilization. We aimed to reduce hospital-onset C. difficile infections (HO-CDIs), C. difficile detection, and overall stool testing by 20% within 1 year. METHODS We conducted a quality improvement project from 2018 to 2020 at a large children's hospital. Interventions included development of a C. difficile testing and treatment clinical care pathway, new options for gastrointestinal panel testing with or without C. difficile (results were suppressed if not ordered), clinical decision support tool to restrict testing, and targeted prevention efforts. Outcomes included the rate of HO-CDI (primary), C. difficile detection, and overall stool testing. All measures were evaluated monthly among hospitalized children per 10 000 patient-days (PDs) using statistical process-control charts. For balancing measures, we tracked suppressed C. difficile results that were released during real-time monitoring because of concern for true infection and C. difficile-related adverse events. RESULTS HO-CDI decreased by 55%, from 11 to 5 per 10 000 PDs. C. difficile detection decreased by 44%, from 18 to 10 per 10 000 PDs, and overall test utilization decreased by 29%, from 99 to 70 per 10 000 PDs. The decrease in stool tests resulted in annual savings of $55 649. Only 2.3% of initially suppressed positive C. difficile results were released, and no patients had adverse events. CONCLUSIONS Diagnostic stewardship strategies, coupled with an evidence-based clinical care pathway, can be used to decrease C. difficile and improve overall test utilization.
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Affiliation(s)
- Jillian M Cotter
- Department of Pediatrics, University of Colorado, Aurora, Colorado
- Children's Hospital Colorado, Aurora, Colorado
| | - Claire L Stokes
- Department of Pediatrics, University of Colorado, Aurora, Colorado
- Children's Hospital Colorado, Aurora, Colorado
| | - Suhong Tong
- Department of Pediatrics, University of Colorado, Aurora, Colorado
| | - Meghan Birkholz
- Department of Pediatrics, University of Colorado, Aurora, Colorado
- Children's Hospital Colorado, Aurora, Colorado
| | - Jason Child
- Children's Hospital Colorado, Aurora, Colorado
| | - Carrye Cost
- Department of Pediatrics, University of Colorado, Aurora, Colorado
- Children's Hospital Colorado, Aurora, Colorado
| | | | - Stephanie Cox
- Department of Pediatrics, University of Colorado, Aurora, Colorado
- Children's Hospital Colorado, Aurora, Colorado
| | | | - Kathleen Dorris
- Department of Pediatrics, University of Colorado, Aurora, Colorado
- Children's Hospital Colorado, Aurora, Colorado
| | - Keith Z Hazleton
- Department of Pediatrics, University of Colorado, Aurora, Colorado
- Children's Hospital Colorado, Aurora, Colorado
| | | | | | | | - Samuel R Dominguez
- Department of Pediatrics, University of Colorado, Aurora, Colorado
- Children's Hospital Colorado, Aurora, Colorado
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Dop D, Marcu IR, Padureanu V, Caragea DC, Padureanu R, Niculescu SA, Niculescu CE. Clostridium difficile infection in pediatric patients (Review). Biomed Rep 2024; 20:18. [PMID: 38169799 PMCID: PMC10758920 DOI: 10.3892/br.2023.1706] [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: 07/25/2023] [Accepted: 11/27/2023] [Indexed: 01/05/2024] Open
Abstract
Clostridium difficile (C. difficile) infection (CDI) is the most common cause of healthcare-associated diarrhea and among adults, the worldwide incidence rate of the infection is increasing. There is a small amount of data in the literature for pediatric patients, but most indicate an increasing trend. C. difficile is a constituent of the normal microbiota; however, under specific conditions that cause a disruption of the normal bacterial flora, colonization of C. difficile and the released toxins that cause inflammation and mucosal damage occurs. Risk factors for CDI at any age include hospitalization, exposure to antibiotics, administration of proton pump inhibitors, invasive mechanical ventilation, immunosuppression and presence of associated comorbidities. Clinical manifestations range from asymptomatic colonization to fulminant disease characterized by toxic megacolon, intestinal perforation and, rarely, death. The aim of the present review was to outline the features of CDI in pediatric patients.
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Affiliation(s)
- Dalia Dop
- Department of Pediatrics, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Iulia Rahela Marcu
- Department of Physical and Rehabilitation Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Vlad Padureanu
- Department of Internal Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Daniel Cosmin Caragea
- Department of Nephrology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Rodica Padureanu
- Department of Internal Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Stefan-Adrian Niculescu
- Department of Orthopedics, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Carmen Elena Niculescu
- Department of Pediatrics, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
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Ma T, Bu S, Nzerem AC, Paneth N, Kerver JM, Cavalieri CN, Comstock SS. Association of the Infant Gut Microbiome with Temperament at Nine Months of Age: A Michigan Cohort Study. Microorganisms 2024; 12:214. [PMID: 38276199 PMCID: PMC10821406 DOI: 10.3390/microorganisms12010214] [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: 12/20/2023] [Revised: 01/12/2024] [Accepted: 01/12/2024] [Indexed: 01/27/2024] Open
Abstract
Though studies in animals and humans link the gut microbiota to brain development and control of behavior, little research has examined this connection in healthy infants. This prospective study could determine associations between infant gut microbiota at 3 months, and infant temperament at 9 months, in a prospective pregnancy cohort (Michigan Archive for Research on Child Health; n = 159). Microbiota profiling with 16S rRNA gene sequencing was conducted on fecal samples obtained at 3 months of age. Based on the relative abundance of gut microbiotas, three groups were identified, and each group was characterized by different microbes. Infant temperament outcomes were reported by mothers using the Infant Behavior Questionnaire-Revised Very Short Form at a mean age of 9.4 months. Fully adjusted multivariate linear regression models showed that certain clusters were associated with higher negative emotionality scores, prominently among infants who had poor vitamin D intake. However, no associations were evident between gut microbiota clusters and temperament scales after FDR correction. After using three differential abundance tools, Firmicutes was associated with higher positive affect/surgency scores, whereas Clostridioides was associated with lower scores. An association between the gut microbiota and early infancy temperament was observed; thus, this study warrants replication, with a particular focus on vitamin D moderation.
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Affiliation(s)
- Tengfei Ma
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, MI 48824, USA (N.P.)
- Department of Public Health Sciences, Henry Ford Health, Detroit, MI 48202, USA
| | - Sihan Bu
- Department of Food Science and Human Nutrition, Michigan State University, East Lansing, MI 48824, USA
| | - Adannaya C. Nzerem
- Department of Food Science and Human Nutrition, Michigan State University, East Lansing, MI 48824, USA
| | - Nigel Paneth
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, MI 48824, USA (N.P.)
- Department of Pediatrics and Human Development, College of Human Medicine, Michigan State University, East Lansing, MI 48824, USA
| | - Jean M. Kerver
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, MI 48824, USA (N.P.)
- Department of Pediatrics and Human Development, College of Human Medicine, Michigan State University, East Lansing, MI 48824, USA
| | - Cybil Nicole Cavalieri
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, MI 48824, USA (N.P.)
| | - Sarah S. Comstock
- Department of Food Science and Human Nutrition, Michigan State University, East Lansing, MI 48824, USA
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van Prehn J, Crobach MJT, Baktash A, Duszenko N, Kuijper EJ. Diagnostic Guidance for C. difficile Infections. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2024; 1435:33-56. [PMID: 38175470 DOI: 10.1007/978-3-031-42108-2_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
Diagnosis of Clostridioides difficile infection (CDI) can be challenging. First of all, there has been debate on which of the two reference assays, cell cytotoxicity neutralization assay (CCNA) or toxigenic culture (TC), should be considered the gold standard for CDI detection. Although the CCNA suffers most from suboptimal storage conditions and subsequent toxin degradation, TC is reported to falsely increase CDI detection rates as it cannot differentiate CDI patients from patients asymptomatically colonised by toxigenic C. difficile. Several rapid assays are available for CDI detection and fall into three broad categories: (1) enzyme immunoassays for glutamate dehydrogenase, (2) enzyme immunoassays or single-molecule array assays for toxins A/B and (3) nucleic acid amplification tests detecting toxin genes. All three categories have their own limitations, being suboptimal specificity and/or sensitivity or the inability to discern colonised patients from CDI patients. In light of these limitations, multi-step algorithmic testing has been advocated by international guidelines (IDSA/SHEA and ESCMID) in order to optimize diagnostic accuracy. As a result, a survey performed in 2018-2019 in Europe revealed that most of all hospital sites reported using more than one test to diagnose CDI. CDI incidence rates are also influenced by sample selection criteria, as several studies have shown that if not all unformed stool samples are tested for CDI, many cases may be missed due to an absence of clinical suspicion. Since methods for diagnosing CDI remain imperfect, there has been a growing interest in alternative testing strategies like faecal microbiota biomarkers, immune modulating interleukins, cytokines and imaging methods. At the moment, these alternative methods might play an adjunctive role, but they are not suitable to replace conventional CDI testing strategies.
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Affiliation(s)
- Joffrey van Prehn
- Department of Medical Microbiology, Leiden University Centre for Infectious Diseases (LU-CID), Leiden University Medical Centre, Leiden, The Netherlands.
- ESCMID Study Group for C. difficile (ESGCD) and Study Group for Host and Microbiota Interaction (ESGHAMI), Basel, Switzerland.
| | - Monique J T Crobach
- Department of Medical Microbiology, Leiden University Centre for Infectious Diseases (LU-CID), Leiden University Medical Centre, Leiden, The Netherlands
| | - Amoe Baktash
- Department of Medical Microbiology, Leiden University Centre for Infectious Diseases (LU-CID), Leiden University Medical Centre, Leiden, The Netherlands
| | - Nikolas Duszenko
- Department of Medical Microbiology, Leiden University Centre for Infectious Diseases (LU-CID), Leiden University Medical Centre, Leiden, The Netherlands
| | - Ed J Kuijper
- Department of Medical Microbiology, Leiden University Centre for Infectious Diseases (LU-CID), Leiden University Medical Centre, Leiden, The Netherlands
- ESCMID Study Group for C. difficile (ESGCD) and Study Group for Host and Microbiota Interaction (ESGHAMI), Basel, Switzerland
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Levy EI, Dinleyici M, Dinleyici E, Vandenplas Y. Clostridioides difficile Infections: Prevention and Treatment Strategies. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2024; 1449:175-186. [PMID: 39060738 DOI: 10.1007/978-3-031-58572-2_11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/28/2024]
Abstract
Clostridioides difficile is the most common causative agent of antibiotic-associated diarrhea. This spore forming, obligate anaerobic, gram-positive bacillus is becoming responsible for an increasing number of infections worldwide, both in community and in hospital settings, whose severity can vary widely from an asymptomatic infection to a lethal disease. While discontinuation of antimicrobial agents and antibiotic treatment of the infection remain the cornerstone of therapy, more recent fecal microbiota transplantation has also been valid as a therapy. The use of probiotics, especially Saccharomyces boulardii CNCM I-745 have become valid forms of prevention therapy. Although there are studies in adults with microbiota-targeted new generation therapies and Clostridium difficile vaccines, there are no data in the paediatric age group yet.
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Affiliation(s)
- Elvira Ingrid Levy
- Department of Pediatrics, C.H.U. Saint-Pieter, Free University of Brussels, Brussels, Belgium
| | - Meltem Dinleyici
- Eskisehir Osmangazi University Faculty of Medicine, Department of Social Pediatrics, Eskisehir, Turkey
| | - Ener Dinleyici
- Department of Pediatrics, Eskisehir Osmangazi University School of Medicine, Eskisehir, Turkey
| | - Yvan Vandenplas
- Vrije Universiteit Brussel (VUB), UZ Brussel, KidZ Health Castle, Brussels, Belgium.
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DuPont HL, Salge MMH. The Importance of a Healthy Microbiome in Pregnancy and Infancy and Microbiota Treatment to Reverse Dysbiosis for Improved Health. Antibiotics (Basel) 2023; 12:1617. [PMID: 37998819 PMCID: PMC10668833 DOI: 10.3390/antibiotics12111617] [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: 10/21/2023] [Revised: 11/05/2023] [Accepted: 11/09/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND The microbiome of newborn infants during the first 1000 days, influenced early on by their mothers' microbiome health, mode of delivery and breast feeding, orchestrates the education and programming of the infant's immune system and determines in large part the general health of the infant for years. METHODS PubMed was reviewed for maternal infant microbiome health and microbiota therapy in this setting with prebiotics, probiotics, vaginal seeding and fecal microbiota transplantation (FMT). RESULTS A healthy nonobese mother, vaginal delivery and strict breast feeding contribute to microbiome health in a newborn and young infant. With reduced microbiome diversity (dysbiosis) during pregnancy, cesarean delivery, prematurity, and formula feeding contribute to dysbiosis in the newborn. Microbiota therapy is an important approach to repair dysbiosis in pregnant women and their infants. Currently available probiotics can have favorable metabolic effects on mothers and infants, but these effects are variable. In research settings, reversal of infant dysbiosis can be achieved via vaginal seeding or FMT. Next generation probiotics in development should replace current probiotics and FMT. CONCLUSIONS The most critical phase of human microbiome development is in the first 2-3 years of life. Preventing and treating dysbiosis during pregnancy and early life can have a profound effect on an infant's later health.
