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Leal J, Shen Y, Faris P, Dalton B, Sabuda D, Ocampo W, Bresee L, Chow B, Fletcher JR, Henderson E, Kaufman J, Kim J, Raman M, Kraft S, Lamont NC, Larios O, Missaghi B, Holroyd-Leduc J, Louie T, Conly J. Effectiveness of Bio-K+ for the prevention of Clostridioides difficile infection: Stepped-wedge cluster-randomized controlled trial. Infect Control Hosp Epidemiol 2024; 45:443-451. [PMID: 38073551 PMCID: PMC11007362 DOI: 10.1017/ice.2023.169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 05/20/2023] [Accepted: 07/08/2023] [Indexed: 04/10/2024]
Abstract
OBJECTIVE To evaluate the impact of administering probiotics to prevent Clostridioides difficile infection (CDI) among patients receiving therapeutic antibiotics. DESIGN Stepped-wedge cluster-randomized trial between September 1, 2016, and August 31, 2019. SETTING This study was conducted in 4 acute-care hospitals across an integrated health region. PATIENTS Hospitalized patients, aged ≥55 years. METHODS Patients were given 2 probiotic capsules daily (Bio-K+, Laval, Quebec, Canada), containing 50 billion colony-forming units of Lactobacillus acidophilus CL1285, L. casei LBC80R, and L. rhamnosus CLR2. We measured hospital-acquired CDI (HA-CDI) and the number of positive C. difficile tests per 10,000 patient days as well as adherence to administration of Bio-K+ within 48 and 72 hours of antibiotic administration. Mixed-effects generalized linear models, adjusted for influenza admissions and facility characteristics, were used to evaluate the impact of the intervention on outcomes. RESULTS Overall adherence of Bio-K+ administration ranged from 76.9% to 84.6% when stratified by facility and periods. Rates of adherence to administration within 48 and 72 hours of antibiotic treatment were 60.2% -71.4% and 66.7%-75.8%, respectively. In the adjusted analysis, there was no change in HA-CDI (incidence rate ratio [IRR], 0.92; 95% confidence interval [CI], 0.68-1.23) or C. difficile positivity rate (IRR, 1.05; 95% CI, 0.89-1.24). Discharged patients may not have received a complete course of Bio-K+. Our hospitals had a low baseline incidence of HA-CDI. Patients who did not receive Bio-K+ may have differential risks of acquiring CDI, introducing selection bias. CONCLUSIONS Hospitals considering probiotics as a primary prevention strategy should consider the baseline incidence of HA-CDI in their population and timing of probiotics relative to the start of antimicrobial administration.
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Affiliation(s)
- Jenine Leal
- Infection Prevention and Control, Alberta Health Services, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Microbiology, Immunology, and Infectious Diseases, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- O’Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Ye Shen
- Infection Prevention and Control, Alberta Health Services, Alberta, Canada
| | - Peter Faris
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Analytics, Alberta Health Services, Alberta, Canada
| | - Bruce Dalton
- Pharmacy Services, Alberta Health Services, Calgary, Alberta, Canada
| | - Deana Sabuda
- Pharmacy Services, Alberta Health Services, Calgary, Alberta, Canada
| | - Wrechelle Ocampo
- O’Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
- W21 Research and Innovation Centre, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada
| | - Lauren Bresee
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- O’Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Blanda Chow
- Infection Prevention and Control, Alberta Health Services, Alberta, Canada
| | - Jared R. Fletcher
- Department of Health and Physical Education, Mount Royal University, Calgary, Alberta, Canada
| | - Elizabeth Henderson
- Infection Prevention and Control, Alberta Health Services, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Microbiology, Immunology, and Infectious Diseases, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- O’Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Jaime Kaufman
- W21 Research and Innovation Centre, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada
| | - Joseph Kim
- Infection Prevention and Control, Alberta Health Services, Alberta, Canada
- Department of Medicine, Cumming School of Medicine University of Calgary, Calgary, Alberta, Canada
| | - Maitreyi Raman
- Calvin, Phoebe, and Joan Snyder Institute for Chronic Diseases, University of Calgary, Calgary, Alberta, Canada
| | - Scott Kraft
- W21 Research and Innovation Centre, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada
| | - Nicole C. Lamont
- W21 Research and Innovation Centre, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada
| | - Oscar Larios
- Infection Prevention and Control, Alberta Health Services, Alberta, Canada
- Department of Medicine, Cumming School of Medicine University of Calgary, Calgary, Alberta, Canada
- Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada
| | - Bayan Missaghi
- Infection Prevention and Control, Alberta Health Services, Alberta, Canada
- Department of Medicine, Cumming School of Medicine University of Calgary, Calgary, Alberta, Canada
- Calvin, Phoebe, and Joan Snyder Institute for Chronic Diseases, University of Calgary, Calgary, Alberta, Canada
| | - Jayna Holroyd-Leduc
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- O’Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, Cumming School of Medicine University of Calgary, Calgary, Alberta, Canada
| | - Thomas Louie
- Infection Prevention and Control, Alberta Health Services, Alberta, Canada
- Department of Microbiology, Immunology, and Infectious Diseases, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, Cumming School of Medicine University of Calgary, Calgary, Alberta, Canada
| | - John Conly
- Infection Prevention and Control, Alberta Health Services, Alberta, Canada
- Department of Microbiology, Immunology, and Infectious Diseases, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- O’Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, Cumming School of Medicine University of Calgary, Calgary, Alberta, Canada
- Calvin, Phoebe, and Joan Snyder Institute for Chronic Diseases, University of Calgary, Calgary, Alberta, Canada
- Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada
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Okhuysen PC, Ramesh MS, Louie T, Kiknadze N, Torre-Cisneros J, de Oliveira CM, Van Steenkiste C, Stychneuskaya A, Garey KW, Garcia-Diaz J, Li J, Duperchy E, Chang BY, Sukbuntherng J, Montoya JG, Styles L, Clow F, James D, Dubberke ER, Wilcox M. A Randomized, Double-Blind, Phase 3 Safety and Efficacy Study of Ridinilazole Versus Vancomycin for Treatment of Clostridioides difficile Infection: Clinical Outcomes With Microbiome and Metabolome Correlates of Response. Clin Infect Dis 2024:ciad792. [PMID: 38305378 DOI: 10.1093/cid/ciad792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND Exposure to antibiotics predisposes to dysbiosis and Clostridioides difficile infection (CDI) that can be severe, recurrent (rCDI), and life-threatening. Nonselective drugs that treat CDI and perpetuate dysbiosis are associated with rCDI, in part due to loss of microbiome-derived secondary bile acid (SBA) production. Ridinilazole is a highly selective drug designed to treat CDI and prevent rCDI. METHODS In this phase 3 superiority trial, adults with CDI, confirmed with a stool toxin test, were randomized to receive 10 days of ridinilazole (200 mg twice daily) or vancomycin (125 mg 4 times daily). The primary endpoint was sustained clinical response (SCR), defined as clinical response and no rCDI through 30 days after end of treatment. Secondary endpoints included rCDI and change in relative abundance of SBAs. RESULTS Ridinilazole and vancomycin achieved an SCR rate of 73% versus 70.7%, respectively, a treatment difference of 2.2% (95% CI: -4.2%, 8.6%). Ridinilazole resulted in a 53% reduction in recurrence compared with vancomycin (8.1% vs 17.3%; 95% CI: -14.1%, -4.5%; P = .0002). Subgroup analyses revealed consistent ridinilazole benefit for reduction in rCDI across subgroups. Ridinilazole preserved microbiota diversity, increased SBAs, and did not increase the resistome. Conversely, vancomycin worsened CDI-associated dysbiosis, decreased SBAs, increased Proteobacteria abundance (∼3.5-fold), and increased the resistome. CONCLUSIONS Although ridinilazole did not meet superiority in SCR, ridinilazole greatly reduced rCDI and preserved microbiome diversity and SBAs compared with vancomycin. These findings suggest that treatment of CDI with ridinilazole results in an earlier recovery of gut microbiome health. Clinical Trials Registration.Ri-CoDIFy 1 and 2: NCT03595553 and NCT03595566.
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Affiliation(s)
- Pablo C Okhuysen
- Department of Infectious Diseases, Infection Control, and Employee Heatlh, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | - Thomas Louie
- Foothills Medical Center and University of Calgary, Calgary, Canada
| | | | - Julian Torre-Cisneros
- Reina Sofia University Hospital-IMIBIC, University of Córdoba, CIBERINFEC, Cordoba, Spain
| | | | | | | | - Kevin W Garey
- University of Houston College of Pharmacy, Houston, Texas, USA
| | | | - Jianling Li
- Summit Therapeutics, Menlo Park, California, USA
| | | | | | | | - Jose G Montoya
- Summit Therapeutics, Menlo Park, California, USA
- Dr. Jack S. Remington Laboratory for Specialty Diagnostics, Palo Alto Medical Foundation, Palo Alto, California, USA
| | - Lori Styles
- Summit Therapeutics, Menlo Park, California, USA
| | - Fong Clow
- Summit Therapeutics, Menlo Park, California, USA
| | | | - Erik R Dubberke
- Washington University School of Medicine, St.Louis, Missouri, USA
| | - Mark Wilcox
- Leeds Teaching Hospitals and University of Leeds, School of Medicine, Leeds, United Kingdom
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3
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Bresee LC, Lamont N, Ocampo W, Holroyd-Leduc J, Sabuda D, Leal J, Dalton B, Kaufman J, Missaghi B, Kim J, Larios OE, Henderson E, Raman M, Fletcher JR, Faris P, Kraft S, Shen Y, Louie T, Conly JM. Implementation strategies for hospital-based probiotic administration in a stepped-wedge cluster randomized trial design for preventing hospital-acquired Clostridioides difficile infection. BMC Health Serv Res 2023; 23:1386. [PMID: 38082421 PMCID: PMC10714625 DOI: 10.1186/s12913-023-10350-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 11/17/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Clostridioides difficile infection (CDI) is associated with considerable morbidity and mortality in hospitalized patients, especially among older adults. Probiotics have been evaluated to prevent hospital-acquired (HA) CDI in patients who are receiving systemic antibiotics, but the implementation of timely probiotic administration remains a challenge. We evaluated methods for effective probiotic implementation across a large health region as part of a study to assess the real-world effectiveness of a probiotic to prevent HA-CDI (Prevent CDI-55 +). METHODS We used a stepped-wedge cluster-randomized controlled trial across four acute-care adult hospitals (n = 2,490 beds) to implement the use of the probiotic Bio-K + ® (Lactobacillus acidophilus CL1285®, L. casei LBC80R® and L. rhamnosus CLR2®; Laval, Quebec, Canada) in patients 55 years and older receiving systemic antimicrobials. The multifaceted probiotic implementation strategy included electronic clinical decision support, local site champions, and both health care provider and patient educational interventions. Focus groups were conducted during study implementation to identify ongoing barriers and facilitators to probiotic implementation, guiding needed adaptations of the implementation strategy. Focus groups were thematically analyzed using the Theoretical Domains Framework and the Consolidated Framework of Implementation Research. RESULTS A total of 340 education sessions with over 1,800 key partners and participants occurred before and during implementation in each of the four hospitals. Site champions were identified for each included hospital, and both electronic clinical decision support and printed educational resources were available to health care providers and patients. A total of 15 individuals participated in 2 focus group and 7 interviews. Key barriers identified from the focus groups resulted in adaptation of the electronic clinical decision support and the addition of nursing education related to probiotic administration. As a result of modifying implementation strategies for identified behaviour change barriers, probiotic adherence rates were from 66.7 to 75.8% at 72 h of starting antibiotic therapy across the four participating acute care hospitals. CONCLUSIONS Use of a barrier-targeted multifaceted approach, including electronic clinical decision support, education, focus groups to guide the adaptation of the implementation plan, and local site champions, resulted in a high probiotic adherence rate in the Prevent CDI-55 + study.