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Affiliation(s)
- Herbert L. DuPont
- Division of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, University of Texas, Houston, TX 77030, USA
- Department of Internal Medicine, University of Texas McGovern Medical School, Houston, TX 77030, USA
- Department of Medicine, Baylor College of Medicine, Houston, TX 77030, USA
- Kelsey Research Foundation, Houston, TX 77005, USA
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Lee BR, Harrison CJ, Hassan F, Sasidharan A, Moffatt ME, Weltmer K, Payne DC, Wikswo ME, Parashar U, Selvarangan R. A Comparison of Pathogen Detection and Risk Factors among Symptomatic Children with Gastroenteritis Compared with Asymptomatic Children in the Post-rotavirus Vaccine Era. J Pediatr 2023; 261:113551. [PMID: 37315778 PMCID: PMC11215998 DOI: 10.1016/j.jpeds.2023.113551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 05/25/2023] [Accepted: 06/06/2023] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To describe demographics, pathogen distribution/seasonality, and risk factors in children seeking care for acute gastroenteritis (AGE) at a midwestern US emergency department during 5 postrotavirus vaccine years (2011-2016), and further, to compare the same data with matched healthy controls (HC). STUDY DESIGN AGE and HC participants <11 years old enrolled in the New Vaccine Surveillance Network study between December 2011 to June 2016 were included. AGE was defined as ≥3 diarrhea episodes or ≥1 vomiting episode. Each HC's age was similar to an AGE participant's age. Pathogens were analyzed for seasonality effects. Participant risk factors for AGE illness and pathogen detections were compared between HC and a matched subset of AGE cases. RESULTS One or more organisms was detected in 1159 of 2503 children (46.3%) with AGE compared with 99 of 537 HC (17.3%). Norovirus was detected most frequently among AGE (n = 568 [22.7%]) and second-most frequently in HC (n = 39 [6.8%]). Rotavirus was the second most frequently detected pathogen among AGE (n = 196 [7.8%]). Children with AGE were significantly more likely to have reported a sick contact compared with HC, both outside the home (15.6% vs 1.4%; P < .001) and inside the home (18.6% vs 2.1%; P < .001). Daycare attendance was higher among children with AGE (41.4%) compared with HC (29.5%; P < .001). The Clostridium difficile detection rate was slightly higher among HC (7.0%) than AGE (5.3%). CONCLUSIONS Norovirus was the most prevalent pathogen among children with AGE. Norovirus was detected in some HC, suggesting potential asymptomatic shedding among HC. The proportion of AGE participants with a sick contact was approximately 10 times greater than that of HC.
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Affiliation(s)
- Brian R Lee
- Children's Mercy Kansas City and University of Missouri Kansas City School of Medicine, Kansas City, MO.
| | - Christopher J Harrison
- Children's Mercy Kansas City and University of Missouri Kansas City School of Medicine, Kansas City, MO
| | - Ferdaus Hassan
- Children's Mercy Kansas City and University of Missouri Kansas City School of Medicine, Kansas City, MO
| | - Anjana Sasidharan
- Children's Mercy Kansas City and University of Missouri Kansas City School of Medicine, Kansas City, MO
| | - Mary E Moffatt
- Children's Mercy Kansas City and University of Missouri Kansas City School of Medicine, Kansas City, MO
| | - Kirsten Weltmer
- Children's Mercy Kansas City and University of Missouri Kansas City School of Medicine, Kansas City, MO
| | - Daniel C Payne
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Mary E Wikswo
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Umesh Parashar
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Rangaraj Selvarangan
- Children's Mercy Kansas City and University of Missouri Kansas City School of Medicine, Kansas City, MO
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Iana E, Boboc C, Vlad AG, Cosoreanu MT, Anghel M, Boboc AA, Ioan A, Ionescu MI, Gavriliu L, Galos F. A Multifaced Aspect of Clostridium difficile Infection in Pediatric Patients with Inflammatory Bowel Disease: Case Series and Literature Review. J Pers Med 2023; 13:1413. [PMID: 37763180 PMCID: PMC10532824 DOI: 10.3390/jpm13091413] [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: 08/15/2023] [Revised: 09/14/2023] [Accepted: 09/17/2023] [Indexed: 09/29/2023] Open
Abstract
Children with inflammatory bowel disease (IBD) have an increased susceptibility to Clostridium difficile infection (CDI), with a rising incidence over time. Differentiating between CDI and IBD exacerbation is challenging due to overlapping symptoms. In our cohort of 55 pediatric IBD patients, 6 were diagnosed with CDI. Upon conducting a thorough patient evaluation and subsequent data analysis, an exhaustive review of the existing literature was undertaken. CDI is more prevalent in ulcerative colitis (UC) than Crohn's disease (CD) patients, as seen in our patients and in the existing literature. The management of a pediatric patient with IBD is itself a challenge for a clinician because of the chronic, possibly relapsing course, and substantial long-term morbidity. When CDI is added, it becomes even more demanding, since CDI leads to more severe disease in children with IBD. A multidisciplinary approach and intensive treatment for possible sepsis, anemia, hypoalbuminemia, and hydro-electrolytic and acid-base imbalances are frequently mandatory in patients with CDI and IBD, which leads to a significant health care burden in hospitalized children with IBD. After the infection is treated with antibiotic therapy, important considerations regarding the future treatment for the underlying IBD are also necessary; in most cases, a treatment escalation is required, as also seen in our study group.
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Affiliation(s)
- Elena Iana
- Department of Pediatrics, Marie Curie Emergency Children’s Hospital, 041451 Bucharest, Romania
| | - Catalin Boboc
- Department of Pediatrics, Marie Curie Emergency Children’s Hospital, 041451 Bucharest, Romania
| | - Andreea Gabriela Vlad
- Department of Pediatrics, Marie Curie Emergency Children’s Hospital, 041451 Bucharest, Romania
| | - Maria Teodora Cosoreanu
- Department of Pediatrics, Marie Curie Emergency Children’s Hospital, 041451 Bucharest, Romania
| | - Malina Anghel
- Department of Pediatrics, Marie Curie Emergency Children’s Hospital, 041451 Bucharest, Romania
| | - Anca Andreea Boboc
- Department of Pediatrics, Marie Curie Emergency Children’s Hospital, 041451 Bucharest, Romania
- Department of Pediatrics, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Andreea Ioan
- Department of Pediatrics, Marie Curie Emergency Children’s Hospital, 041451 Bucharest, Romania
| | - Mara Ioana Ionescu
- Department of Pediatrics, Marie Curie Emergency Children’s Hospital, 041451 Bucharest, Romania
- Department of Physiology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Liana Gavriliu
- Department for Prevention of Healthcare-Associated Infections, Marie Curie Emergency Children’s Hospital, 041451 Bucharest, Romania
- Department of Infectious Disease, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Felicia Galos
- Department of Pediatrics, Marie Curie Emergency Children’s Hospital, 041451 Bucharest, Romania
- Department of Pediatrics, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
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12
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Jolivet S, Couturier J, Grohs P, Vilfaillot A, Zahar JR, Frange P, Casetta A, Moulin V, Lawrence C, Baune P, Bourgeois C, Bouffier A, Laussucq C, Sienzonit L, Picard S, Podglajen I, Kassis-Chikhani N, Barbut F. Prevalence and risk factors of toxigenic Clostridioides difficile asymptomatic carriage in 11 French hospitals. Front Med (Lausanne) 2023; 10:1221363. [PMID: 37547619 PMCID: PMC10402895 DOI: 10.3389/fmed.2023.1221363] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 06/28/2023] [Indexed: 08/08/2023] Open
Abstract
Clostridioides difficile infection (CDI) incidence has increased over the last 20 years. Studies suggest that asymptomatic carriers may be an important reservoir of C. difficile in healthcare settings. We conducted a point prevalence study to estimate the toxigenic C. difficile asymptomatic carriage rate and the associated risk factors in patients >3 years old. Between September 16, 2019 and January 15, 2020, all patients hospitalized in 11 healthcare facilities in the Paris urban area were included in the study. They were screened on the day of the survey for toxigenic C. difficile carriage by rectal swab and interviewed. Isolates were characterized by PCR ribotyping and multiplex PCR targeting toxin genes. A logistic regression model was used to determine the risk factors associated with toxigenic C. difficile asymptomatic carriage using uni- and multivariate analysis in the subpopulation of patients >3 years old. During the study period, 2,389 patients were included and screened. The median age was 62 years (interquartile range 35-78 years) and 1,153 were male (48.3%). Nineteen patients had a previous CDI (0.9%). Overall, 185/2389 patients were positive for C. difficile (7.7%), including 93 toxigenic strains (3.9%): 77 (82.8%) were asymptomatic (prevalence 3.2%) whereas 12 (12.9%) were diarrheic. Prevalences of toxigenic C. difficile were 3.5% in patients >3 years old and 7.0% in ≤3 years old subjects, respectively. Toxigenic strains mainly belonged to PCR ribotypes 106 (n = 14, 15.0%), 014 (n = 12, 12.9%), and 020 (n = 10, 10.8%). Among toxigenic strains, 6 (6.4%) produced the binary toxin. In multivariate analysis, two factors were positively associated with toxigenic C. difficile asymptomatic carriage in patients >3 years old: multidrug-resistant organisms co-carriage [adjusted Odd Ratio (aOR) 2.3, CI 95% 1.2-4.7, p = 0.02] and previous CDI (aOR 5.8, CI 95% 1.2-28.6, p = 0.03). Conversely, consumption of raw milk products were associated with reduced risk of toxigenic C. difficile colonization (aOR 0.5, CI 95% 0.2-0.9, p = 0.01). We showed that there was a low prevalence of asymptomatic toxigenic C. difficile carriage in hospitalized patients. Consumption of raw milk prevents toxigenic C. difficile colonization, probably due to the barrier effect of milk-associated bacteria.
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Affiliation(s)
- Sarah Jolivet
- Unité de prévention du risque infectieux, Hôpital Saint Antoine, Paris, France
| | - Jeanne Couturier
- Laboratoire de microbiologie de l’environnement, Hôpital Saint Antoine, Paris, France
- National Reference Laboratory for Clostridioides difficile, Paris, France
| | - Patrick Grohs
- Laboratoire de microbiologie, Hôpital Européen Georges Pompidou, Paris, France
| | - Aurélie Vilfaillot
- Unité de Recherche Clinique, Hôpital Européen Georges Pompidou, Paris, France
- INSERM Centre d’Investigation Clinique 1418, Paris, France
| | - Jean-Ralph Zahar
- Unité de Prévention du Risque infectieux, Hôpitaux Avicenne, Bobigny/Jean Verdier, Bondy/René Muret, Sevran, France
| | - Pierre Frange
- Équipe de Prévention du Risque infectieux, Laboratoire de microbiologie clinique, Hôpital Necker – Enfants malades, Groupe hospitalier Assistance Publique – Hôpitaux de Paris (APHP) Centre – Université Paris Cité, Paris, France
| | - Anne Casetta
- Équipe de Prévention du Risque infectieux, Hôpital Cochin, Paris, France
| | - Véronique Moulin
- Équipe de Prévention du Risque infectieux, Hôpitaux Corentin Celton/Vaugirard, Issy-les-Moulineaux, France
| | - Christine Lawrence
- Équipe de Prévention du Risque infectieux, GHU Paris-Saclay site R. Poincaré, Garches, France
| | - Patricia Baune
- Équipe de Prévention du Risque infectieux, Hôpital Paul Brousse, Villejuif, France
| | - Cléo Bourgeois
- Unité de Recherche Clinique, Hôpital Européen Georges Pompidou, Paris, France
- INSERM Centre d’Investigation Clinique 1418, Paris, France
| | - Axel Bouffier
- Unité de Recherche Clinique, Hôpital Européen Georges Pompidou, Paris, France
- INSERM Centre d’Investigation Clinique 1418, Paris, France
| | - Claudine Laussucq
- Laboratoire de microbiologie, Hôpital Européen Georges Pompidou, Paris, France
| | - Lydia Sienzonit
- Laboratoire de microbiologie, Hôpital Européen Georges Pompidou, Paris, France
| | - Simon Picard
- Laboratoire de microbiologie, Hôpital Européen Georges Pompidou, Paris, France
| | - Isabelle Podglajen
- Laboratoire de microbiologie, Hôpital Européen Georges Pompidou, Paris, France
| | - Najiby Kassis-Chikhani
- Équipe de Prévention du Risque infectieux, Hôpital Européen Georges Pompidou, Paris, France
| | - Frédéric Barbut
- Unité de prévention du risque infectieux, Hôpital Saint Antoine, Paris, France
- Laboratoire de microbiologie de l’environnement, Hôpital Saint Antoine, Paris, France
- National Reference Laboratory for Clostridioides difficile, Paris, France
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13
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Boyanova L, Markovska R, Yordanov D, Gergova R, Hadzhiyski P. Anaerobes in specific infectious and noninfectious diseases: new developments. Anaerobe 2023; 81:102714. [PMID: 37349047 DOI: 10.1016/j.anaerobe.2023.102714] [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: 11/19/2022] [Revised: 01/21/2023] [Accepted: 02/03/2023] [Indexed: 06/24/2023]
Abstract
With the buildup of new research data, newer associations between anaerobic bacteria and diseases/conditions were evaluated. The aim of the mini-review was to draw attention and to encourage further multidisciplinary studies of the associations. We considered microbiome-disease correlations such as a decrease of fecal Faecalibacterium prausnitzii abundance in inflammatory bowel disease (IBD) and IBD recurrence, suggesting that F. prausnitzii could be a good biomarker for IBD. A link of subgingival Porphyromonas gingivalis with cardiovascular diseases was reported. Decreased Roseburia abundance was observed in the gut of Alzheimer's and Parkinson's disease patients. Akkermansia muciniphila was found to improve adipose/glucose metabolism, however, its intestinal abundance was observed in neurodegenerative diseases as well. Severe Clostridioides difficile infections have been reported in neonates and young children. Carcinogenic potential of anaerobes has been suggested. Fusobacterium nucleatum was implicated in the development of oral and colorectal cancer, Porphyromonas gingivalis and Tannerella forsythia were linked to esophageal cancer and Cutibacterium acnes subsp. defendens was associated with prostate cancer. However, there are some controversies about the results. In a Swedish longitudinal study, neither P. gingivalis nor T. forsythia exhibited oncogenic potential. The present data can enrich knowledge of anaerobic bacteria and their multifaceted significance for health and disease and can draw future research directions. However, more studies on large numbers of patients over prolonged periods are needed, taking into account the possible changes in the microbiota over time.
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Affiliation(s)
- Lyudmila Boyanova
- Department of Medical Microbiology, Medical University of Sofia, 2 Zdrave Str., 1431, Sofia, Bulgaria.
| | - Rumyana Markovska
- Department of Medical Microbiology, Medical University of Sofia, 2 Zdrave Str., 1431, Sofia, Bulgaria
| | - Daniel Yordanov
- Department of Medical Microbiology, Medical University of Sofia, 2 Zdrave Str., 1431, Sofia, Bulgaria
| | - Raina Gergova
- Department of Medical Microbiology, Medical University of Sofia, 2 Zdrave Str., 1431, Sofia, Bulgaria
| | - Petyo Hadzhiyski
- Specialized Hospital for Active Pediatric Treatment, Medical University of Sofia, "Acad. Ivan Evstatiev Geshov" Blvd, 1606, Sofia, Bulgaria
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14
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Huertas-Díaz L, Kyhnau R, Ingribelli E, Neuzil-Bunesova V, Li Q, Sasaki M, Lauener RP, Roduit C, Frei R, Study Group CKCARE, Sundekilde U, Schwab C. Breastfeeding and the major fermentation metabolite lactate determine occurrence of Peptostreptococcaceae in infant feces. Gut Microbes 2023; 15:2241209. [PMID: 37592891 PMCID: PMC10449005 DOI: 10.1080/19490976.2023.2241209] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 07/18/2023] [Accepted: 07/20/2023] [Indexed: 08/19/2023] Open
Abstract
Previous studies indicated an intrinsic relationship between infant diet, intestinal microbiota composition and fermentation activity with a strong focus on the role of breastfeeding on microbiota composition. Yet, microbially formed short-chain fatty acids acetate, propionate and butyrate and other fermentation metabolites such as lactate not only act as substrate for bacterial cross-feeding and as mediators in microbe-host interactions but also confer antimicrobial activity, which has received considerably less attention in the past research. It was the aim of this study to investigate the nutritional-microbial interactions that contribute to the development of infant gut microbiota with a focus on human milk oligosaccharide (HMO) fermentation. Infant fecal microbiota composition, fermentation metabolites and milk composition were analyzed from 69 mother-infant pairs of the Swiss birth cohort Childhood AlleRgy nutrition and Environment (CARE) at three time points depending on breastfeeding status defined at the age of 4 months, using quantitative microbiota profiling, HPLC-RI and 1H-NMR. We conducted in vitro fermentations in the presence of HMO fermentation metabolites and determined the antimicrobial activity of lactate and acetate against major Clostridiaceae and Peptostreptococcaceae representatives. Our data show that fucosyllactose represented 90% of the HMOs present in breast milk at 1- and 3-months post-partum with fecal accumulation of fucose, 1,2-propanediol and lactate indicating fermentation of HMOs that is likely driven by Bifidobacterium. Concurrently, there was a significantly lower absolute abundance of Peptostreptococcaceae in feces of exclusively breastfed infants at 3 months. In vitro, lactate inhibited strains of Peptostreptococcaceae. Taken together, this study not only identified breastfeeding dependent fecal microbiota and metabolite profiles but suggests that HMO-derived fermentation metabolites might exert an inhibitory effect against selected gut microbes.
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Affiliation(s)
- Lucía Huertas-Díaz
- Department of Biological and Chemical Engineering, Aarhus University, Aarhus, Denmark
| | - Rikke Kyhnau
- Department of Food Science, Aarhus University, Aarhus, Denmark
| | - Eugenio Ingribelli
- Department of Microbiology, Nutrition and Dietetics, Czech University of Life Sciences Prague, Prague, Czech Republic
| | - Vera Neuzil-Bunesova
- Department of Microbiology, Nutrition and Dietetics, Czech University of Life Sciences Prague, Prague, Czech Republic
| | - Qing Li
- Department of Biological and Chemical Engineering, Aarhus University, Aarhus, Denmark
| | - Mari Sasaki
- University Children’s Hospital Zürich, Zürich, Switzerland
| | - Roger P. Lauener
- Christine Kühne-Center for Allergy Research and Education (CK-CARE), Davos, Switzerland
- Children’s Hospital St. Gallen, St. Gallen, Switzerland
| | - Caroline Roduit
- University Children’s Hospital Zürich, Zürich, Switzerland
- Christine Kühne-Center for Allergy Research and Education (CK-CARE), Davos, Switzerland
- Children’s Hospital St. Gallen, St. Gallen, Switzerland
- Department of Paediatrics, Inselspital, University of Bern, Bern, Switzerland
| | - Remo Frei
- Christine Kühne-Center for Allergy Research and Education (CK-CARE), Davos, Switzerland
- Department of Paediatrics, Inselspital, University of Bern, Bern, Switzerland
| | - CK-CARE Study Group
- Department of Biological and Chemical Engineering, Aarhus University, Aarhus, Denmark
- Department of Food Science, Aarhus University, Aarhus, Denmark
- Department of Microbiology, Nutrition and Dietetics, Czech University of Life Sciences Prague, Prague, Czech Republic
- University Children’s Hospital Zürich, Zürich, Switzerland
- Christine Kühne-Center for Allergy Research and Education (CK-CARE), Davos, Switzerland
- Children’s Hospital St. Gallen, St. Gallen, Switzerland
- Department of Paediatrics, Inselspital, University of Bern, Bern, Switzerland
| | | | - Clarissa Schwab
- Department of Biological and Chemical Engineering, Aarhus University, Aarhus, Denmark
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15
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Oliver MB, Vaughn BP. Fidaxomicin Use in the Pediatric Population with Clostridioides difficile. Clin Pharmacol 2022; 14:91-98. [PMID: 36177387 PMCID: PMC9514785 DOI: 10.2147/cpaa.s273318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 09/15/2022] [Indexed: 11/23/2022] Open
Abstract
Clostridioides difficile infection (CDI) remains a devastating infection both in hospital settings and in the community. While a number of antibiotics have anti-C. difficile activity, fidaxomicin is unique as a minimally absorbed antibiotic with narrow spectrum of activity. These features make it an appealing option for pediatric CDI to balance safety and efficacy. The purpose of this structured review was to outline the clinical evidence for safety and efficacy of fidaxomicin for pediatric CDI. A structured literature search was performed to identify relevant clinical data. Fidaxomicin is similarly effective to oral vancomycin with a lower rate of recurrent CDI. There were no serious safety signals reported with fidaxomicin. In conclusion, fidaxomicin is a safe and effective treatment option for pediatric CDI.
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Affiliation(s)
- Meredith B Oliver
- M Health Fairview, Masonic Children’s Hospital, Minneapolis, MN, USA
| | - Byron P Vaughn
- Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis, MN, USA
- Correspondence: Byron P Vaughn, Department of Medicine, 1-205 Philips Wangensteen Building, 516 Delaware Street S.E, MMC36, Minneapolis, MN, 55455, Tel +1 612 625 8999, Fax +1 612 625 5620, Email
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16
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Sandora TJ, Williams DN, Daugherty K, Geer C, Cuddemi C, Kociolek LK, Chen X, Xu H, Savage TJ, Banz A, Garey KW, Gonzales-Luna AJ, Kelly CP, Pollock NR. Stool Toxin Concentration Does Not Distinguish Clostridioides difficile Infection from Colonization in Children Less Than 3 Years of Age. J Pediatric Infect Dis Soc 2022; 11:454-458. [PMID: 35801632 PMCID: PMC9595052 DOI: 10.1093/jpids/piac059] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Accepted: 06/10/2022] [Indexed: 11/14/2022]
Abstract
In a prospective cohort study, stools from children <3 years with and without diarrhea who were Clostridioides difficile nucleic acid amplification test-positive underwent ultrasensitive and quantitative toxin measurement. Among 37 cases and 46 controls, toxin concentration distributions overlapped substantially. Toxin concentration alone does not distinguish C. difficile infection from colonization in young children.
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Affiliation(s)
- Thomas J Sandora
- Corresponding Author: Thomas J. Sandora, MD MPH, Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA 02115, USA. E-mail:
| | - David N Williams
- Institutional Centers for Clinical and Translational Research, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - Kaitlyn Daugherty
- Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Christine Geer
- Institutional Centers for Clinical and Translational Research, Boston Children’s Hospital, Boston, Massachusetts, USA,Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Christine Cuddemi
- Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Larry K Kociolek
- Division of Infectious Diseases, Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Xinhua Chen
- Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Hua Xu
- Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Timothy J Savage
- Division of Infectious Diseases, Department of Pediatrics, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Kevin W Garey
- Department of Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, Houston, Texas, USA
| | - Anne J Gonzales-Luna
- Department of Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, Houston, Texas, USA
| | - Ciarán P Kelly
- Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Nira R Pollock
- Department of Laboratory Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, USA,Division of Infectious Diseases, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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17
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Josyabhatla R, Tatevian N, Tchakarov AS, Cox CS, Van Arsdall MR. Chronic Diarrhea in an Infant With Malrotation: A Diagnostic Dilemma. JPGN REPORTS 2022; 3:e177. [PMID: 37168912 PMCID: PMC10158313 DOI: 10.1097/pg9.0000000000000177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 01/10/2022] [Indexed: 05/13/2023]
Abstract
In children, diarrhea has a global incidence of 2.7 episodes per child-year and contributes to significant disease burden and mortality in children under 5 years of age. Chronic diarrhea, defined as diarrhea lasting for more than 2 weeks, may be particularly challenging to evaluate and manage in children under 2 years of age. While most have infectious enteritis or cow milk protein intolerance, others have conditions such as malnutrition, anatomic abnormalities, or congenital enteropathies that can be challenging to diagnose and treat. We present here a complex case of chronic diarrhea in an infant and highlight such diagnostic and therapeutic challenges.