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Affiliation(s)
- Lauren C Bresee
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- O'Brien Institute of Public Health, University of Calgary, Calgary, AB, Canada
| | - Nicole Lamont
- W21 Research and Innovation Centre, University of Calgary and Alberta Health Services, Calgary, AB, Canada
| | - Wrechelle Ocampo
- W21 Research and Innovation Centre, University of Calgary and Alberta Health Services, Calgary, AB, Canada
| | - Jayna Holroyd-Leduc
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- O'Brien Institute of Public Health, University of Calgary, Calgary, AB, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, AB, Canada
| | - Deana Sabuda
- Pharmacy Services, Alberta Health Services, Calgary, AB, Canada
| | - Jenine Leal
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- O'Brien Institute of Public Health, University of Calgary, Calgary, AB, Canada
- Infection Prevention and Control, Alberta Health Services, Calgary, AB, Canada
- Department of Microbiology, Immunology, and Infectious Diseases, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Bruce Dalton
- Pharmacy Services, Alberta Health Services, Calgary, AB, Canada
| | - Jaime Kaufman
- W21 Research and Innovation Centre, University of Calgary and Alberta Health Services, Calgary, AB, Canada
| | - Bayan Missaghi
- Department of Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, AB, Canada
- Infection Prevention and Control, Alberta Health Services, Calgary, AB, Canada
- Calvin, Phoebe, and Joan Snyder Institute for Chronic Diseases, University of Calgary and Alberta Health Services, Calgary, AB, Canada
| | - Joseph Kim
- Department of Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, AB, Canada
- Infection Prevention and Control, Alberta Health Services, Calgary, AB, Canada
| | - Oscar E Larios
- Department of Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, AB, Canada
- Infection Prevention and Control, Alberta Health Services, Calgary, AB, Canada
- Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, AB, Canada
| | - Elizabeth Henderson
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- O'Brien Institute of Public Health, University of Calgary, Calgary, AB, Canada
- Infection Prevention and Control, Alberta Health Services, Calgary, AB, Canada
- Department of Microbiology, Immunology, and Infectious Diseases, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Maitreyi Raman
- Department of Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, AB, Canada
- Calvin, Phoebe, and Joan Snyder Institute for Chronic Diseases, University of Calgary and Alberta Health Services, Calgary, AB, Canada
| | - Jared R Fletcher
- Department of Health and Physical Education, Mount Royal University, Calgary, AB, Canada
| | - Peter Faris
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Analytics, Alberta Health Services, Calgary, AB, Canada
| | - Scott Kraft
- W21 Research and Innovation Centre, University of Calgary and Alberta Health Services, Calgary, AB, Canada
| | - Ye Shen
- Infection Prevention and Control, Alberta Health Services, Calgary, AB, Canada
| | - Thomas Louie
- Department of Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, AB, Canada
- Infection Prevention and Control, Alberta Health Services, Calgary, AB, Canada
- Department of Microbiology, Immunology, and Infectious Diseases, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Calvin, Phoebe, and Joan Snyder Institute for Chronic Diseases, University of Calgary and Alberta Health Services, Calgary, AB, Canada
| | - John M Conly
- O'Brien Institute of Public Health, University of Calgary, Calgary, AB, Canada.
- W21 Research and Innovation Centre, University of Calgary and Alberta Health Services, Calgary, AB, Canada.
- Department of Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, AB, Canada.
- Infection Prevention and Control, Alberta Health Services, Calgary, AB, Canada.
- Department of Microbiology, Immunology, and Infectious Diseases, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
- Calvin, Phoebe, and Joan Snyder Institute for Chronic Diseases, University of Calgary and Alberta Health Services, Calgary, AB, Canada.
- Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, AB, Canada.
- AGW5 - Special Services Bldg, Foothills Medical Centre, 1403 29th Street NW, Calgary, AB, Canada, T2N 2T9.
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4
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Liu C, Monaghan T, Yadegar A, Louie T, Kao D. Insights into the Evolving Epidemiology of Clostridioides difficile Infection and Treatment: A Global Perspective. Antibiotics (Basel) 2023; 12:1141. [PMID: 37508237 PMCID: PMC10376792 DOI: 10.3390/antibiotics12071141] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 06/27/2023] [Accepted: 06/29/2023] [Indexed: 07/30/2023] Open
Abstract
Clostridioides difficile remains an important public health threat, globally. Since the emergence of the hypervirulent strain, ribotype 027, new strains have been reported to cause C. difficile infection (CDI) with poor health outcomes, including ribotypes 014/020, 017, 056, 106, and 078/126. These strains differ in their geographic distribution, genetic makeup, virulence factors, and antimicrobial susceptibility profiles, which can affect their ability to cause disease and respond to treatment. As such, understanding C. difficile epidemiology is increasingly important to allow for effective prevention measures. Despite the heightened epidemiological surveillance of C. difficile over the past two decades, it remains challenging to accurately estimate the burden and international epidemiological trends given the lack of concerted global effort for surveillance, especially in low- and middle-income countries. This review summarizes the changing epidemiology of C. difficile based on available data within the last decade, highlights the pertinent ribotypes from a global perspective, and discusses evolving treatments for CDI.
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Affiliation(s)
- Crystal Liu
- Department of Medicine, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Tanya Monaghan
- National Institute for Health Research, Nottingham Biomedical Research Centre, Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK
| | - Abbas Yadegar
- Foodborne and Waterborne Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran 1985717411, Iran
| | - Thomas Louie
- Medicine and Microbiology, School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Dina Kao
- Division of Gastroenterology, University of Alberta, Edmonton, AB T6G 2P8, Canada
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5
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Gonzales-Luna AJ, Skinner AM, Alonso CD, Bouza E, Cornely OA, de Meij TGJ, Drew RJ, Garey KW, Gerding DN, Johnson S, Kahn SA, Kato H, Kelly CP, Kelly CR, Kociolek LK, Kuijper EJ, Louie T, Riley TV, Sandora TJ, Vehreschild MJGT, Wilcox MH, Dubberke ER. Redefining Clostridioides difficile infection antibiotic response and clinical outcomes. Lancet Infect Dis 2023; 23:e259-e265. [PMID: 37062301 DOI: 10.1016/s1473-3099(23)00047-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 01/04/2023] [Accepted: 01/09/2023] [Indexed: 04/18/2023]
Abstract
With the approval and development of narrow-spectrum antibiotics for the treatment of Clostridioides difficile infection (CDI), the primary endpoint for treatment success of CDI antibiotic treatment trials has shifted from treatment response at end of therapy to sustained response 30 days after completed therapy. The current definition of a successful response to treatment (three or fewer unformed bowel movements [UBMs] per day for 1-2 days) has not been validated, does not reflect CDI management, and could impair assessments for successful treatment at 30 days. We propose new definitions to optimise trial design to assess sustained response. Primarily, we suggest that the initial response at the end of treatment be defined as (1) three or fewer UBMs per day, (2) a reduction in UBMs of more than 50% per day, (3) a decrease in stool volume of more than 75% for those with ostomy, or (4) attainment of bowel movements of Bristol Stool Form Scale types 1-4, on average, by day 2 after completion of primary CDI therapy (ie, assessed on day 11 and day 12 of a 10-day treatment course) and following an investigator determination that CDI treatment can be ceased.
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Affiliation(s)
- Anne J Gonzales-Luna
- Department of Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, Houston, TX, USA
| | - Andrew M Skinner
- Department of Medicine, Loyola University Medical Center, Maywood, IL, USA; Department of Medicine and Department of Research, Edward Hines Jr Veterans Administration Hospital, Hines, IL, USA
| | - Carolyn D Alonso
- Division of Infectious Diseases, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Emilio Bouza
- Department of Microbiology and Infectious Diseases, Universidad Complutense, Madrid, Spain
| | - Oliver A Cornely
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Disease, Translational Research, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany; Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf and Excellence Center for Medical Mycology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany; Clinical Trials Centre Cologne, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany; German Centre for Infection Research, Partner Site Bonn-Cologne, Cologne, Germany
| | - Tim G J de Meij
- Department of Pediatric Gastroenterology, Emma Children's Hospital, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Richard J Drew
- Clinical Innovation Unit, Rotunda Hospital and Children's Health Ireland, Dublin, Ireland; Irish Meningitis and Sepsis Reference Laboratory, Children's Health Ireland at Temple Street, Dublin, Ireland; Department of Microbiology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Kevin W Garey
- Department of Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, Houston, TX, USA
| | - Dale N Gerding
- Department of Medicine and Department of Research, Edward Hines Jr Veterans Administration Hospital, Hines, IL, USA
| | - Stuart Johnson
- Department of Medicine and Department of Research, Edward Hines Jr Veterans Administration Hospital, Hines, IL, USA
| | - Stacy A Kahn
- Division of Gastroenterology, Hepatology & Nutrition, Boston Children's Hospital, Boston, MA, USA
| | - Haru Kato
- Antimicrobial Resistance Research Center, National Institute of Infectious Diseases, Tokyo, Japan
| | - Ciaran P Kelly
- Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Colleen R Kelly
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Larry K Kociolek
- Division of Pediatric Infectious Diseases, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Ed J Kuijper
- Department of Medical Microbiology, Leiden University Medical Centre, Leiden, Netherlands
| | - Thomas Louie
- Infectious Diseases, Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Thomas V Riley
- School of Biomedical Sciences, The University of Western Australia, Crawley, WA, Australia
| | - Thomas J Sandora
- Department of Pediatrics, Boston Children's Hospital, Boston, MA, USA
| | - Maria J G T Vehreschild
- Infectious Diseases, Department of Internal Medicine, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Mark H Wilcox
- Microbiology, Old Medical School, Leeds General Infirmary, Leeds, UK
| | - Erik R Dubberke
- Division of Infectious Diseases, Washington University School of Medicine, St Louis, MO, USA.
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Lee C, Louie T, Bancke L, Guthmueller B, Harvey A, Feuerstadt P, Khanna S, Orenstein R, Dubberke ER. Safety of fecal microbiota, live-jslm (REBYOTA ™) in individuals with recurrent Clostridioides difficile infection: data from five prospective clinical trials. Therap Adv Gastroenterol 2023; 16:17562848231174277. [PMID: 37333464 PMCID: PMC10272687 DOI: 10.1177/17562848231174277] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 04/06/2023] [Indexed: 06/20/2023] Open
Abstract
Background Microbiota-based treatments reduce the incidence of recurrent Clostridioides difficile infections (rCDIs), but prospectively collected safety data needed to broaden patient access and protect public health have been limited. Objectives We provide cumulative safety data from five prospective clinical trials evaluating fecal microbiota, live-jslm (RBL) - the first microbiota-based live biotherapeutic product approved by the US Food and Drug Administration - for preventing rCDI in adults. Design Integrated safety analysis includes three phase II trials (PUNCH CD, PUNCH CD2, PUNCH Open-Label) and two phase III trials (PUNCH CD3, PUNCH CD3-OLS) of RBL. Methods Trial participants were at least 18 years of age with documented rCDI who completed standard-of-care antibiotic therapy before treatment with RBL. Assigned study treatment regimen was one or two doses of RBL (or placebo) administered rectally, depending on the trial design. In four of the five trials, participants with CDI recurrence within 8 weeks after RBL or placebo administration were eligible for treatment with open-label RBL. Treatment-emergent adverse events (TEAEs) were recorded for at least 6 months following last study treatment; in PUNCH CD2 and PUNCH Open-Label trials, TEAEs and serious TEAEs were collected through 12 and 24 months, respectively. Results Among the five trials, 978 participants received at least one dose of RBL (assigned treatment or after recurrence) and 83 participants received placebo only. TEAEs were reported in 60.2% of Placebo Only participants and 66.4% of RBL Only participants. Only abdominal pain, nausea, and flatulence were significantly higher in the RBL Only group compared with the Placebo Only group. Most TEAEs were mild or moderate in severity and were most frequently related to preexisting conditions. There were no reported infections for which the causative pathogen was traced to RBL. Potentially life-threatening TEAEs were infrequent (3.0% of participants). Conclusion Across five clinical trials, RBL was well tolerated in adults with rCDI. In aggregate, these data consistently demonstrated the safety of RBL.
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Affiliation(s)
- Christine Lee
- Medical Microbiologist and Researcher, Island Health, Clinical Professor, Department of Pathology and Laboratory Medicine, The University of British Columbia Faculty of Medicine, Vancouver, BC V6T 1Z3, Canada
- Island Medical Program University of British Columbia, University of Victoria, Victoria, BC, Canada
| | - Thomas Louie
- University of Calgary and Foothills Medical Center, Calgary, AB, Canada
| | - Lindy Bancke
- Rebiotix Inc., a Ferring Company, Roseville, MN, USA
| | | | - Adam Harvey
- Rebiotix Inc., a Ferring Company, Roseville, MN, USA
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7
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Louie T, Golan Y, Khanna S, Bobilev D, Erpelding N, Fratazzi C, Carini M, Menon R, Ruisi M, Norman JM, Faith JJ, Olle B, Li M, Silber JL, Pardi DS. VE303, a Defined Bacterial Consortium, for Prevention of Recurrent Clostridioides difficile Infection: A Randomized Clinical Trial. JAMA 2023; 329:1356-1366. [PMID: 37060545 PMCID: PMC10105904 DOI: 10.1001/jama.2023.4314] [Citation(s) in RCA: 32] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 03/07/2023] [Indexed: 04/16/2023]
Abstract
Importance The effect of rationally defined nonpathogenic, nontoxigenic, commensal strains of Clostridia on prevention of Clostridioides difficile infection (CDI) is unknown. Objective To determine the efficacy of VE303, a defined bacterial consortium of 8 strains of commensal Clostridia, in adults at high risk for CDI recurrence. The primary objective was to determine the recommended VE303 dosing for a phase 3 trial. Design, Setting, and Participants Phase 2, randomized, double-blind, placebo-controlled, dose-ranging study conducted from February 2019 to September 2021 at 27 sites in the US and Canada. The study included 79 participants aged 18 years or older who were diagnosed with laboratory-confirmed CDI with 1 or more prior CDI episodes in the last 6 months and those with primary CDI at high risk for recurrence (defined as aged ≥75 years or ≥65 years with ≥1 risk factors: creatinine clearance <60 mL/min/1.73 m2, proton pump inhibitor use, remote [>6 months earlier] CDI history). Interventions Participants were randomly assigned to high-dose VE303 (8.0 × 109 colony-forming units [CFUs]) (n = 30), low-dose VE303 (1.6 × 109 CFUs) (n = 27), or placebo capsules (n = 22) orally once daily for 14 days. Main Outcomes and Measures The primary efficacy end point was the proportion of participants with CDI recurrence at 8 weeks using a combined clinical and laboratory definition. The primary efficacy end point was analyzed in 3 prespecified analyses, using successively broader definitions for an on-study CDI recurrence: (1) diarrhea consistent with CDI plus a toxin-positive stool sample; (2) diarrhea consistent with CDI plus a toxin-positive, polymerase chain reaction-positive, or toxigenic culture-positive stool sample; and (3) diarrhea consistent with CDI plus laboratory confirmation or (in the absence of a stool sample) treatment with a CDI-targeted antibiotic. Results Baseline characteristics were similar across the high-dose VE303 (n = 29; 1 additional participant excluded from efficacy analysis), low-dose VE303 (n = 27), and placebo (n = 22) groups. The participants' median age was 63.5 years (range, 24-96); 70.5% were female; and 1.3% were Asian, 1.3% Black, 2.6% Hispanic, and 96.2% White. CDI recurrence rates through week 8 (using the efficacy analysis 3 definition) were 13.8% (4/29) for high-dose VE303, 37.0% (10/27) for low-dose VE303, and 45.5% (10/22) for placebo (P = .006, high-dose VE303 vs placebo). Conclusions and Relevance Among adults with laboratory-confirmed CDI with 1 or more prior CDI episodes in the last 6 months and those with primary CDI at high risk for recurrence, high-dose VE303 prevented recurrent CDI compared with placebo. A larger, phase 3 study is needed to confirm these findings. Trial Registration ClinicalTrials.gov Identifier: NCT03788434.
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Affiliation(s)
- Thomas Louie
- University of Calgary and Foothills Medical Centre, Calgary, Alberta, Canada
| | - Yoav Golan
- Tufts Medical Center, Boston, Massachusetts
| | | | - Dmitri Bobilev
- Vedanta Biosciences Inc, Cambridge, Massachusetts
- Fusion Pharmaceuticals, Boston, Massachusetts
| | - Nathalie Erpelding
- Vedanta Biosciences Inc, Cambridge, Massachusetts
- Bicycle Therapeutics, Cambridge, Massachusetts
| | - Candida Fratazzi
- Vedanta Biosciences Inc, Cambridge, Massachusetts
- Boston Biotech Clinical Research, Natick, Massachusetts
| | - Meg Carini
- Vedanta Biosciences Inc, Cambridge, Massachusetts
| | - Rajita Menon
- Vedanta Biosciences Inc, Cambridge, Massachusetts
| | - Mary Ruisi
- Vedanta Biosciences Inc, Cambridge, Massachusetts
- C4 Therapeutics, Watertown, Massachusetts
| | | | | | - Bernat Olle
- Vedanta Biosciences Inc, Cambridge, Massachusetts
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8
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Watson AR, Füssel J, Veseli I, DeLongchamp JZ, Silva M, Trigodet F, Lolans K, Shaiber A, Fogarty E, Runde JM, Quince C, Yu MK, Söylev A, Morrison HG, Lee STM, Kao D, Rubin DT, Jabri B, Louie T, Eren AM. Metabolic independence drives gut microbial colonization and resilience in health and disease. Genome Biol 2023; 24:78. [PMID: 37069665 PMCID: PMC10108530 DOI: 10.1186/s13059-023-02924-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 04/07/2023] [Indexed: 04/19/2023] Open
Abstract
BACKGROUND Changes in microbial community composition as a function of human health and disease states have sparked remarkable interest in the human gut microbiome. However, establishing reproducible insights into the determinants of microbial succession in disease has been a formidable challenge. RESULTS Here we use fecal microbiota transplantation (FMT) as an in natura experimental model to investigate the association between metabolic independence and resilience in stressed gut environments. Our genome-resolved metagenomics survey suggests that FMT serves as an environmental filter that favors populations with higher metabolic independence, the genomes of which encode complete metabolic modules to synthesize critical metabolites, including amino acids, nucleotides, and vitamins. Interestingly, we observe higher completion of the same biosynthetic pathways in microbes enriched in IBD patients. CONCLUSIONS These observations suggest a general mechanism that underlies changes in diversity in perturbed gut environments and reveal taxon-independent markers of "dysbiosis" that may explain why widespread yet typically low-abundance members of healthy gut microbiomes can dominate under inflammatory conditions without any causal association with disease.