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Affiliation(s)
- Rohit Josyabhatla
- From the Department of Pediatrics, Division of Pediatric Gastroenterology, UTHealth McGovern Medical School, Houston, TX
| | - Nina Tatevian
- Department of Pathology and Laboratory Medicine, UTHealth McGovern Medical School, Houston, TX; and
| | - Amanda S. Tchakarov
- Department of Pathology and Laboratory Medicine, UTHealth McGovern Medical School, Houston, TX; and
| | - Charles S. Cox
- Department of Pediatric Surgery, UTHealth McGovern Medical School, Houston, TX
| | - Melissa R. Van Arsdall
- From the Department of Pediatrics, Division of Pediatric Gastroenterology, UTHealth McGovern Medical School, Houston, TX
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18
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Breastfeeding as a regulating factor of the development of the intestinal microbiome in the early stages of life. Eur Food Res Technol 2022. [DOI: 10.1007/s00217-022-04012-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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19
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Marcela K, de Meij GT, Fidelma F, Richard DJ, Mark WH, Ed KJ. How to: Clostridioides difficile infection in children. Clin Microbiol Infect 2022; 28:1085-1090. [DOI: 10.1016/j.cmi.2022.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 02/07/2022] [Accepted: 03/01/2022] [Indexed: 12/12/2022]
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20
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Chung HS, Park JS, Shin BM, Yoo HM, Kim H, Cho J, Lee CH, Ryoo NH, Kim JS, Chung JW, Hong KH, Kim YS, Cho YS. Nationwide Survey for Current Status of Laboratory Diagnosis of Clostridioides difficile Infection in Korea. J Korean Med Sci 2022; 37:e38. [PMID: 35132844 PMCID: PMC8822111 DOI: 10.3346/jkms.2022.37.e38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 12/15/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The interest in Clostridioides difficile infection (CDI) has increased, and the choice of assays became wider since the first national survey in Korea on CDI diagnosis in 2015. We conducted a survey of the domestic CDI assays with more varied questions to understand the current situation in Korea. METHODS In April 2018, about 50 questions on the current status of CDI assays and details on implementation and perceptions were written, and a survey questionnaire was administered to laboratory medicine specialists in 200 institutions. RESULTS One-hundred and fifty institutions responded to the questionnaire, of which 90 (60.0%) including one commercial laboratory, performed CDI assays. The toxin AB enzyme immunoassay (toxin AB EIA), nucleic acid amplification test (NAAT), and C. difficile culture, glutamate dehydrogenase assay, alone or in combination with other assays, were used in 75 (84.3%), 52 (58.4%), 35 (36.0%), and 23 (25.8%), respectively, and 65 (73.0%) institutions performed a combination of two or more assays. The sensitivity of toxin AB EIA was more negatively perceived, and that on specificity was more positively perceived. The perception of sensitivity and specificity of NAAT was mostly positive. Perception on the algorithm test projected it as useful but in need of countermeasures. Sixty-three (73.3%) institutions responded that they performed surveillance on CDI. CONCLUSION This study provides useful evidence on the current status of CDI laboratory diagnosis in Korea as well as on items that require improvement and is thought to aid in standardizing and improving the CDI laboratory diagnosis in Korea.
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Affiliation(s)
- Hae-Sun Chung
- Department of Laboratory Medicine, Ewha Womans University College of Medicine, Seoul, Korea
| | - Jeong Su Park
- Department of Laboratory Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Bo-Moon Shin
- Department of Laboratory Medicine, Sanggye Paik Hospital, School of Medicine, Inje University, Seoul, Korea.
| | - Hyeon Mi Yoo
- Infection Control Office, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Heejung Kim
- Department of Laboratory Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea
| | - Jihyun Cho
- Department of Laboratory Medicine, Wonkwang University Hospital, Iksan, Korea
| | - Chae Hoon Lee
- Department of Laboratory Medicine, College of Medicine, Yeungnam University, Daegu, Korea
| | - Nam Hee Ryoo
- Department of Laboratory Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Jae-Seok Kim
- Department of Laboratory Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Jae-Woo Chung
- Department of Laboratory Medicine, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Ki Ho Hong
- Department of Laboratory Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - You Sun Kim
- Department of Internal Medicine, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Young-Seok Cho
- Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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21
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Detection of Clostridioides difficile toxin B gene: benefits of identifying gastrointestinal pathogens by mPCR assay in the diagnosis of diarrhea in pediatric patients. BMC Infect Dis 2022; 22:126. [PMID: 35123434 PMCID: PMC8818185 DOI: 10.1186/s12879-022-07104-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 01/29/2022] [Indexed: 12/05/2022] Open
Abstract
Background In the pediatric population, severe Clostridioides difficile infection (CDI) sometimes occurs, but most cases are asymptomatic. The asymptomatic carriage rate in pediatric populations is reportedly higher than in the adult population. It is difficult to diagnose CDI, even if C. difficile is detected in children with diarrhea. This study aimed to evaluate the positivity rate of toxigenic C. difficile in the pediatric population with diarrhea. Methods We collected and retrospectively analyzed gastrointestinal pathogen multiplex PCR results of 960 patients to estimate the positivity rate of toxigenic C. difficile in pediatric populations aged between 0 and 18 years. Results The overall rate of C. difficile toxin B positivity was 10.1% in the stool samples. The positivity rate peaked in 1-year-old infants (29/153, 19.0%) and continually decreased thereafter. The positivity rate we observed was lower than the rates described in the literature. Remarkably, no C. difficile was detected in neonates. Antibiotic usage was inversely related to the positivity rate, especially in infants < 2 years of age. The odds ratio of antibiotics was 0.44 (95% confidence interval (CI) 0.28–0.68; P < 0.001). The presence of concomitant gastrointestinal pathogens was not associated with toxigenic C. difficile positivity. Conclusions Even though toxigenic C. difficile infection is neither an important nor a common cause of pediatric diarrhea, children can spread it to adults at risk of developing CDI. The pediatric population can act as hidden reservoirs for pathogenic strains in the community.
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Rzayev T, Yüksel Mayda P, Erkan T, Kocazeybek B, Kutlu T. Clostridium difficile Colonization Before and After Hospitalization in Children. Turk Arch Pediatr 2022; 56:585-590. [PMID: 35110057 PMCID: PMC8848804 DOI: 10.5152/turkarchpediatr.2021.21139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background: Beginning in the early 2000s, Clostridium difficile infection has become a major health problem in the United States, Canada, and in most European countries and has not only increased in incidence but also the severity. There are 2 conditions for the development of C. difficile infection: disruption of the normal gastrointestinal flora, and exogenous ingestion of the microorganism. We aimed to study C. difficile colonization in hospitalized children. We identified 2 issues: (1) the relationship between risks before hospital admission and colonization on the first day of hospitalization and (2) the effect of the factors that patients are exposed to during hospitalization on the colonization status at discharge. Methods: Patients aged between 2 and 18 years who were hospitalized with various diagnoses were included in this study. C. difficile toxin A/B was investigated in the stool samples taken on the admission and discharge days. Results: One hundred six patients were included in the study, of whom 24.5% and 48.1% of hemato-oncology patients were positive for C. difficile toxin A/B. Antibiotic usage within 1 month preceding hospitalization and the presence of underlying disease impact the C. difficile colonization status on the first day of hospitalization. Conclusion: Toxigenic C. difficile colonization prevalence is high in hospitalized children, especially in the hemato-oncology patient group.
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Affiliation(s)
- Türkay Rzayev
- Division of Neonatology, Department of Pediatrics, Marmara University School of Medicine, İstanbul, Turkey
| | - Pelin Yüksel Mayda
- Department of Pharmaceutical Microbiology, Bezmialem Vakif University School of Medicine, Istanbul, Turkey
| | - Tülay Erkan
- Division of Gastroenterology, Department of Pediatrics, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Bekir Kocazeybek
- Department of Microbiology, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Tufan Kutlu
- Division of Gastroenterology, Department of Pediatrics, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
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Schwenk HT, Pollock NR, Vaughan-Malloy AM. Pediatric Clostridioides difficile Infection: Diagnosis and Diagnostic Stewardship. J Pediatric Infect Dis Soc 2021; 10:S16-S21. [PMID: 34791395 DOI: 10.1093/jpids/piab054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Although the pathogenesis of Clostridioides difficile infection (CDI) is complex and incompletely understood, it is believed that the elaboration of C. difficile toxins is necessary for disease. There are a variety of tests available for the detection of both the C. difficile organism and its toxins; however, each has limitations and the best application of these tests to the diagnosis of CDI in children remains uncertain. Nucleic acid amplification tests are unable to reliably discriminate between CDI and C. difficile colonization, while commercially available enzyme immunoassays for toxin detection lack sensitivity. An understanding of preanalytic factors, relevant patient features, and test performance characteristics is essential to the accurate diagnosis of CDI in children. Specific diagnostic stewardship strategies can also increase the likelihood that positive tests reflect disease rather than colonization. Ultimately, CDI remains a clinical diagnosis and clinical judgment is essential when interpreting test results, regardless of the methods used.
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Affiliation(s)
- Hayden T Schwenk
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Stanford University School of Medicine, Stanford, California, USA
| | - Nira R Pollock
- Department of Laboratory Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Ana M Vaughan-Malloy
- Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
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Chen CC, Chiu CH. Current and future applications of fecal microbiota transplantation for children. Biomed J 2021; 45:11-18. [PMID: 34781002 PMCID: PMC9133305 DOI: 10.1016/j.bj.2021.11.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 10/23/2021] [Accepted: 11/07/2021] [Indexed: 12/18/2022] Open
Abstract
Fecal microbiota transplantation (FMT) is a new and adequate route to modify the microbial ecosystem in gastrointestinal tract of the hosts. Intestinal microbiota is highly associated with human health and disease. According to the reports of human clinical trials or case series, the application of FMT ranged from Clostridiodes difficile infection (CDI), inflammatory bowel disease (IBD), irritable bowel syndrome, refractory diarrhea, diabetes mellitus, metabolic syndrome, and even neurologic diseases, including Parkinson disease, and neuropsychiatric disorder (autism spectrum disorder, ASD). Although the current allowed indication of FMT is CDI in Taiwan, more application and development are expectable in the future. There is a relative rare data available for children in application of fecal microbiota transplantation. Thus, we review previous published research inspecting FMT in children, and address particular considerations when conducting FMT in pediatric patients.
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Affiliation(s)
- Chien-Chang Chen
- Division of Pediatric Gastroenterology and Hepatology, Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Cheng-Hsun Chiu
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.
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Okeahialam CA, Rabaan AA, Bolhuis A. An evaluation of toxigenic Clostridioides difficile positivity as a patient outcome metric of antimicrobial stewardship in Saudi Arabia. J Infect Prev 2021; 22:231-236. [PMID: 34659461 DOI: 10.1177/17571774211012780] [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: 06/17/2020] [Accepted: 04/06/2021] [Indexed: 11/17/2022] Open
Abstract
Background Antimicrobial stewardship has been associated with a reduction in the incidence of healthcare-associated Clostridium difficile infection (HA-CDI). However, CDI remains under-recognised in many low and middle-income countries where clinical and surveillance resources required to identify HA-CDI are often lacking. The rate of toxigenic C. difficile stool positivity in the stool of hospitalised patients may offer an alternative metric for these settings, but its utility remains largely untested. Aim/objective To examine the impact of antimicrobial stewardship on the rate of toxigenic C. difficile positivity among hospitalised patients presenting with diarrhea. Methods A 12-year retrospective review of laboratory data was conducted to compare the rates of toxigenic C. difficile in diarrhoea stool of patients in a hospital in Saudi Arabia, before and after implementation of an antimicrobial stewardship programme. Result There was a significant decline in the rate of toxigenic C. difficile positivity from 9.8 to 7.4% following the implementation of the antimicrobial stewardship programme, and a reversal of a rising trend. Discussion The rate of toxigenic C. difficile positivity may be a useful patient outcome metric for evaluating the long-term impact of antimicrobial stewardship on CDI, especially in settings with limited surveillance resources. The accuracy of this metric is, however, dependent on the avoidance of arbitrary repeated testing of a patient for cure, and testing only unformed or diarrhoea stool specimens. Further studies are required within and beyond Saudi Arabia to examine the utility of this metric.