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Affiliation(s)
- Andrea R Watson
- Department of Medicine, The University of Chicago, Chicago, IL, 60637, USA
- Committee On Microbiology, The University of Chicago, Chicago, IL, 60637, USA
| | - Jessika Füssel
- Department of Medicine, The University of Chicago, Chicago, IL, 60637, USA
- Institute for Chemistry and Biology of the Marine Environment, University of Oldenburg, 26129, Oldenburg, Germany
| | - Iva Veseli
- Biophysical Sciences Program, The University of Chicago, Chicago, IL, 60637, USA
| | | | - Marisela Silva
- Department of Medicine, The University of Calgary, Calgary, AB, T2N 1N4, Canada
| | - Florian Trigodet
- Department of Medicine, The University of Chicago, Chicago, IL, 60637, USA
| | - Karen Lolans
- Department of Medicine, The University of Chicago, Chicago, IL, 60637, USA
| | - Alon Shaiber
- Biophysical Sciences Program, The University of Chicago, Chicago, IL, 60637, USA
| | - Emily Fogarty
- Department of Medicine, The University of Chicago, Chicago, IL, 60637, USA
- Committee On Microbiology, The University of Chicago, Chicago, IL, 60637, USA
| | - Joseph M Runde
- Department of Pediatrics, Lurie Children's Hospital of Chicago, Chicago, IL, 60611, USA
| | - Christopher Quince
- Organisms and Ecosystems, Earlham Institute, Norwich, Norwich, NR4 7UZ, UK
- Gut Microbes and Health, Quadram Institute, Norwich, NR4 7UQ, UK
| | - Michael K Yu
- Toyota Technological Institute at Chicago, Chicago, IL, 60637, USA
| | - Arda Söylev
- Department of Computer Engineering, Konya Food and Agriculture University, Konya, Turkey
| | - Hilary G Morrison
- Marine Biological Laboratory, Josephine Bay Paul Center, Woods Hole, Falmouth, MA, 02543, USA
| | - Sonny T M Lee
- Department of Medicine, The University of Chicago, Chicago, IL, 60637, USA
| | - Dina Kao
- Department of Medicine, University of Alberta, Edmonton, AB, T6G 2G3, Canada
| | - David T Rubin
- Department of Medicine, The University of Chicago, Chicago, IL, 60637, USA
| | - Bana Jabri
- Department of Medicine, The University of Chicago, Chicago, IL, 60637, USA
| | - Thomas Louie
- Department of Medicine, The University of Calgary, Calgary, AB, T2N 1N4, Canada
| | - A Murat Eren
- Department of Medicine, The University of Chicago, Chicago, IL, 60637, USA.
- Committee On Microbiology, The University of Chicago, Chicago, IL, 60637, USA.
- Institute for Chemistry and Biology of the Marine Environment, University of Oldenburg, 26129, Oldenburg, Germany.
- Marine Biological Laboratory, Josephine Bay Paul Center, Woods Hole, Falmouth, MA, 02543, USA.
- Helmholtz Institute for Functional Marine Biodiversity, 26129, Oldenburg, Germany.
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9
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Khanna S, Assi M, Lee C, Yoho D, Louie T, Knapple W, Aguilar H, Garcia-Diaz J, Wang GP, Berry SM, Marion J, Su X, Braun T, Bancke L, Feuerstadt P. Efficacy and Safety of RBX2660 in PUNCH CD3, a Phase III, Randomized, Double-Blind, Placebo-Controlled Trial with a Bayesian Primary Analysis for the Prevention of Recurrent Clostridioides difficile Infection. Drugs 2022; 82:1527-1538. [PMID: 36287379 PMCID: PMC9607700 DOI: 10.1007/s40265-022-01797-x] [Citation(s) in RCA: 75] [Impact Index Per Article: 37.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2022] [Indexed: 12/02/2022]
Abstract
BACKGROUND Recurrent Clostridioides difficile infection, associated with dysbiosis of gut microbiota, has substantial disease burden in the USA. RBX2660 is a live biotherapeutic product consisting of a broad consortium of microbes prepared from human stool that is under investigation for the reduction of recurrent C. difficile infection. METHODS A randomized, double-blind, placebo-controlled, phase III study, with a Bayesian primary analysis integrating data from a previous phase IIb study, was conducted. Adults who had one or more C. difficile infection recurrences with a positive stool assay for C. difficile and who were previously treated with standard-of-care antibiotics were randomly assigned 2:1 to receive a subsequent blinded, single-dose enema of RBX2660 or placebo. The primary endpoint was treatment success, defined as the absence of C. difficile infection diarrhea within 8 weeks of study treatment. RESULTS Of the 320 patients screened, 289 were randomly assigned and 267 received blinded treatment (n = 180, RBX2660; n = 87, placebo). Original model estimates of treatment success were 70.4% versus 58.1% with RBX2660 and placebo, respectively. However, after aligning the data to improve the exchangeability and interpretability of the Bayesian analysis, the model-estimated treatment success rate was 70.6% with RBX2660 versus 57.5% with placebo, with an estimated treatment effect of 13.1% and a posterior probability of superiority of 0.991. More than 90% of the participants who achieved treatment success at 8 weeks had sustained response through 6 months in both the RBX2660 and the placebo groups. Overall, RBX2660 was well tolerated, with manageable adverse events. The incidence of treatment-emergent adverse events was higher in RBX2660 recipients compared with placebo and was mostly driven by a higher incidence of mild gastrointestinal events. CONCLUSIONS RBX2660 is a safe and effective treatment to reduce recurrent C. difficile infection following standard-of-care antibiotics with a sustained response through 6 months. CLINICAL TRIAL REGISTRATION NCT03244644; 9 August, 2017.
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Affiliation(s)
- Sahil Khanna
- Gastroenterology and Hepatology, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA.
| | - Maha Assi
- University of Kansas School of Medicine-Wichita, Wichita, KS, USA
| | | | - David Yoho
- Kaiser Permanente Springfield Medical Center, Springfield, VA, USA
| | | | | | | | | | | | | | | | - Xin Su
- Formerly of Rebiotix, Inc, Roseville, MN, USA
| | | | | | - Paul Feuerstadt
- Yale School of Medicine, New Haven, CT, USA
- PACT Gastroenterology Center, Hamden, CT, USA
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10
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Khanna S, Assi M, Lee C, Yoho D, Louie T, Knapple W, Aguilar H, Garcia-Diaz J, Wang GP, Berry SM, Marion J, Su X, Braun T, Bancke L, Feuerstadt P. Correction to: Efficacy and Safety of RBX2660 in PUNCH CD3, a Phase III, Randomized, Double-Blind, Placebo-Controlled Trial with a Bayesian Primary Analysis for the Prevention of Recurrent Clostridioides difficile Infection. Drugs 2022; 82:1539. [PMID: 36342618 PMCID: PMC9652262 DOI: 10.1007/s40265-022-01805-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Sahil Khanna
- Gastroenterology and Hepatology, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA.
| | - Maha Assi
- University of Kansas School of Medicine-Wichita, Wichita, KS, USA
| | | | - David Yoho
- Kaiser Permanente Springfield Medical Center, Springfield, VA, USA
| | | | | | | | | | | | | | | | - Xin Su
- Formerly of Rebiotix, Inc, Roseville, MN, USA
| | | | | | - Paul Feuerstadt
- Yale School of Medicine, New Haven, CT, USA
- PACT Gastroenterology Center, Hamden, CT, USA
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11
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Lin YC, Malott RJ, Ward L, Kiplagat L, Pabbaraju K, Gill K, Berenger BM, Hu J, Fonseca K, Noyce RS, Louie T, Evans DH, Conly JM. Detection and quantification of infectious severe acute respiratory coronavirus-2 in diverse clinical and environmental samples. Sci Rep 2022. [PMID: 35354854 DOI: 10.1101/2021.07.08.21259744] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023] Open
Abstract
To explore the potential modes of Severe Acute Respiratory Coronavirus-2 (SARS-CoV-2) transmission, we collected 535 diverse clinical and environmental samples from 75 infected hospitalized and community patients. Infectious SARS-CoV-2 with quantitative burdens varying from 5 plaque-forming units/mL (PFU/mL) up to 1.0 × 106 PFU/mL was detected in 151/459 (33%) of the specimens assayed and up to 1.3 × 106 PFU/mL on fomites with confirmation by plaque morphology, PCR, immunohistochemistry, and/or sequencing. Infectious virus in clinical and associated environmental samples correlated with time since symptom onset with no detection after 7-8 days in immunocompetent hosts and with N-gene based Ct values ≤ 25 significantly predictive of yielding plaques in culture. SARS-CoV-2 isolated from patient respiratory tract samples caused illness in a hamster model with a minimum infectious dose of ≤ 14 PFU. Together, our findings offer compelling evidence that large respiratory droplet and contact (direct and indirect i.e., fomites) are important modes of SARS-CoV-2 transmission.
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Affiliation(s)
- Yi-Chan Lin
- Department of Medical Microbiology and Immunology, University of Alberta, 6-142L Katz Group Centre, Edmonton, AB, T6G 2J7, Canada
| | - Rebecca J Malott
- Cumming School of Medicine, University of Calgary, 3030 Hospital Dr NW, Calgary, AB, T2N 4W4, Canada
| | - Linda Ward
- Cumming School of Medicine, University of Calgary, 3030 Hospital Dr NW, Calgary, AB, T2N 4W4, Canada
- Foothills Medical Centre, Alberta Health Services, 1403 29 Street NW, Calgary, AB, 2TN 2T9, Canada
| | - Linet Kiplagat
- Cumming School of Medicine, University of Calgary, 3030 Hospital Dr NW, Calgary, AB, T2N 4W4, Canada
| | - Kanti Pabbaraju
- Alberta Public Health Laboratory, Alberta Precision Laboratories, Calgary, AB, Canada
| | - Kara Gill
- Alberta Public Health Laboratory, Alberta Precision Laboratories, Calgary, AB, Canada
| | - Byron M Berenger
- Cumming School of Medicine, University of Calgary, 3030 Hospital Dr NW, Calgary, AB, T2N 4W4, Canada
- Alberta Public Health Laboratory, Alberta Precision Laboratories, Calgary, AB, Canada
| | - Jia Hu
- Cumming School of Medicine, University of Calgary, 3030 Hospital Dr NW, Calgary, AB, T2N 4W4, Canada
| | - Kevin Fonseca
- Cumming School of Medicine, University of Calgary, 3030 Hospital Dr NW, Calgary, AB, T2N 4W4, Canada
- Foothills Medical Centre, Alberta Health Services, 1403 29 Street NW, Calgary, AB, 2TN 2T9, Canada
- Alberta Public Health Laboratory, Alberta Precision Laboratories, Calgary, AB, Canada
| | - Ryan S Noyce
- Department of Medical Microbiology and Immunology, University of Alberta, 6-142L Katz Group Centre, Edmonton, AB, T6G 2J7, Canada
| | - Thomas Louie
- Cumming School of Medicine, University of Calgary, 3030 Hospital Dr NW, Calgary, AB, T2N 4W4, Canada
- Foothills Medical Centre, Alberta Health Services, 1403 29 Street NW, Calgary, AB, 2TN 2T9, Canada
| | - David H Evans
- Department of Medical Microbiology and Immunology, University of Alberta, 6-142L Katz Group Centre, Edmonton, AB, T6G 2J7, Canada.
| | - John M Conly
- Cumming School of Medicine, University of Calgary, 3030 Hospital Dr NW, Calgary, AB, T2N 4W4, Canada
- Foothills Medical Centre, Alberta Health Services, 1403 29 Street NW, Calgary, AB, 2TN 2T9, Canada
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12
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Vehreschild MJGT, Ducher A, Louie T, Cornely OA, Feger C, Dane A, Varastet M, Vitry F, de Gunzburg J, Andremont A, Mentré F, Wilcox MH. An open randomized multicentre Phase 2 trial to assess the safety of DAV132 and its efficacy to protect gut microbiota diversity in hospitalized patients treated with fluoroquinolones. J Antimicrob Chemother 2022; 77:1155-1165. [PMID: 35016205 PMCID: PMC8969469 DOI: 10.1093/jac/dkab474] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 11/19/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND DAV132 (colon-targeted adsorbent) has prevented antibiotic-induced effects on microbiota in healthy volunteers. OBJECTIVES To assess DAV132 safety and biological efficacy in patients. PATIENTS AND METHODS An open-label, randomized [stratification: fluoroquinolone (FQ) indication] multicentre trial comparing DAV132 (7.5 g, 3 times a day, orally) with No-DAV132 in hospitalized patients requiring 5-21 day treatment with FQs and at risk of Clostridioides difficile infection (CDI). FQ and DAV132 were started simultaneously, DAV132 was administered for 48 h more, and patients were followed up for 51 days. The primary endpoint was the rate of adverse events (AEs) independently adjudicated as related to DAV132 and/or FQ. The planned sample size of 260 patients would provide a 95% CI of ±11.4%, assuming a 33% treatment-related AE rate. Plasma and faecal FQ concentrations, intestinal microbiota diversity, intestinal colonization with C. difficile, MDR bacteria and yeasts, and ex vivo resistance to C. difficile faecal colonization were assessed. RESULTS Two hundred and forty-three patients (median age 71 years; 96% with chronic comorbidity) were included (No-DAV132, n = 120; DAV132, n = 123). DAV132- and/or FQ-related AEs did not differ significantly: 18 (14.8%) versus 13 (10.8%) in DAV132 versus No-DAV132 patients (difference 3.9%; 95% CI: -4.7 to 12.6). Day 4 FQ plasma levels were unaffected. DAV132 was associated with a >98% reduction in faecal FQ levels (Day 4 to end of treatment; P < 0.001), less impaired microbiota diversity (Shannon index; P = 0.003), increased ex vivo resistance to C. difficile colonization (P = 0.0003) and less frequent FQ-induced VRE acquisition (P = 0.01). CONCLUSIONS In FQ-treated hospitalized patients, DAV132 was well tolerated, and FQ plasma concentrations unaffected. DAV132 preserved intestinal microbiota diversity and C. difficile colonization resistance.
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Affiliation(s)
- Maria J G T Vehreschild
- Department of Internal Medicine, Infectious Diseases, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
| | | | - Thomas Louie
- Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Oliver A Cornely
- Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Excellence Center for Medical Mycology (ECMM), University of Cologne, Cologne, Germany.,Faculty of Medicine and University Hospital Cologne, Chair Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany.,Faculty of Medicine and University Hospital Cologne, Clinical Trials Centre Cologne (ZKS Köln), University of Cologne, Cologne, Germany.,German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | - Celine Feger
- Da Volterra, Paris, France.,EMIBiotech, Paris, France
| | | | | | | | | | - Antoine Andremont
- Da Volterra, Paris, France.,Université de Paris, IAME, INSERM U1137, Paris, France
| | - France Mentré
- Université de Paris, IAME, INSERM U1137, Paris, France
| | - Mark H Wilcox
- Leeds Institute of Medical Research, University of Leeds and Leeds Teaching Hospitals, Leeds, UK
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13
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Monaghan TM, Seekatz AM, Markham NO, Yau TO, Hatziapostolou M, Jilani T, Christodoulou N, Roach B, Birli E, Pomenya O, Louie T, Lacy DB, Kim P, Lee C, Kao D, Polytarchou C. Fecal Microbiota Transplantation for Recurrent Clostridioides difficile Infection Associates With Functional Alterations in Circulating microRNAs. Gastroenterology 2021; 161:255-270.e4. [PMID: 33844988 PMCID: PMC8579492 DOI: 10.1053/j.gastro.2021.03.050] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 03/20/2021] [Accepted: 03/23/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS The molecular mechanisms underlying successful fecal microbiota transplantation (FMT) for recurrent Clostridioides difficile infection (rCDI) remain poorly understood. The primary objective of this study was to characterize alterations in microRNAs (miRs) following FMT for rCDI. METHODS Sera from 2 prospective multicenter randomized controlled trials were analyzed for miRNA levels with the use of the Nanostring nCounter platform and quantitative reverse-transcription (RT) polymerase chain reaction (PCR). In addition, rCDI-FMT and toxin-treated animals and ex vivo human colonoids were used to compare intestinal tissue and circulating miRs. miR inflammatory gene targets in colonic epithelial and peripheral blood mononuclear cells were evaluated by quantitative PCR (qPCR) and 3'UTR reporter assays. Colonic epithelial cells were used for mechanistic, cytoskeleton, cell growth, and apoptosis studies. RESULTS miRNA profiling revealed up-regulation of 64 circulating miRs 4 and 12 weeks after FMT compared with screening, of which the top 6 were validated in the discovery cohort by means of RT-qPCR. In a murine model of relapsing-CDI, RT-qPCR analyses of sera and cecal RNA extracts demonstrated suppression of these miRs, an effect reversed by FMT. In mouse colon and human colonoids, C difficile toxin B (TcdB) mediated the suppressive effects of CDI on miRs. CDI dysregulated DROSHA, an effect reversed by FMT. Correlation analyses, qPCR ,and 3'UTR reporter assays revealed that miR-23a, miR-150, miR-26b, and miR-28 target directly the 3'UTRs of IL12B, IL18, FGF21, and TNFRSF9, respectively. miR-23a and miR-150 demonstrated cytoprotective effects against TcdB. CONCLUSIONS These results provide novel and provocative evidence that modulation of the gut microbiome via FMT induces alterations in circulating and intestinal tissue miRs. These findings contribute to a greater understanding of the molecular mechanisms underlying FMT and identify new potential targets for therapeutic intervention in rCDI.
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Affiliation(s)
- Tanya M Monaghan
- National Institute for Health Research Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, United Kingdom; Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, Nottingham, United Kingdom.
| | - Anna M Seekatz
- Department of Biological Sciences, Clemson University, Clemson, South Carolina, USA
| | - Nicholas O Markham
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Epithelial Biology Center, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Tung On Yau
- Department of Biosciences, John van Geest Cancer Research Centre, Centre for Health Aging and Understanding Disease, School of Science and Technology, Nottingham Trent University, Nottingham, United Kingdom
| | - Maria Hatziapostolou
- Department of Biosciences, John van Geest Cancer Research Centre, Centre for Health Aging and Understanding Disease, School of Science and Technology, Nottingham Trent University, Nottingham, United Kingdom
| | - Tahseen Jilani
- Advanced Data Analysis Centre, School of Computer Science, University of Nottingham, Nottingham, United Kingdom
| | - Niki Christodoulou
- Department of Biosciences, John van Geest Cancer Research Centre, Centre for Health Aging and Understanding Disease, School of Science and Technology, Nottingham Trent University, Nottingham, United Kingdom
| | - Brandi Roach
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Eleni Birli
- Department of Biosciences, John van Geest Cancer Research Centre, Centre for Health Aging and Understanding Disease, School of Science and Technology, Nottingham Trent University, Nottingham, United Kingdom
| | - Odette Pomenya
- Department of Biosciences, John van Geest Cancer Research Centre, Centre for Health Aging and Understanding Disease, School of Science and Technology, Nottingham Trent University, Nottingham, United Kingdom
| | - Thomas Louie
- Department of Microbiology and infectious Diseases, University of Calgary, Calgary, Alberta, Canada
| | - D Borden Lacy
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University School of Medicine, Nashville, Tennessee, USA; Veterans Affairs Tennessee Valley Healthcare System, Nashville, Tennessee, USA
| | - Peter Kim
- Department of Mathematics and Statistics, University of Guelph, Ontario, Canada
| | - Christine Lee
- Vancouver Island Health Authority, Victoria, British Columbia, Canada; Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Dina Kao
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
| | - Christos Polytarchou
- Department of Biosciences, John van Geest Cancer Research Centre, Centre for Health Aging and Understanding Disease, School of Science and Technology, Nottingham Trent University, Nottingham, United Kingdom.