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Affiliation(s)
| | - Ali A Rabaan
- Molecular Diagnostic Laboratory, Johns Hopkins Aramco Healthcare, Saudi Arabia
| | - Albert Bolhuis
- Department of Pharmacy & Pharmacology, University of Bath, UK
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Vancomycin Use in Children and Neonates across Three Decades: A Bibliometric Analysis of the Top-Cited Articles. Pathogens 2021; 10:pathogens10101343. [PMID: 34684291 PMCID: PMC8537673 DOI: 10.3390/pathogens10101343] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 09/17/2021] [Accepted: 09/29/2021] [Indexed: 12/13/2022] Open
Abstract
Vancomycin is frequently prescribed in pediatrics, especially in intensive care unit settings, to treat Gram-positive bacterial infections. This work aims to collect the top-cited articles of pediatric and infectious diseases areas to gather the current evidence and gaps of knowledge on the use of vancomycin in these populations. The most relevant journals reported in the "pediatrics" and "infectious diseases" categories of the 2019 edition of Journal Citation Reports were browsed. Articles with more than 30 citations and published over the last three decades were collected. A bibliometric analysis was performed and 115 articles were retrieved. They were published in 21 journals, with a median impact factor of 4.6 (IQR 2.9-5.4). Sixty-eight of them (59.1%) belonged to "infectious diseases" journals. The most relevant topic was "bloodstream/complicated/invasive infections", followed by "antibiotic resistance/MRSA treatment". As for population distribution, 27 articles were on children only and 27 on neonates, most of which were from intensive care unit (ICU) settings. The current literature mainly deals with vancomycin as a treatment for severe infections and antibiotic resistance, especially in neonatal ICU settings. Lately, attention to new dosing strategies in the neonatal and pediatric population has become a sensible topic.
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Absence of Toxemia in Clostridioides difficile Infection: Results from Ultrasensitive Toxin Assay of Serum. Dig Dis Sci 2021; 66:3303-3306. [PMID: 33164145 PMCID: PMC8105423 DOI: 10.1007/s10620-020-06683-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 10/15/2020] [Indexed: 12/18/2022]
Abstract
Clostridioides difficile infection (CDI) is caused by Toxins A and B, secreted from pathogenic strains of C. difficle. This infection can vary greatly in symptom severity and in clinical presentation. Current assays used to diagnose CDI may lack the required sensitivity to detect the exotoxins circulating in blood. The ultrasensitive single molecule array (Simoa) assay was modified to separately detect toxin A and toxin B in serum with a limit of detection at the low picogram level. When applied to a diverse cohort, Simoa was unable to detect toxins A or B in serum from patients with CDI, including many classified as having severe disease. The detection of toxin may be limited by the inference of antitoxin antibodies circulating in serum. This result does not support the hypothesis that toxemia occurs in C. difficile infection, conflicting with the findings of other published reports.
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[ Clostridium difficile infection and its susceptibility factors in children with inflammatory bowel disease]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2021; 23. [PMID: 34266530 PMCID: PMC8292652 DOI: 10.7499/j.issn.1008-8830.2103129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To investigate the incidence rates of Clostridium difficile colonization and Clostridium difficile infection (CDI) in children with inflammatory bowel disease (IBD) and the susceptibility factors for CDI in children with IBD. METHODS A total of 62 children diagnosed with IBD were enrolled as the IBD group. Forty-two children who attended the hospital due to persistent or chronic diarrhea and were excluded from IBD were enrolled as the non-IBD group. The incidence rate of CDI was compared between the two groups. According to the presence or absence of CDI, the IBD group was subdivided into two groups:IBD+CDI (n=12) and non-CDI IBD (n=50), and the clinical data were collected from the two groups to analyze the susceptibility factors for CDI. RESULTS The IBD group had a significantly higher incidence rate of CDI[19% (12/62) vs 2% (1/42); P < 0.05] than the non-IBD group (P < 0.05). Compared with the non-CDI IBD group, the IBD+CDI group had a significantly longer disease course (P < 0.05), and a significantly higher proportion of children with fever, diarrhea, or abdominal pain (P < 0.05). The IBD+CDI group had significantly higher activity indices of pediatric Crohn's disease, C-reactive protein levels and erythrocyte sedimentation rate than the non-CDI IBD group (P < 0.05). The univariate analysis showed that compared with the non-CDI IBD group, the IBD+CDI group had a significantly higher proportion of children with moderate-to-severe disease, use of glucocorticoids, or treatment with broad-spectrum antibiotics for more than 14 days before diagnosis (P < 0.05). CONCLUSIONS The children with IBD have a higher incidence of CDI than those without IBD. Severe disease conditions and use of broad-spectrum antibiotics or glucocorticoids may be associated with an increased incidence of CDI in children with IBD.
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Stultz JS, Hopp J, Orndahl CM, Omecene NE, Pakyz AL. Changes in Metronidazole and Vancomycin Utilization for Nonsevere Clostridioides difficile Infection Among Institutions Caring for Children. Pediatr Infect Dis J 2021; 40:634-636. [PMID: 33657601 DOI: 10.1097/inf.0000000000003117] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Clostridioides difficile infection guidelines were published in final format on April 1, 2018. Among 4962 and 3545 C. difficile infection cases in children the year before and after publication, oral metronidazole use decreased from 63.0% to 44.3% (P < 0.001) and oral vancomycin use increased from 27.3% to 47.7% (P < 0.001). Quarterly metronidazole utilization decreased postguidelines among 117 institutions, incidence rate ratios 0.86 (95% confidence intervals: 0.78-0.96).
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Affiliation(s)
- Jeremy S Stultz
- From the Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center, Memphis, TN
- Department of Pharmacy, Le Bonheur Children's Hospital, Memphis, TN
| | - Jaclyn Hopp
- Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, TN
| | | | - Nicole E Omecene
- Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University School of Pharmacy, Richmond, VA
| | - Amy L Pakyz
- Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University School of Pharmacy, Richmond, VA
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30
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Lee HW, Han SB, Rhim JW. Application of a Multiplex Polymerase Chain Reaction Test for Diagnosing Bacterial Enteritis in Children in a Real-Life Clinical Setting. CHILDREN-BASEL 2021; 8:children8070538. [PMID: 34202436 PMCID: PMC8307519 DOI: 10.3390/children8070538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 06/17/2021] [Accepted: 06/21/2021] [Indexed: 11/16/2022]
Abstract
This study aimed to determine the subjects for bacterial multiplex polymerase chain reaction (mPCR) testing and to interpret the mPCR test results based on patients' clinical symptoms and diagnoses. The medical records of 710 pediatric patients who underwent a bacterial mPCR test were retrospectively reviewed. Clinical characteristics and mPCR test results were compared between patients with positive (n = 199) and negative mPCR test results (n = 511) and between patients with invasive pathogens (n = 95) and toxigenic pathogens (n = 70). Positive mPCR test results were significantly associated with older age (p < 0.001), diagnosis of acute gastroenteritis (p = 0.021), presence of hematochezia (p < 0.001), and absence of cough (p = 0.004). The diagnosis of acute gastroenteritis (p = 0.003), presence of fever (p = 0.027) and diarrhea (p = 0.043), and higher C-reactive protein levels (p = 0.025) were significantly associated with the identification of invasive pathogens in patients with positive mPCR test results. Thus, selective bacterial mPCR testing should be performed based on the patients' clinical symptoms and diagnoses, and the results should be interpreted in consideration with identified pathogens.
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Affiliation(s)
- Hyun-Woo Lee
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (H.-W.L.); (J.-W.R.)
| | - Seung-Beom Han
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (H.-W.L.); (J.-W.R.)
- The Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
- Department of Pediatrics, Daejeon St. Mary’s Hospital, The Catholic University of Korea, Daejeon 34943, Korea
- Correspondence: ; Tel.: +82-42-220-9218
| | - Jung-Woo Rhim
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (H.-W.L.); (J.-W.R.)
- Department of Pediatrics, Daejeon St. Mary’s Hospital, The Catholic University of Korea, Daejeon 34943, Korea
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Dunn AN, Radakovich N, Ancker JS, Donskey CJ, Deshpande A. The Impact of Clinical Decision Support Alerts on Clostridioides difficile Testing: A Systematic Review. Clin Infect Dis 2021; 72:987-994. [PMID: 32060501 DOI: 10.1093/cid/ciaa152] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 02/12/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Several studies have investigated the utility of electronic decision support alerts in diagnostic stewardship for Clostridioides difficile infection (CDI). However, it is unclear if alerts are effective in reducing inappropriate CDI testing and/or CDI rates. The aim of this systematic review was to determine if alerts related to CDI diagnostic stewardship are effective at reducing inappropriate CDI testing volume and CDI rates among hospitalized adult patients. METHODS We searched Ovid Medline and 5 other databases for original studies evaluating the association between alerts for CDI diagnosis and CDI testing volume and/or CDI rate. Two investigators independently extracted data on study characteristics, study design, alert triggers, cointerventions, and study outcomes. RESULTS Eleven studies met criteria for inclusion. Studies varied significantly in alert triggers and in study outcomes. Six of 11 studies demonstrated a statistically significant decrease in CDI testing volume, 6 of 6 studies evaluating appropriateness of CDI testing found a significant reduction in the proportion of inappropriate testing, and 4 of 7 studies measuring CDI rate demonstrated a significant decrease in the CDI rate in the postintervention vs preintervention period. The magnitude of the increase in appropriate CDI testing varied, with some studies reporting an increase with minimal clinical significance. CONCLUSIONS The use of electronic alerts for diagnostic stewardship for C. difficile was associated with reductions in CDI testing, the proportion of inappropriate CDI testing, and rates of CDI in most studies. However, broader concerns related to alerts remain understudied, including unintended adverse consequences and alert fatigue.
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Affiliation(s)
- Aaron N Dunn
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA
| | - Nathan Radakovich
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA
| | - Jessica S Ancker
- Division of Health Informatics, Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, New York, USA
| | - Curtis J Donskey
- Geriatric Research, Education, and Clinical Center, Cleveland Veterans Affairs Medical Center, Cleveland, Ohio, USA
| | - Abhishek Deshpande
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA.,Center for Value-Based Care Research, Cleveland Clinic Community Care, Cleveland Clinic, Cleveland, Ohio, USA.,Department of Infectious Diseases, Cleveland Clinic, Cleveland, Ohio, USA
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Mizusawa M, Carroll KC. Advances and required improvements in methods to diagnosing Clostridioides difficile infections in the healthcare setting. Expert Rev Mol Diagn 2021; 21:311-321. [PMID: 33682564 DOI: 10.1080/14737159.2021.1900737] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Clostrididioides difficile is associated with adverse clinical outcomes and increased morbidity, mortality, length of hospital stay, and health-care costs.Areas Covered: We searched relevant papers in PubMed for the last 10 years. In major papers, we scanned the bibliographies to ensure that important articles were included. This review addresses the evolving epidemiology of Clostridioides difficile infection (CDI) and discusses novel methods/approaches for improving the diagnosis of this important disease. EXPERT OPINION No single diagnostic test to date has demonstrated optimum sensitivity and specificity for detection of CDI. Many institutions have developed multi-step algorithms consistent with guidelines established by various professional societies. Some institutions have successfully tried to improve the pretest probability of molecular assays by implementing appropriate sample rejection criteria and establishing best practice alerts at the time of electronic order entry. Others have established PCR cycle threshold cutoffs to attempt to differentiate symptomatic patients from asymptomatic carriers or to make predictions about severity of disease with variable success. As research advances our understanding of C. difficile pathogenesis and pathophysiology, more information on CDI specific biomarkers is emerging. Finally, assessments of the microbiome and metabolome may expand the diagnostic armamentarium with advances in mass spectrometry and sequencing technologies.
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Affiliation(s)
- Masako Mizusawa
- Section of Infectious Diseases, Department of Internal Medicine, University of Missouri, Kansas City, Missouri, Kansas City, MO, USA
| | - Karen C Carroll
- Director Division of Medical Microbiology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Zacharioudakis IM, Zervou FN, Phillips MS, Aguero-Rosenfeld ME. Rate and consequences of missed Clostridioides (Clostridium) difficile infection diagnosis from nonreporting of Clostridioides difficile results of the multiplex GI PCR panel: experience from two-hospitals. Diagn Microbiol Infect Dis 2021; 100:115346. [PMID: 33647544 DOI: 10.1016/j.diagmicrobio.2021.115346] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 01/18/2021] [Accepted: 02/09/2021] [Indexed: 01/28/2023]
Abstract
INTRODUCTION It is common among microbiology laboratories to blind the Clostridioides difficile (C. difficile) BioFire FilmArray GI Panel result in fear of overdiagnosis. METHODS We examined the rate of missed community-onset C. difficile infection (CDI) diagnosis and associated outcomes. Adult patients with FilmArray GI Panel positive for C. difficile on hospital admission who lacked dedicated C. difficile testing were included. RESULTS Among 144 adults with a FilmArray Panel positive for C. difficile, 18 did not have concurrent dedicated C. difficile testing. Eight patients were categorized as possible, 5 as probable and 4 as definite cases of missed CDI diagnosis. We observed associated delays in initiation of appropriate therapy, intensive care unit admissions, hospital readmissions, colorectal surgery and death/discharge to hospice. Five out of 17 lacked risk factors for CDI. CONCLUSION The practice of concealing C. difficile FilmArray GI Panel results needs to be reconsidered in patients presenting with community-onset colitis.
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Affiliation(s)
- Ioannis M Zacharioudakis
- Division of Infectious Diseases and Immunology, Department of Medicine, NYU School of Medicine, New York, NY, USA.
| | - Fainareti N Zervou
- Division of Infectious Diseases and Immunology, Department of Medicine, NYU School of Medicine, New York, NY, USA
| | - Michael S Phillips
- Division of Infectious Diseases and Immunology, Department of Medicine, NYU School of Medicine, New York, NY, USA
| | - Maria E Aguero-Rosenfeld
- Division of Infectious Diseases and Immunology, Department of Medicine, NYU School of Medicine, New York, NY, USA; Department of Pathology, NYU School of Medicine, New York, NY, USA
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Wolf J, Kalocsai K, Fortuny C, Lazar S, Bosis S, Korczowski B, Petit A, Bradford D, Croos-Dabrera R, Incera E, Melis J, van Maanen R. Safety and Efficacy of Fidaxomicin and Vancomycin in Children and Adolescents with Clostridioides (Clostridium) difficile Infection: A Phase 3, Multicenter, Randomized, Single-blind Clinical Trial (SUNSHINE). Clin Infect Dis 2020; 71:2581-2588. [PMID: 31773143 PMCID: PMC7744996 DOI: 10.1093/cid/ciz1149] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 11/26/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Fidaxomicin, a narrow-spectrum antibiotic approved for Clostridioides (Clostridium) difficile infection (CDI) in adults, is associated with lower rates of recurrence than vancomycin; however, pediatric data are limited. This multicenter, investigator-blind, phase 3, parallel-group trial assessed the safety and efficacy of fidaxomicin in children. METHODS Patients aged <18 years with confirmed CDI were randomized 2:1 to 10 days of treatment with fidaxomicin (suspension or tablets, twice daily) or vancomycin (suspension or tablets, 4 times daily). Safety assessments included treatment-emergent adverse events. The primary efficacy end point was confirmed clinical response (CCR), 2 days after the end of treatment (EOT). Secondary end points included global cure (GC; CCR without CDI recurrence) 30 days after EOT (end of study; EOS). Plasma and stool concentrations of fidaxomicin and its active metabolite OP-1118 were measured. RESULTS Of 148 patients randomized, 142 were treated (30 <2 years old). The proportion of participants with treatment-emergent adverse events was similar with fidaxomicin (73.5%) and vancomycin (75.0%). Of 3 deaths in the fidaxomicin arm during the study, none were CDI or treatment related. The rate of CCR at 2 days after EOT was 77.6% (76 of 98 patients) with fidaxomicin and 70.5% (31 of 44) with vancomycin, whereas the rate of GC at EOS was significantly higher in participants receiving fidaxomicin (68.4% vs 50.0%; adjusted treatment difference, 18.8%; 95% confidence interval, 1.5%-35.3%). Systemic absorption of fidaxomicin and OP-1118 was minimal, and stool concentrations were high. CONCLUSIONS Compared with vancomycin, fidaxomicin was well tolerated and demonstrated significantly higher rates of GC in children and adolescents with CDI. CLINICAL TRIALS REGISTRATION NCT02218372.
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Affiliation(s)
- Joshua Wolf
- Department of Infectious Diseases, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Krisztina Kalocsai
- Gyermekinfektológia, Dél-pesti Centrumkórház Országos Haematológiai és Infektológiai Intézet, Budapest, Hungary
| | - Claudia Fortuny
- Department of Paediatric Infectious Diseases, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - Stefan Lazar
- Department of Pediatrics, Clinical Hospital for Infectious and Tropical Diseases “Dr. Victor Babeș,” Bucharest, Romania
| | - Samantha Bosis
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Bartosz Korczowski
- Department of Pediatrics and Pediatric Gastroenterology, University of Rzeszów, Rzeszów, Poland
| | - Arnaud Petit
- Department of Pediatric Hematology and Oncology, Hôpital Trousseau, HUEP, APHP, Paris, France
- Faculty of Medicine, Sorbonne Université, UMRS 938, GRC MyPAC, Paris, France
| | | | | | | | - Joost Melis
- Astellas Pharma B.V., Leiden, the Netherlands
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Oba J, Silva CA, Toma RK, Carvalho WBD, Delgado AF. COVID-19 and coinfection with Clostridioides (Clostridium) difficile in an infant with gastrointestinal manifestation. EINSTEIN-SAO PAULO 2020; 18:eRC6048. [PMID: 33295435 PMCID: PMC7690928 DOI: 10.31744/einstein_journal/2020rc6048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 10/08/2020] [Indexed: 01/19/2023] Open
Abstract
We report the clinical case of an infant with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection with gastrointestinal signs and symptoms, predominantly vomiting. The patient also had colic, poor feeding, mild diarrhea and mild rhinorrhea without fever. The child had evidence of altered coagulation, increased interleukin 10, moderate dehydration and she was admitted to the pediatric intensive care unit. Simultaneously, the patient was diagnosed as Clostridioides difficile infection, which possibly may have facilitated the persistence of SARS-CoV-2 in feces, for more than 27 days, even after the nasopharyngeal test turned negative. This coinfection might exacerbate the gastrointestinal signs and symptoms and increased the possibility of fecal-oral transmission of SARS-CoV-2 and Clostridioides . The patient was breastfed and received complementary infant formula, hydrated with intravenous fluid, and was discharged without complications, 4 days after admission.
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Affiliation(s)
- Jane Oba
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Clovis Artur Silva
- Instituto da Criança, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | - Werther Brunow de Carvalho
- Instituto da Criança, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Artur Figueiredo Delgado
- Instituto da Criança, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
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Simon M, Levy EI, Vandenplas Y. Safety considerations when managing gastro-esophageal reflux disease in infants. Expert Opin Drug Saf 2020; 20:37-49. [PMID: 33115255 DOI: 10.1080/14740338.2020.1843630] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Introduction: Gastro-esophageal reflux disease (GERD) in infants is worldwide diagnosed with increasing frequency, resulting in an increasing number of infants exposed to treatment. In this review, we focus on the safety of therapeutic options. Areas covered: English articles were searched from 1990 until May 2020 in PubMed and Google Scholar. Evidence suggests that non-pharmacological treatment is often effective and safe. Guidelines restrict pharmacological treatment to acid-suppressive medication, which is associated with adverse effects, often related to gastro-intestinal dysbiosis and consequences of the latter. Aluminum-free alginates have some efficacy and are not associated with relevant adverse effects. Especially in infants, GERD is often nonacid related. Prokinetics are not recommended because of lack of efficacy and numerous adverse effects. Expert opinion: Pediatric trials are underpowered regarding adverse effects. The number of infants exposed to anti-secretory agents is increasing worldwide, often without indication. Informing healthcare providers about adverse effects of acid-secretory medication may contribute to a more rational use. Acid inhibiting agents such as alginates are a drug class associated with limited efficacy and devoid of serious adverse effects. Regarding prokinetics, the risk of adverse effects outweighs the benefit. Reassurance of parents and nutritional management of GERD in infants is effective and safe.
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Affiliation(s)
- Melina Simon
- KidZ Health Castle, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel , Brussels, Belgium
| | - Elvira Ingrid Levy
- KidZ Health Castle, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel , Brussels, Belgium
| | - Yvan Vandenplas
- KidZ Health Castle, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel , Brussels, Belgium
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Couturier J, Franconeri L, Janoir C, Ferraris L, Syed-Zaidi R, Youssouf A, Gateau C, Hoys S, Aires J, Barbut F. Characterization of Non-Toxigenic Clostridioides difficile Strains Isolated from Preterm Neonates and In Vivo Study of Their Protective Effect. J Clin Med 2020; 9:jcm9113650. [PMID: 33202811 PMCID: PMC7696784 DOI: 10.3390/jcm9113650] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/06/2020] [Accepted: 11/09/2020] [Indexed: 12/24/2022] Open
Abstract
In a previous monocentric study in preterm neonates (PN), we described a high Clostridioides difficile colonization rate (74%) with two uncommon non-toxigenic strains (NTCD) belonging to PCR-ribotype (RT) (CE)847 and (CE)032. To determine the extent of carriage of both NTCD in other spatio-temporal settings, strains isolated in PN stools from two multicenter cohorts were characterized by PCR-ribotyping, MLVA and MLST. We also evaluated the protective role of two NTCD from these RT against C. difficile infection in a hamster caecitis model. Animals were administered either each NTCD alone (n = 7), or followed by a 027 strain (n = 9). A control group received only the 027 strain (n = 8). Clinical activity and colonization by C. difficile in stools were monitored daily until death or sacrifice at D20. We isolated 18 RT(CE)032 (ST-83) strains and 2 RT(CE)847 (ST-26) strains among 247 PN from both cohorts. Within each RT, strains were genetically related. The survival rate was significantly increased when animals received a RT(CE)847 or (CE)032 strain before the 027 strain (4/9 deaths, p = 0.029; 1/9 death, p = 0.0004, respectively). We describe two predominant uncommon NTCD strains, in a PN population from different healthcare facilities. Both NTCD provide a potential protection against C. difficile infection.
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Affiliation(s)
- Jeanne Couturier
- Faculty of Pharmacy, Paris University, INSERM UMR S-1139, 4 Avenue de l’Observatoire, 75006 Paris, France; (L.F.); (J.A.); (F.B.)
- National Reference Center for Clostridioides difficile, Saint-Antoine Hospital, 184 rue du Faubourg Saint-Antoine, 75012 Paris, France; (L.F.); (R.S.-Z.); (A.Y.); (C.G.)
- Correspondence:
| | - Léa Franconeri
- National Reference Center for Clostridioides difficile, Saint-Antoine Hospital, 184 rue du Faubourg Saint-Antoine, 75012 Paris, France; (L.F.); (R.S.-Z.); (A.Y.); (C.G.)
| | - Claire Janoir
- Micalis Institute, INRA, AgroParisTech, Université Paris-Saclay, 92290 Châtenay-Malabry, France; (C.J.); (S.H.)
| | - Laurent Ferraris
- Faculty of Pharmacy, Paris University, INSERM UMR S-1139, 4 Avenue de l’Observatoire, 75006 Paris, France; (L.F.); (J.A.); (F.B.)
| | - Rabab Syed-Zaidi
- National Reference Center for Clostridioides difficile, Saint-Antoine Hospital, 184 rue du Faubourg Saint-Antoine, 75012 Paris, France; (L.F.); (R.S.-Z.); (A.Y.); (C.G.)
| | - Anlyata Youssouf
- National Reference Center for Clostridioides difficile, Saint-Antoine Hospital, 184 rue du Faubourg Saint-Antoine, 75012 Paris, France; (L.F.); (R.S.-Z.); (A.Y.); (C.G.)
| | - Cécile Gateau
- National Reference Center for Clostridioides difficile, Saint-Antoine Hospital, 184 rue du Faubourg Saint-Antoine, 75012 Paris, France; (L.F.); (R.S.-Z.); (A.Y.); (C.G.)
| | - Sandra Hoys
- Micalis Institute, INRA, AgroParisTech, Université Paris-Saclay, 92290 Châtenay-Malabry, France; (C.J.); (S.H.)
| | - Julio Aires
- Faculty of Pharmacy, Paris University, INSERM UMR S-1139, 4 Avenue de l’Observatoire, 75006 Paris, France; (L.F.); (J.A.); (F.B.)
| | - Frédéric Barbut
- Faculty of Pharmacy, Paris University, INSERM UMR S-1139, 4 Avenue de l’Observatoire, 75006 Paris, France; (L.F.); (J.A.); (F.B.)
- National Reference Center for Clostridioides difficile, Saint-Antoine Hospital, 184 rue du Faubourg Saint-Antoine, 75012 Paris, France; (L.F.); (R.S.-Z.); (A.Y.); (C.G.)