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14
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Berenger BM, Conly JM, Fonseca K, Hu J, Louie T, Schneider AR, Singh T, Stokes W, Ward L, Zelyas N. Saliva collected in universal transport media is an effective, simple and high-volume amenable method to detect SARS-CoV-2. Clin Microbiol Infect 2020; 27:656-657. [PMID: 33160035 PMCID: PMC7641592 DOI: 10.1016/j.cmi.2020.10.035] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 10/28/2020] [Accepted: 10/29/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Byron M Berenger
- Alberta Public Health Laboratory, Alberta Precision Laboratories, Calgary, Canada; Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Canada.
| | - John M Conly
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Canada; Department of Microbiology, Immunology and Infectious Diseases and Snyder Institute for Chronic Diseases, University of Calgary, Calgary, Canada; Department of Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, Canada; Infection Prevention and Control, Alberta Health Services, Calgary, Canada
| | - Kevin Fonseca
- Alberta Public Health Laboratory, Alberta Precision Laboratories, Calgary, Canada; Department of Microbiology, Immunology and Infectious Diseases and Snyder Institute for Chronic Diseases, University of Calgary, Calgary, Canada
| | - Jia Hu
- Department of Community Health Sciences, University of Calgary, Calgary, Canada; Communicable Diseases, Public Health, Alberta Health Services, Calgary, Canada
| | - Thomas Louie
- Department of Microbiology, Immunology and Infectious Diseases and Snyder Institute for Chronic Diseases, University of Calgary, Calgary, Canada; Department of Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, Canada; Infection Prevention and Control, Alberta Health Services, Calgary, Canada
| | - Angela R Schneider
- Department of Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, Canada
| | - Takshveer Singh
- Department of Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, Canada
| | - William Stokes
- Alberta Public Health Laboratory, Alberta Precision Laboratories, Calgary, Canada
| | - Linda Ward
- Infection Prevention and Control, Alberta Health Services, Calgary, Canada
| | - Nathan Zelyas
- Alberta Public Health Laboratory, Alberta Precision Laboratories, Calgary, Canada; Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Canada
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15
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Doolan CP, Louie T, Lata C, Larios OE, Stokes W, Kim J, Brown K, Beck P, Deardon R, Pillai DR. Latent class analysis for the diagnosis of Clostridioides difficile infection. Clin Infect Dis 2020; 73:e2673-e2679. [PMID: 33053174 DOI: 10.1093/cid/ciaa1553] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Clostridioides difficile infection (CDI) is an opportunistic disease that lacks a gold standard test. Nucleic acid amplification tests (NAATs) such as real-time PCR demonstrate excellent an limit of detection (LOD) whereas antigenic methods are able to detect free toxin. Latent class analysis (LCA) provides an unbiased statistical approach to resolving true disease. METHODS A cross-sectional study was conducted with suspected CDI patients (n=96). Four commercial real-time PCR tests, toxin antigen detection by enzyme immunoassay (EIA), toxigenic culture, and fecal calprotectin were performed. CDI clinical diagnosis was determined by consensus majority of three experts. LCA was performed using laboratory and clinical variables independent of any gold standard. RESULTS Six LCA models were generated to determine CDI probability using four variables including toxin EIA, toxigenic culture, clinical diagnosis, and fecal calprotectin levels. Three defined zones as a function of real-time PCR cycle threshold (Ct) were identified using LCA: CDI likely (>90% probability), equivocal (<90% and >10%), CDI unlikely (<10%). A single model comprising toxigenic culture, clinical diagnosis, and toxin EIA showed the best fitness. The following Ct cut-offs for four commercial test platforms were obtained using this model to delineate three CDI probability zones: [GeneXpert ® : 24.00, 33.61], [Simplexa ® 28.97, 36.85], [Elite MGB ® 30.18, 37.43], and [BD Max ™ 27.60, 34.26]. CONCLUSION The clinical implication of applying LCA to CDI is to report Ct values assigned to probability zones based on the commercial real-time PCR platform. A broad range of equivocation suggests clinical judgement is essential to the confirmation of CDI.
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Affiliation(s)
- Cody P Doolan
- Clinical Section of Microbiology, Alberta Precision Laboratories, Calgary, AB, Canada.,Department of Microbiology, Immunology, and Infectious Diseases, University of Calgary, AB, Canada.,Department Pathology and Laboratory Medicine, University of Calgary, Calgary, AB, Canada
| | - Thomas Louie
- Clinical Section of Infectious Diseases, Department of Medicine, University of Calgary, Calgary, AB, Canada
| | | | - Oscar E Larios
- Clinical Section of Microbiology, Alberta Precision Laboratories, Calgary, AB, Canada.,Department Pathology and Laboratory Medicine, University of Calgary, Calgary, AB, Canada.,Clinical Section of Infectious Diseases, Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - William Stokes
- Clinical Section of Microbiology, Alberta Precision Laboratories, Calgary, AB, Canada.,Department Pathology and Laboratory Medicine, University of Calgary, Calgary, AB, Canada.,Clinical Section of Infectious Diseases, Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Joseph Kim
- Clinical Section of Infectious Diseases, Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Kristen Brown
- Clinical Section of Microbiology, Alberta Precision Laboratories, Calgary, AB, Canada.,Department Pathology and Laboratory Medicine, University of Calgary, Calgary, AB, Canada.,Clinical Section of Infectious Diseases, Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Paul Beck
- Clinical Section of Gastroenterology, Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Rob Deardon
- Department of Mathematics and Statistics, Faculty of Science, University of Calgary, Calgary, AB, Canada.,Department of Production Animal Health, Faculty of Veterinary Medicine, University of Calgary, Calgary, AB, Canada
| | - Dylan R Pillai
- Clinical Section of Microbiology, Alberta Precision Laboratories, Calgary, AB, Canada.,Department of Microbiology, Immunology, and Infectious Diseases, University of Calgary, AB, Canada.,Department Pathology and Laboratory Medicine, University of Calgary, Calgary, AB, Canada.,Clinical Section of Infectious Diseases, Department of Medicine, University of Calgary, Calgary, AB, Canada
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16
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McClure JA, Conly JM, Obasuyi O, Ward L, Ugarte-Torres A, Louie T, Zhang K. A Novel Assay for Detection of Methicillin-Resistant Staphylococcus aureus Directly From Clinical Samples. Front Microbiol 2020; 11:1295. [PMID: 32625187 PMCID: PMC7314949 DOI: 10.3389/fmicb.2020.01295] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 05/20/2020] [Indexed: 12/16/2022] Open
Abstract
The timely detection of Methicillin-resistant Staphylococcus aureus (MRSA) is crucial for antimicrobial therapy and a key factor to limit the hospital spread of MRSA. Currently available commercial MRSA detection assays target the 3' end of the orfX gene and the right extremity of Staphylococcal Cassette Chromosome mec (SCCmec). These assays suffer from both false positive due to SCC-like elements that lack mecA and false negative results due to the inability to detect new or variant SCCmec cassettes with the existing primers. We developed a novel MRSA detection scheme, designed to circumvent issues present in the existing commercial assays. Our assay demonstrated specificity and accuracy, capable of detecting prototypic strains of SCCmec types I-XIII [C(t) values ranged 8.58-26.29]. Previous false positive isolates (N = 19) by Xpert MRSA nasal assay were accurately classified with our assay. Further validation with 218 randomly selected clinical isolates (73 MRSA, 75 MSSA, 43 MR-CoNS, and 27 MS-CoNS) confirmed its feasibility and practicality. Testing assay performance with 88 direct clinical swabs from 33 patients showed that the assay was 96.6% in agreement with clinical culture results. Our novel MRSA detection assay targets both the S. aureus specific sequence and the mecA/mecC genes simultaneously to overcome the false positive and false negative deficits of currently available commercial assays. The results validate our assay and confirmed its feasibility and practicality. The assay is not affected by SCCmec types and only needs modification if new mec homologs emerge and establishes a new platform for other emerging SCCmec types.
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Affiliation(s)
- Jo-Ann McClure
- Centre for Antimicrobial Resistance, Alberta Health Services/Alberta Precision Laboratories/University of Calgary, Calgary, AB, Canada
| | - John M Conly
- Centre for Antimicrobial Resistance, Alberta Health Services/Alberta Precision Laboratories/University of Calgary, Calgary, AB, Canada.,Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, AB, Canada.,Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, AB, Canada.,Department of Medicine, University of Calgary, Calgary, AB, Canada.,The Calvin, Phoebe and Joan Snyder Institute for Chronic Diseases, University of Calgary, Calgary, AB, Canada
| | - Osahon Obasuyi
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, AB, Canada
| | - Linda Ward
- Alberta Health Services, Calgary, AB, Canada
| | - Alejandra Ugarte-Torres
- Department of Medicine, University of Calgary, Calgary, AB, Canada.,Alberta Health Services, Calgary, AB, Canada
| | - Thomas Louie
- Department of Medicine, University of Calgary, Calgary, AB, Canada.,Alberta Health Services, Calgary, AB, Canada
| | - Kunyan Zhang
- Centre for Antimicrobial Resistance, Alberta Health Services/Alberta Precision Laboratories/University of Calgary, Calgary, AB, Canada.,Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, AB, Canada.,Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, AB, Canada.,Department of Medicine, University of Calgary, Calgary, AB, Canada.,The Calvin, Phoebe and Joan Snyder Institute for Chronic Diseases, University of Calgary, Calgary, AB, Canada
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17
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Fischer M, Kao D, Kassam Z, Smith J, Louie T, Sipe B, Torbeck M, Xu H, Ouyang F, Mozaffarian D, Allegretti JR. Stool Donor Body Mass Index Does Not Affect Recipient Weight After a Single Fecal Microbiota Transplantation for Clostridium difficile Infection. Clin Gastroenterol Hepatol 2018; 16:1351-1353. [PMID: 29246701 DOI: 10.1016/j.cgh.2017.12.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 12/03/2017] [Accepted: 12/04/2017] [Indexed: 02/07/2023]
Affiliation(s)
- Monika Fischer
- Department of Gastroenterology, Indiana University School of Medicine, Indianapolis, Indiana.