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Carius BM, Liang SY, Koyfman A, Long B. Clostridioides difficile infection evaluation and management in the emergency department. Am J Emerg Med 2020; 38:2203-2208. [DOI: 10.1016/j.ajem.2020.06.083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/24/2020] [Accepted: 06/28/2020] [Indexed: 11/15/2022] Open
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Schuster JE, Johnston SH, Piya B, Dulek DE, Wikswo ME, McHenry R, Browne H, Gautam R, Bowen MD, Vinjé J, Payne DC, Azimi P, Selvarangan R, Halasa N, Englund JA. Infectious Causes of Acute Gastroenteritis in US Children Undergoing Allogeneic Hematopoietic Cell Transplant: A Longitudinal, Multicenter Study. J Pediatric Infect Dis Soc 2020; 9:421-427. [PMID: 31550350 DOI: 10.1093/jpids/piz063] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 08/08/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND Acute gastroenteritis (AGE) in hematopoietic cell transplant (HCT) patients causes significant morbidity and mortality. Data regarding the longitudinal assessment of infectious pathogens during symptomatic AGE and asymptomatic periods, particularly in children, are limited. We investigated the prevalence of AGE-associated infectious pathogens in children undergoing allogeneic HCT. METHODS From March 2015 through May 2016, 31 pediatric patients at 4 US children's hospitals were enrolled and had stool collected weekly from pre-HCT through 100 days post-HCT for infectious AGE pathogens by molecular testing. Demographics, clinical symptoms, antimicrobials, vaccination history, and outcomes were manually abstracted from the medical record into a standardized case report form. RESULTS We identified a pathogen in 18% (38/206) of samples, with many detections occurring during asymptomatic periods. Clostridioides difficile was the most commonly detected pathogen in 39% (15/38) of positive specimens, although only 20% (3/15) of C. difficile-positive specimens were obtained from children with diarrhea. Detection of sapovirus, in 21% (8/38) of pathogen-positive specimens, was commonly associated with AGE, with 87.5% of specimens obtained during symptomatic periods. Norovirus was not detected, and rotavirus was detected infrequently. Prolonged shedding of infectious pathogens was rare. CONCLUSIONS This multicenter, prospective, longitudinal study suggests that the epidemiology of AGE pathogens identified from allogeneic HCT patients may be changing. Previously reported viruses, such as rotavirus and norovirus, may be less common due to widespread vaccination and institution of infection control precautions, and emerging viruses such as sapoviruses may be increasingly recognized due to the use of molecular diagnostics.
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Affiliation(s)
| | - Samantha H Johnston
- Department of Pediatrics, University of California San Francisco Benioff Children's Hospital Oakland, Nashville, Tennessee
| | - Bhinnata Piya
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Daniel E Dulek
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Mary E Wikswo
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Rendie McHenry
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Hannah Browne
- Oak Ridge Institute for Science and Education, Tennessee
| | - Rashi Gautam
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Michael D Bowen
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jan Vinjé
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Daniel C Payne
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Parvin Azimi
- Department of Pediatrics, University of California San Francisco Benioff Children's Hospital Oakland, Nashville, Tennessee
| | - Rangaraj Selvarangan
- Department of Pathology and Laboratory Medicine, Children's Mercy Kansas City, Missouri
| | - Natasha Halasa
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Janet A Englund
- Department of Pediatrics, Seattle Children's Hospital, Washington
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Levy EI, Hoang DM, Vandenplas Y. The effects of proton pump inhibitors on the microbiome in young children. Acta Paediatr 2020; 109:1531-1538. [PMID: 32027402 DOI: 10.1111/apa.15213] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 01/22/2020] [Accepted: 02/04/2020] [Indexed: 12/11/2022]
Abstract
AIM The use of proton pump inhibitor (PPI) treatments are increasing among paediatric patients worldwide. We aimed to review the effects of PPIs on the microbiome and its associated effect on the gastrointestinal, respiratory and metabolic systems. The role of probiotics is discussed. METHODS We searched for relevant articles published in English language in PubMed and Google Scholar. Articles were extracted using subject heading and key words of interest to the topic. RESULTS There is evidence that PPIs modify the microbiome of the mouth, gut and lungs. The specific adverse effects associated with PPIs were necrotising enterocolitis, late onset sepsis in premature infants, Clostridium difficile infection, asthma, obesity and small intestine bacterial overgrowth in young children. Studies on the use of probiotics to counteract adverse effects of PPIs were limited. CONCLUSION PPIs create dysbiosis of the microbiome in the mouth, gut and lungs in the paediatric population. Probiotics could restore dysbiosis but it has very poorly been studied if probiotics can counteract or prevent PPI induced adverse effects.
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Affiliation(s)
- Elvira I. Levy
- KidZ Health Castle Universitair Ziekenhuis Brussel Vrije Universiteit Brussel Brussels Belgium
| | - Delphine M. Hoang
- KidZ Health Castle Universitair Ziekenhuis Brussel Vrije Universiteit Brussel Brussels Belgium
| | - Yvan Vandenplas
- KidZ Health Castle Universitair Ziekenhuis Brussel Vrije Universiteit Brussel Brussels Belgium
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41
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Shankar S, Rosenbaum J. Chronic diarrhoea in children: A practical algorithm-based approach. J Paediatr Child Health 2020; 56:1029-1038. [PMID: 32725734 DOI: 10.1111/jpc.14986] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 04/05/2020] [Accepted: 05/10/2020] [Indexed: 12/17/2022]
Abstract
Diarrhoea is a leading cause of morbidity and mortality world-wide. Most diarrhoeal episodes are acute and infectious in origin. Diarrhoea lasting for longer than 4 weeks with no discernible infectious aetiology warrants thorough evaluation. The aim of this review is to elucidate an approach to evaluation of diarrhoea based on its pathophysiologic mechanisms with focus on aetiology, investigation and management of chronic diarrhoea. It includes a brief description of normal fluid homeostasis in the gut and pathophysiology of diarrhoea. Further, diarrhoea is classified as 'watery', 'fatty' and 'bloody' based on stool characteristics. Relevant history, physical examination findings, first and second-line investigations which help in differentiating the different types of diarrhoea are listed and an algorithmic approach to individual types of diarrhoea has been devised. Principles of management and recent advances in diagnostics and therapeutics of diarrhoea are briefly discussed.
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Affiliation(s)
- Sahana Shankar
- Consultant Pediatric Gastroenterologist, Department of Pediatrics, Mazumdar Shaw Medical Centre, Narayana Health, Bangalore, India.,Department of Gastroenterology and Clinical Nutrition, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Jeremy Rosenbaum
- Department of Gastroenterology and Clinical Nutrition, Royal Children's Hospital, Melbourne, Victoria, Australia
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42
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Pahud BA, Hassan F, Harrison CJ, Halasa NB, Chappell JD, Englund JA, Klein EJ, Szilagyi PG, Weinberg GA, Sherman AK, Polage C, Wikswo ME, McDonald LC, Payne DC, Selvarangan R. Detection of Clostridioides difficile by Real-time PCR in Young Children Does Not Predict Disease. Hosp Pediatr 2020; 10:555-562. [PMID: 32482733 DOI: 10.1542/hpeds.2020-0012] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVES Diagnosing Clostridioides difficile infections in young children with high asymptomatic colonization is challenging. We compared the frequency of C difficile detection by polymerase chain reaction (PCR) in healthy control (HC) children with those with acute gastroenteritis (AGE) and evaluated fecal-lactoferrin and organism load as possible indicators of true C difficile infection disease. METHODS Stool was collected from children <2 years old with AGE and from HCs. C difficile was detected by real-time PCR, and lactoferrin was measured by enzyme-linked immunosorbent assay. Clinical data were obtained via interviews and chart review. Mann-Whitney U test and χ2 tests were used for group comparisons. RESULTS Of 524 stools collected from 524 children (250 with AGE, 274 HCs), C difficile was detected less in children with AGE (14%, 36 of 250) than in HCs (28%, 76 of 274) stools (P < .0001). Among infants <1 year old (n = 297), C difficile was detected in 18% of children with AGE versus 32% of HCs (P < .005), and among children 1 to 2 years old (n = 227), C difficile was detected in 10% of children with AGE versus 21% of HCs (P < .02). There was no significant difference in C difficile PCR cycle threshold values between children with AGE and HCs or lactoferrin levels in C difficile PCR-positive versus -negative stools. CONCLUSIONS HC children <2 years of age had higher rates of C difficile detection by PCR than children with AGE; C difficile detection by real-time PCR alone is not a reliable means to diagnose C difficile disease in children <2 years old.
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Affiliation(s)
- Barbara A Pahud
- Children's Mercy Hospital Kansas City and University of Missouri, Kansas City, Kansas City, Missouri;
| | - Ferdaus Hassan
- Children's Mercy Hospital Kansas City and University of Missouri, Kansas City, Kansas City, Missouri
| | - Christopher J Harrison
- Children's Mercy Hospital Kansas City and University of Missouri, Kansas City, Kansas City, Missouri
| | - Natasha B Halasa
- Department of Pediatrics, School of Medicine, Vanderbilt University, Nashville, Tennessee
| | - James D Chappell
- Department of Pediatrics, School of Medicine, Vanderbilt University, Nashville, Tennessee
| | - Janet A Englund
- Department of Pediatrics, Seattle Children's Hospitals, Seattle, Washington
| | - Eileen J Klein
- Department of Pediatrics, Seattle Children's Hospitals, Seattle, Washington
| | - Peter G Szilagyi
- School of Medicine and Dentistry, University of Rochester, Rochester, New York
| | - Geoffrey A Weinberg
- School of Medicine and Dentistry, University of Rochester, Rochester, New York
| | - Ashley K Sherman
- Children's Mercy Hospital Kansas City and University of Missouri, Kansas City, Kansas City, Missouri
| | - Christopher Polage
- Department of Pathology and Laboratory Medicine, University of California-Davis Medical Center, Sacramento, California.,Clinical Microbiology Laboratory, Duke University Health System and Duke University, Durham, North Carolina; and
| | - Mary E Wikswo
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Daniel C Payne
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Rangaraj Selvarangan
- Children's Mercy Hospital Kansas City and University of Missouri, Kansas City, Kansas City, Missouri
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Miranda-Katz M, Parmar D, Dang R, Alabaster A, Greenhow TL. Epidemiology and Risk Factors for Community Associated Clostridioides difficile in Children. J Pediatr 2020; 221:99-106. [PMID: 32171559 DOI: 10.1016/j.jpeds.2020.02.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 02/03/2020] [Accepted: 02/05/2020] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To assess which risk factors are associated with community-associated Clostridioides difficile infection (CDI) in children. STUDY DESIGN This case control study was a retrospective review of all children 1-17 years of age with stool specimens sent for C difficile testing from January 1, 2012, to December 31, 2016. Cases and controls were children who had C difficile testing performed in the community or first 48 hours of hospital admission and >12 weeks after hospital discharge, with no prior positive C difficile testing in last 8 weeks, without other identified causes of diarrhea, and with clinical symptoms. Cases had positive confirmatory testing for C difficile. Controls had negative testing for C difficile and were matched to cases 1:1 by age and year of specimen collection. RESULTS The overall incidence rate of community-acquired CDI in this cohort was 13.7 per 100 000 children per year. There was a substantial increase in community-acquired CDI from 9.6 per 100 000 children per year in 2012 to a peak of 16.9 per 100 000 children per year in 2015 (Cochran-Armitage test for trend P = .002). The risk factors for community-acquired CDI included non-Hispanic ethnicity; amoxicillin-clavulanate, cephalosporin, and clindamycin use within the previous 12 weeks; a previous positive C difficile test within 6 months; and increased health care visits in the last year. CONCLUSIONS As rates of community-acquired CDI are increasing, enhanced antibiotic stewardship and recognition of health care disparities may ease the burden of community-acquired CDI.
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Affiliation(s)
| | - Deepika Parmar
- Department of Pediatrics, Kaiser Permanente Northern California, Oakland, CA
| | - Rebecca Dang
- Department of Pediatrics, Kaiser Permanente Northern California, Oakland, CA
| | - Amy Alabaster
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Tara L Greenhow
- Division of Infectious Diseases, Department of Pediatrics, Kaiser Permanente Northern California, San Francisco, CA.
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Gnocchi M, Gagliardi M, Gismondi P, Gaiani F, de’ Angelis GL, Esposito S. Updated Management Guidelines for Clostridioides difficile in Paediatrics. Pathogens 2020; 9:pathogens9040291. [PMID: 32316346 PMCID: PMC7238231 DOI: 10.3390/pathogens9040291] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 04/10/2020] [Accepted: 04/14/2020] [Indexed: 01/04/2023] Open
Abstract
Clostridioides difficile, formerly known as Clostridium difficile, causes infections (CDI) varying from self-limited diarrhoea to severe conditions, including toxic megacolon and bowel perforation. For this reason, a prompt diagnosis is fundamental to early treatment and the prevention of transmission. The aim of this article is to review diagnostic laboratory methods that are now available to detect C. difficile and to discuss the most recent recommendations on CDI treatment in children. Currently, there is no consensus on the best method for detecting C. difficile. Indeed, none of the available diagnostics possess at the same time high sensitivity and specificity, low cost and rapid turnaround times. Appropriate therapy is targeted according to age, severity and recurrence of the episode of infection, and the recent availability of new antibiotics opens new opportunities. De-escalation of antibiotics that are directly associated with CDI remains a priority and the cautious use of probiotics is recommended. Vancomycin represents the first-line therapy for CDI, although in children metronidazole can still be used as a first-line drug. Fidaxomicin is a new treatment option with equivalent initial response rates as vancomycin but lower relapse rates of CDI. Faecal microbiota transplantation should be considered for patients with multiple recurrences of CDI. Monoclonal antibodies and vaccines seem to represent a future perspective against CDI. However, only further studies will permit us to understand whether these new approaches could be effective in therapy and prevention of CDI in paediatric populations.
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Affiliation(s)
- Margherita Gnocchi
- Pediatric Clinic, Pietro Barilla Children’s Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (M.G.); (M.G.); (P.G.)
| | - Martina Gagliardi
- Pediatric Clinic, Pietro Barilla Children’s Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (M.G.); (M.G.); (P.G.)
| | - Pierpacifico Gismondi
- Pediatric Clinic, Pietro Barilla Children’s Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (M.G.); (M.G.); (P.G.)
| | - Federica Gaiani
- Unit of Gastroenterology and Digestive Endoscopy, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (F.G.); (G.L.d.A.)
| | - Gian Luigi de’ Angelis
- Unit of Gastroenterology and Digestive Endoscopy, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (F.G.); (G.L.d.A.)
| | - Susanna Esposito
- Pediatric Clinic, Pietro Barilla Children’s Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (M.G.); (M.G.); (P.G.)
- Pietro Barilla Children’s Hospital, Department of Medicine and Surgery, University of Parma, Via Gramsci 14, 43126 Parma, Italy
- Correspondence: ; Tel.: +39-0521-903524
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45
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Madden GR, Enfield KB, Sifri CD. Patient Outcomes With Prevented vs Negative Clostridioides difficile Tests Using a Computerized Clinical Decision Support Tool. Open Forum Infect Dis 2020; 7:ofaa094. [PMID: 32328506 PMCID: PMC7166115 DOI: 10.1093/ofid/ofaa094] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 03/16/2020] [Indexed: 02/07/2023] Open
Abstract
Background Overtesting and overdiagnosis of Clostridioides difficile infection are suspected to be common. Reducing inappropriate testing through interventions designed to promote evidence-based diagnostic testing (ie, diagnostic stewardship) may improve C. difficile test utilization. However, the safety of these interventions is not well understood despite the potential risk for missed or delayed diagnoses. Methods This retrospective case-control study examined the outcomes of patients admitted to the University of Virginia Medical Center following introduction of a computerized clinical decision support tool without hard-stops designed to reduce inappropriate tests. Outcomes were compared between patients with a prevented C. difficile nucleic acid amplification test and those with a negative result. Chart reviews were performed for patients with a subsequent positive within 7 days, as well as those patients who received C. difficile-active antibiotics after implementation of the computerized clinical decision support tool. Results Multivariate analysis of 637 cases (490 negative, 147 prevented) showed that a prevented test was not significantly associated with the primary composite outcome (inpatient mortality or intensive care unit transfer) compared with a negative test (adjusted odds ratio, 0.912; P = .747). Fifty-four of 147 (37%) prevented tests were followed by a completed test within 7 days; 11 of these results were positive, resulting in a potential delay in diagnosis. Individual case reviews found that either clinical changes warranted the delay in testing or no adverse events occurred attributable to C. difficile infection. C. difficile treatment without a positive test was not identified. Conclusions Diagnostic stewardship of C. difficile testing using computerized clinical decision support may be both safe and effective for reducing inappropriate inpatient testing.
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Affiliation(s)
- Gregory R Madden
- Division of Infectious Diseases & International Health, Department of Medicine, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Kyle B Enfield
- Division of Pulmonary & Critical Care Medicine, Department of Medicine, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Costi D Sifri
- Division of Infectious Diseases & International Health, Department of Medicine, University of Virginia School of Medicine, Charlottesville, Virginia, USA.,Office of Hospital Epidemiology/Infection Prevention & Control, University of Virginia School of Medicine, Charlottesville, Virginia, USA
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Characterization of Circulating Clostridium difficile Strains, Host Response and Intestinal Microbiome in Hospitalized Children With Diarrhea. Pediatr Infect Dis J 2020; 39:221-228. [PMID: 31876614 DOI: 10.1097/inf.0000000000002559] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Clostridium difficile is capable of causing severe enterocolitis in adults. The significance of toxin-producing C. difficile in children with diarrhea is unclear and practice differs on whether to institute treatment. We aimed to characterize the microbiome in relation to the presence of C. difficile and co-infection with other pathogens and to describe host response to infection. METHODS Participants were children with acute diarrhea, 0-16 years of age, from whom stool samples had been submitted to the hospital laboratory for routine microbiology/virology. Convenience sampling was used for 50 prospective and 150 retrospective samples. No participants were treated for C. difficile. Rates of culture positivity for C. difficile, presence of toxin and PCR-ribotype were compared between age groups. Presence of other potential pathogens, comorbidities and complications were recorded. Microbiotal diversity was measured by 16S profiling. RESULTS Nineteen of 77 (25%) children <2 years of age and 13 of 119 (11%) children >2 years of age were C. difficile positive, of whom 10 (53%) and 9 (69%), respectively, carried toxigenic strains. Increased Shannon diversity was seen in children carrying C. difficile, with altered milieu. Presence of C. difficile was not associated with adverse clinical outcomes. In stools containing both Norovirus and C. difficile, there was increased relative abundance of verrucomicrobia. CONCLUSIONS Children with diarrhea regularly carried toxigenic and non-toxigenic strains of C. difficile, demonstrating enhanced microbiotal diversity, and change in milieu, without apparent morbidity. This unexpected finding is contrary to that seen in adults with C. difficile disease.
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Reducing C. difficile in children: An agent-based modeling approach to evaluate intervention effectiveness. Infect Control Hosp Epidemiol 2020; 41:522-530. [PMID: 32052722 DOI: 10.1017/ice.2020.14] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Clostridioides difficile infection (CDI) is rapidly increasing in children's hospitals nationwide. Thus, we aimed to compare the effectiveness of 9 infection prevention interventions and 6 multiple-intervention bundles at reducing hospital-onset CDI and asymptomatic C. difficile colonization. DESIGN Agent-based simulation model of C. difficile transmission. SETTING Computer-simulated, 80-bed freestanding, tertiary-care pediatric hospital, including 8 identical wards with 10 single-bed patient rooms each. PARTICIPANTS The model includes 5 distinct agent types: patients, visitors, caregivers, nurses, and physicians. INTERVENTIONS Daily and terminal environmental disinfection, screening at admission, reduced intrahospital patient transfers, healthcare worker (HCW), visitor, and patient hand hygiene, and HCW and visitor contact precautions. RESULTS The model predicted that daily environmental disinfection with sporicidal product, combined with screening for asymptomatic C. difficile at admission, was the most effective 2-pronged infection prevention bundle, reducing hospital-onset CDI by 62.0% and asymptomatic colonization by 88.4%. Single-intervention strategies, including daily disinfection, terminal disinfection, asymptomatic screening at admission, HCW hand hygiene, and patient hand hygiene, as well as decreasing intrahospital patient transfers, all also reduced both hospital-onset CDI and asymptomatic colonization in the model. Visitor hand hygiene and visitor and HCW contact precautions were not effective at reducing either measure. CONCLUSIONS Hospitals can achieve substantial reduction in hospital-onset CDIs by implementing a small number of highly effective interventions.
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Taniyama Y, Shoji K, Hashimoto M, Ishuguro A, Miyairi I. Impact of the 3-day rule for stool culture in a children's hospital. Pediatr Int 2020; 62:246-247. [PMID: 32104991 DOI: 10.1111/ped.14100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 10/12/2019] [Accepted: 11/26/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Yoshihiko Taniyama
- Center for Postgraduate Education and Training, National Center for Child Health and Development, Tokyo, Japan
| | - Kensuke Shoji
- Division of Infectious Diseases, Department of Medical Subspecialties, National Center for Child Health and Development, Tokyo, Japan
| | - Miku Hashimoto
- Division of Microbiology, Department of Clinical Laboratory Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Akira Ishuguro
- Center for Postgraduate Education and Training, National Center for Child Health and Development, Tokyo, Japan
| | - Isao Miyairi
- Division of Infectious Diseases, Department of Medical Subspecialties, National Center for Child Health and Development, Tokyo, Japan.,Department of Microbiology, Immunology, and Biochemistry, University of Tennessee Health Science Center, Memphis, TN, USA
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Khalil A, Hendaus MA, Elmagboul E, Mohamed A, Deshmukh A, Elmasoudi A. Incidence Of Clostridium difficile Infection And Associated Risk Factors Among Hospitalized Children In Qatar. Ther Clin Risk Manag 2019; 15:1343-1350. [PMID: 31819461 PMCID: PMC6874111 DOI: 10.2147/tcrm.s229540] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 11/03/2019] [Indexed: 12/20/2022] Open
Abstract
Background Clostridium difficile infection (CDI) is the single most common cause of nosocomial diarrhea in both adults and children. There is a deficiency in the literature regarding the incidence and associated risk factors in hospitalized children. This study aimed to determine the incidence of CDI and its associated risk factors. Methods A retrospective study was conducted among 200 pediatric patients admitted to the pediatric ward at Hamad General Hospital (HGH) in Qatar. The study collected data from January 1, 2015 till December 2015. Univariate and multivariate logistic regression methods were used to assess each risk factor of CDI. Results Among the 200 patients, 23 were diagnosed with CDI (incidence: 5.9 per 1000 inpatient admission cases). The mean patient age (±SD) was 6.4 ± 3.4 years. The incidence of antibiotic exposure (22.5; 95% CI: 15.0–38.7; P <0.001), prolonged hospitalization (28.9; 95% CI: 17.1–43.3; P <0.001), and enteral feeding (33.3; 95% CI: 15.9–55.1; P <0.001) were significant risk factors for CDI. Conclusion Antibiotics exposure, prolonged hospitalization, and enteral feeding were significant risk factors of CDI in hospitalized children; thus, emphasizing the importance of antimicrobial stewardship programs in the prevention of hospital-associated infection. Further prospective studies are needed to assess the trend in incidence and to identify other risk factors of CDI.
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Affiliation(s)
- Ahmed Khalil
- Department of Pharmacy, Hamad General Hospital, Doha, Qatar
| | - Mohamed A Hendaus
- Department of Pediatrics, Hamad Medical Corporation, Sidra Medicine, Weill Cornell Medicine, Doha, Qatar
| | - Emad Elmagboul
- Microbiology Laboratory, Hamad General Hospital, Doha, Qatar
| | - Asmaa Mohamed
- Department of Pharmacy, Hamad General Hospital, Doha, Qatar
| | - Anand Deshmukh
- Microbiology Laboratory, Hamad General Hospital, Doha, Qatar
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Tomioka Y, Okata Y, Bitoh Y, Tsugawa J, Nishijima E. Acute Onset Rectal Prolapse with a Pseudomembranous Covering. J Pediatr 2019; 215:281-281.e1. [PMID: 31570154 DOI: 10.1016/j.jpeds.2019.08.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 08/19/2019] [Accepted: 08/21/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Yuichiro Tomioka
- Division of Pediatric Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan; Department of Pediatric Surgery, Takatsuki Hospital, Takatsuki, Japan
| | - Yuichi Okata
- Division of Pediatric Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yuko Bitoh
- Division of Pediatric Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Jiro Tsugawa
- Department of Pediatric Surgery, Takatsuki Hospital, Takatsuki, Japan
| | - Eiji Nishijima
- Department of Pediatric Surgery, Takatsuki Hospital, Takatsuki, Japan
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