| | - Dina Kao
- Division of Gastroenterology, University of Alberta, Edmonton, AB, Canada
| | | | - Justin Smith
- Division of Gastroenterology, University of Alberta, Edmonton, AB, Canada
| | - Thomas Louie
- Division of Infectious Diseases, University of Calgary, Calgary, AB, Canada
| | | | - Michelle Torbeck
- Department of Gastroenterology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Huiping Xu
- Department of Biostatistics, Richard M. Fairbanks School of Public Health and School of Medicine, Indiana University, Indianapolis, Indiana
| | - Fangqian Ouyang
- Department of Biostatistics, Richard M. Fairbanks School of Public Health and School of Medicine, Indiana University, Indianapolis, Indiana
| | - Dariush Mozaffarian
- Tufts Friedman School of Nutrition Science and Policy, Boston, Massachusetts
| | - Jessica R Allegretti
- Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
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18
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Loo VG, Davis I, Embil J, Evans GA, Hota S, Lee C, Lee TC, Longtin Y, Louie T, Moayyedi P, Poutanen S, Simor AE, Steiner T, Thampi N, Valiquette L. Association of Medical Microbiology and Infectious Disease Canada treatment practice guidelines for Clostridium difficile infection. ACTA ACUST UNITED AC 2018. [DOI: 10.3138/jammi.2018.02.13] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Vivian G Loo
- McGill University Health Centre, McGill University, Montréal, Québec, Canada
| | - Ian Davis
- Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, Nova Scotia, Canada
| | - John Embil
- Health Sciences Centre, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Gerald A Evans
- Kingston Health Sciences Centre, Queen’s University, Kingston, Ontario, Canada
| | - Susy Hota
- University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Christine Lee
- St. Joseph’s Healthcare, McMaster University, Hamilton, Ontario, Canada
| | - Todd C Lee
- McGill University Health Centre, McGill University, Montréal, Québec, Canada
| | - Yves Longtin
- Jewish General Hospital, McGill University, Montréal, Québec, Canada
| | - Thomas Louie
- Peter Lougheed Hospital, University of Calgary, Calgary, Alberta, Canada
| | - Paul Moayyedi
- Health Sciences Centre, McMaster University, Hamilton, Ontario, Canada
| | - Susan Poutanen
- Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Andrew E Simor
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Theodore Steiner
- Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nisha Thampi
- Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Louis Valiquette
- Centre Hospitalier Universitaire de Sherbrooke, Université de Sherbrooke, Sherbrooke, Québec, Canada
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19
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Kao DH, Roach B, Silva M, Beck P, Rioux KP, Madsen K, Goodman K, Xu H, Chang H, Louie T. A15 A PROSPECTIVE, NON-INFERIORITY, MULTI-CENTER, RANDOMIZED TRIAL COMPARING COLONOSCOPY VS ORAL CAPSULE DELIVERED FECAL MICROBIOTA TRANSPLANTATION (FMT) FOR RECURRENT CLOSTRIDIUM DIFFICILE INFECTION (RCDI). J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy008.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- D H Kao
- University of Alberta, Edmonton, AB, Canada
| | - B Roach
- University of Alberta, Edmonton, AB, Canada
| | - M Silva
- University of Calgary, Calgary, AB, Canada
| | - P Beck
- University of Calgary, Calgary, AB, Canada
| | - K P Rioux
- University of Calgary, Calgary, AB, Canada
| | - K Madsen
- University of Alberta, Edmonton, AB, Canada
| | - K Goodman
- University of Alberta, Edmonton, AB, Canada
| | - H Xu
- Indiana University, Indianapolis, IN
| | - H Chang
- University of Alberta, Edmonton, AB, Canada
| | - T Louie
- University of Calgary, Calgary, AB, Canada
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20
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Khoury S, Parisien M, Wang QP, Neely G, Bortsov A, McLean S, Sofer T, Louie T, Kaunisto M, Kalso E, Belfer I, Slade G, Smith S, Fillingim R, Ohrbach R, Greenspan J, Maixner W, Diatchenko L. Genome wide association study of sleep quality identifies a new association with loci near MPP6. Sleep Med 2017. [DOI: 10.1016/j.sleep.2017.11.463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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21
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Kao D, Roach B, Silva M, Beck P, Rioux K, Kaplan GG, Chang HJ, Coward S, Goodman KJ, Xu H, Madsen K, Mason A, Wong GKS, Jovel J, Patterson J, Louie T. Effect of Oral Capsule- vs Colonoscopy-Delivered Fecal Microbiota Transplantation on Recurrent Clostridium difficile Infection: A Randomized Clinical Trial. JAMA 2017; 318:1985-1993. [PMID: 29183074 PMCID: PMC5820695 DOI: 10.1001/jama.2017.17077] [Citation(s) in RCA: 383] [Impact Index Per Article: 54.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
IMPORTANCE Fecal microbiota transplantation (FMT) is effective in preventing recurrent Clostridium difficile infection (RCDI). However, it is not known whether clinical efficacy differs by route of delivery. OBJECTIVE To determine whether FMT by oral capsule is noninferior to colonoscopy delivery in efficacy. DESIGN, SETTING, AND PARTICIPANTS Noninferiority, unblinded, randomized trial conducted in 3 academic centers in Alberta, Canada. A total of 116 adult patients with RCDI were enrolled between October 2014 and September 2016, with follow-up to December 2016. The noninferiority margin was 15%. INTERVENTIONS Participants were randomly assigned to FMT by capsule or by colonoscopy at a 1:1 ratio. MAIN OUTCOMES AND MEASURES The primary outcome was the proportion of patients without RCDI 12 weeks after FMT. Secondary outcomes included (1) serious and minor adverse events, (2) changes in quality of life by the 36-Item Short Form Survey on a scale of 0 (worst possible quality of life) to 100 (best quality of life), and (3) patient perception on a scale of 1 (not at all unpleasant) to 10 (extremely unpleasant) and satisfaction on a scale of 1 (best) to 10 (worst). RESULTS Among 116 patients randomized (mean [SD] age, 58 [19] years; 79 women [68%]), 105 (91%) completed the trial, with 57 patients randomized to the capsule group and 59 to the colonoscopy group. In per-protocol analysis, prevention of RCDI after a single treatment was achieved in 96.2% in both the capsule group (51/53) and the colonoscopy group (50/52) (difference, 0%; 1-sided 95% CI, -6.1% to infinity; P < .001), meeting the criterion for noninferiority. One patient in each group died of underlying cardiopulmonary illness unrelated to FMT. Rates of minor adverse events were 5.4% for the capsule group vs 12.5% for the colonoscopy group. There was no significant between-group difference in improvement in quality of life. A significantly greater proportion of participants receiving capsules rated their experience as "not at all unpleasant" (66% vs 44%; difference, 22% [95% CI, 3%-40%]; P = .01). CONCLUSIONS AND RELEVANCE Among adults with RCDI, FMT via oral capsules was not inferior to delivery by colonoscopy for preventing recurrent infection over 12 weeks. Treatment with oral capsules may be an effective approach to treating RCDI. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT02254811.
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Affiliation(s)
- Dina Kao
- Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Brandi Roach
- Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Marisela Silva
- Division of Infectious Diseases, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Paul Beck
- Division of Gastroenterology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kevin Rioux
- Division of Gastroenterology, Department of Medicine, University of Victoria, Victoria, British Columbia, Canada
| | - Gilaad G. Kaplan
- Division of Gastroenterology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Stephanie Coward
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Karen J. Goodman
- Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Huiping Xu
- Department of Biostatistics, Indiana University, Indianapolis
| | - Karen Madsen
- Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Andrew Mason
- Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Gane Ka-Shu Wong
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
- Department of Biological Sciences, University of Alberta, Edmonton, Alberta, Canada
- BGI-Shenzhen, Shenzhen, China
| | - Juan Jovel
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Jordan Patterson
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Thomas Louie
- Division of Infectious Diseases, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
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22
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Cannon K, Byrne B, Happe J, Wu K, Ward L, Chesnel L, Louie T. Enteric microbiome profiles during a randomized Phase 2 clinical trial of surotomycin versus vancomycin for the treatment of Clostridium difficile infection. J Antimicrob Chemother 2017; 72:3453-3461. [DOI: 10.1093/jac/dkx318] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 08/01/2017] [Indexed: 12/20/2022] Open
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23
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Daley P, Louie T, Lutz JE, Khanna S, Stoutenburgh U, Jin M, Adedoyin A, Chesnel L, Guris D, Larson KB, Murata Y. Surotomycin versus vancomycin in adults with Clostridium difficile infection: primary clinical outcomes from the second pivotal, randomized, double-blind, Phase 3 trial. J Antimicrob Chemother 2017; 72:3462-3470. [DOI: 10.1093/jac/dkx299] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 07/26/2017] [Indexed: 11/13/2022] Open
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24
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Ugarte Torres A, Chu A, Read R, MacDonald J, Gregson D, Louie T, Delongchamp J, Ward L, McClure J, Zhang K, Conly J. The epidemiology of Staphylococcus aureus carriage in patients attending inner city sexually transmitted infections and community clinics in Calgary, Canada. PLoS One 2017; 12:e0178557. [PMID: 28542601 PMCID: PMC5444836 DOI: 10.1371/journal.pone.0178557] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 05/15/2017] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Although the nares represent the most common carriage site for traditional hospital-associated strains of Staphylococcus aureus (SA), the predominant site of carriage of SA in the community is less certain. METHODS We conducted a cross-sectional study in 285 patients attending sexually transmitted diseases and inner-city clinics to evaluate the prevalence, body site colonisation and risk factors associated with carriage of methicillin susceptible SA (MSSA). All isolates were characterized by pulsed field gel electrophoresis, staphylococcal cassette chromosome mec, staphylococcal protein A and multilocus sequence typing. RESULTS The prevalence of colonisation with SA was 57.5% (164/285); 162 (56.8%) participants were colonized with MSSA, and 4 (1.4%) with methicillin-resistant SA (MRSA), 2 of them were co-colonised with both MRSA and MSSA. The most common sites of colonisation were the throat (73.1%), nares (65.2%) and interdigital web spaces of the hand (21.3%). Three out of 4 MRSA isolates were USA300-MRSA strains. Twelve MSSA isolates were closely related to the USA300 CA-MRSA. We identified sexual behaviours such as having more than 6 heterosexual sexual partners in the last 6 months and trimming pubic hair to be independently associated with MSSA colonisation, and more specifically practicing oral sex as a risk factor for throat colonisation. CONCLUSION There is a high prevalence of MSSA carriage in this population, with a low prevalence of MRSA. The throat was the most common site of carriage and sexual behaviours were found to be risk factors for MSSA colonisation. Close strain relatedness of MSSA and USA300-MRSA isolates suggests either gain or loss of the SCCmec element, respectively.
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Affiliation(s)
- Alejandra Ugarte Torres
- Division of Infectious Diseases, Department of Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada
| | - Angel Chu
- Division of Infectious Diseases, Department of Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada
- Sexually Transmitted Infections Clinic, Alberta Health Services, Calgary, Alberta, Canada
| | - Ron Read
- Division of Infectious Diseases, Department of Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada
- Sexually Transmitted Infections Clinic, Alberta Health Services, Calgary, Alberta, Canada
- Department of Microbiology, Infectious Diseases and Immunology, Cumming School of Medicine, Calgary, Alberta, Canada
- Snyder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada
| | - Judy MacDonald
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Infection Prevention & Control, Alberta Health Services, Calgary, Alberta, Canada
| | - Daniel Gregson
- Division of Infectious Diseases, Department of Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada
- Snyder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada
- Department of Pathology and Laboratory Medicine, Cumming School of Medicine and Alberta Health Services, Calgary, Alberta, Canada
- O’Brien Institute for Public Health, Cumming School of Medicine and Alberta Health Services, University of Calgary, Calgary, Alberta, Canada
| | - Thomas Louie
- Division of Infectious Diseases, Department of Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada
- Department of Microbiology, Infectious Diseases and Immunology, Cumming School of Medicine, Calgary, Alberta, Canada
- Snyder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada
- Infection Prevention & Control, Alberta Health Services, Calgary, Alberta, Canada
| | - Johanna Delongchamp
- Centre for Antimicrobial Resistance, Alberta Health Services and University of Calgary, Alberta, Canada
| | - Linda Ward
- Infection Prevention & Control, Alberta Health Services, Calgary, Alberta, Canada
| | - Joann McClure
- Centre for Antimicrobial Resistance, Alberta Health Services and University of Calgary, Alberta, Canada
| | - Kunyan Zhang
- Division of Infectious Diseases, Department of Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada
- Department of Microbiology, Infectious Diseases and Immunology, Cumming School of Medicine, Calgary, Alberta, Canada
- Snyder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada
- Department of Pathology and Laboratory Medicine, Cumming School of Medicine and Alberta Health Services, Calgary, Alberta, Canada
- Centre for Antimicrobial Resistance, Alberta Health Services and University of Calgary, Alberta, Canada
- Calgary Laboratory Services, Alberta Health Services, Calgary, Alberta, Canada
| | - John Conly
- Division of Infectious Diseases, Department of Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada
- Department of Microbiology, Infectious Diseases and Immunology, Cumming School of Medicine, Calgary, Alberta, Canada
- Snyder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada
- Department of Pathology and Laboratory Medicine, Cumming School of Medicine and Alberta Health Services, Calgary, Alberta, Canada
- O’Brien Institute for Public Health, Cumming School of Medicine and Alberta Health Services, University of Calgary, Calgary, Alberta, Canada
- Centre for Antimicrobial Resistance, Alberta Health Services and University of Calgary, Alberta, Canada
- Calgary Laboratory Services, Alberta Health Services, Calgary, Alberta, Canada
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25
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Ward L, O'Grady HM, Wu K, Cannon K, Workentine M, Louie T. Combined Oral Fecal Capsules Plus Fecal Enema as Treatment of Late-Onset Autism Spectrum Disorder in Children: Report of a Small Case Series. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.1767] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Linda Ward
- Microbiology, Infectious Diseases and Immunology, University of Calgary, Calgary, Alberta, Canada
| | - Heidi Mulcahy O'Grady
- Alberta Health Services, Calgary and Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kaiyu Wu
- Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Matthew Workentine
- Faculty of Veterinary Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Thomas Louie
- Pathology and Laboratory Medicine, University of Calgary, Calgary, Alberta, Canada
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26
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Torres AU, Delongchamp J, Ward L, Mcclure J, Zhang K, Louie T, Macdonald J, Gregson D, Chu A, Larios O, Read R, Conly J. Unexpected High Prevalence of qacA/B and smr Genes Among Staphylococcus spp Isolates From Individuals Attending a Sexually Transmitted Infections Clinic. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Johanna Delongchamp
- Microbiology, Infectious Diseases and Immunology, University of Calgary, Calgary, Alberta, Canada
| | - Linda Ward
- Microbiology, Infectious Diseases and Immunology, University of Calgary, Calgary, Alberta, Canada
- Infection Prevention and Control, Alberta Health Services, Calgary, Alberta, Canada
| | - Joann Mcclure
- Microbiology, Infectious Diseases and Immunology, University of Calgary, Calgary, Alberta, Canada
| | - Kunyan Zhang
- Microbiology, Infectious Diseases and Immunology, University of Calgary, Calgary, Alberta, Canada
- Pathology and Laboratory Medicine, Alberta Health Services, Calgary, Alberta, Canada
- Snyder Institute for Chronic Diseases, Calgary, Alberta, Canada
| | - Thomas Louie
- Microbiology, Infectious Diseases and Immunology, University of Calgary, Calgary, Alberta, Canada
- Infection Prevention and Control, Alberta Health Services, Calgary, Alberta, Canada
- Pathology and Laboratory Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Judy Macdonald
- Public Health, Alberta Health Services, Calgary, Alberta, Canada
- Community Health Sciences, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Daniel Gregson
- Snyder Institute for Chronic Diseases, Calgary, Alberta, Canada
- University of Calgary, Calgary, Alberta, Canada
- Calgary Laboratory Services, Calgary, Alberta, Canada
| | - Angel Chu
- Microbiology, Infectious Diseases and Immunology, University of Calgary, Calgary, Alberta, Canada
- STI Clinic, Alberta Health Services, Calgary, Alberta, Canada
| | - Oscar Larios
- Microbiology, Infectious Diseases and Immunology, University of Calgary, Calgary, Alberta, Canada
- Snyder Institute for Chronic Diseases, Calgary, Alberta, Canada
| | - Ron Read
- Microbiology, Infectious Diseases and Immunology, University of Calgary, Calgary, Alberta, Canada
- Snyder Institute for Chronic Diseases, Calgary, Alberta, Canada
- STI Clinic, Alberta Health Services, Calgary, Alberta, Canada
| | - John Conly
- Microbiology, Infectious Diseases and Immunology, University of Calgary, Calgary, Alberta, Canada
- Infection Prevention and Control, Alberta Health Services, Calgary, Alberta, Canada
- Snyder Institute for Chronic Diseases, Calgary, Alberta, Canada
- Pathology and Laboratory Medicine, University of Calgary, Calgary, Alberta, Canada
- Medicine, Alberta Health Services, Calgary, Alberta, Canada
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Lee CH, Patino H, Stevens C, Rege S, Chesnel L, Louie T, Mullane KM. Surotomycin versus vancomycin for Clostridium difficile infection: Phase 2, randomized, controlled, double-blind, non-inferiority, multicentre trial. J Antimicrob Chemother 2016; 71:2964-71. [PMID: 27432604 DOI: 10.1093/jac/dkw246] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 05/23/2016] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Clostridium difficile infection (CDI) is a major public health concern. Treatment with commonly prescribed antibiotics is associated with high rates of recurrence after initial cure. Here, we present the efficacy and safety of surotomycin, an orally administered, minimally absorbed, selective bactericidal cyclic lipopeptide, compared with vancomycin, in patients with CDI. METHODS In this Phase 2, randomized, controlled, double-blind, non-inferiority, multicentre trial, participants received surotomycin 125 mg twice daily, surotomycin 250 mg twice daily or vancomycin 125 mg four times daily for 10 days. The primary efficacy outcome was clinical response at end of treatment. The registration number of the study on clinicaltrials.gov is NCT01085591. RESULTS Clinical cure rates were similar among treatment groups (92.4% for surotomycin 125 mg twice daily, 86.6% for surotomycin 250 mg twice daily and 89.4% for vancomycin). Recurrence rates were 27.9% for surotomycin 125 mg twice daily, 17.2% for surotomycin 250 mg twice daily and 35.6% for vancomycin. The lower recurrence rate with surotomycin 250 mg twice daily versus vancomycin was statistically significant (P = 0.035). Recurrence rates were statistically similar between the surotomycin dose groups (P = 0.193). Rates of sustained clinical response at end of study were 66.7% for surotomycin 125 mg twice daily, 70.1% for surotomycin 250 mg twice daily and 56.1% for vancomycin. Incidence of adverse events was similar among treatment arms. CONCLUSIONS Recurrence rates of CDI were lower with surotomycin with higher sustained clinical response rates compared with vancomycin, both of which may offer potential clinical benefits.
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Affiliation(s)
- Christine H Lee
- St. Joseph's Healthcare, Hamilton Regional Laboratory Medicine Program, McMaster University, 50 Charlton Avenue East, Hamilton, Ontario L8N 4A6, Canada Island Health Authority, Royal Jubilee Hospital, 1952 Bay St, Victoria BC V8R 1J8, Canada
| | - Hernando Patino
- Merck and Co., Inc., 2000 Galloping Hill Road, Kenilworth, NJ 07033, USA
| | - Chris Stevens
- Gastroenterology Consultant, 55 Huntington Rd, Newton, MA 02458, USA
| | - Shruta Rege
- Merck and Co., Inc., 2000 Galloping Hill Road, Kenilworth, NJ 07033, USA
| | - Laurent Chesnel
- Merck and Co., Inc., 2000 Galloping Hill Road, Kenilworth, NJ 07033, USA
| | - Thomas Louie
- University of Calgary, Foothills Medical Centre, 1403 29th Street NW, Calgary, Alberta T2N 2T9, Canada
| | - Kathleen M Mullane
- The University of Chicago Department of Medicine, 5841 S. Maryland Avenue, Chicago, IL 60637, USA
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Santillana M, Nguyen AT, Louie T, Zink A, Gray J, Sung I, Brownstein JS. Cloud-based Electronic Health Records for Real-time, Region-specific Influenza Surveillance. Sci Rep 2016; 6:25732. [PMID: 27165494 PMCID: PMC4863169 DOI: 10.1038/srep25732] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Accepted: 04/20/2016] [Indexed: 11/30/2022] Open
Abstract
Accurate real-time monitoring systems of influenza outbreaks help public health officials make informed decisions that may help save lives. We show that information extracted from cloud-based electronic health records databases, in combination with machine learning techniques and historical epidemiological information, have the potential to accurately and reliably provide near real-time regional estimates of flu outbreaks in the United States.
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Affiliation(s)
- M. Santillana
- Computational Health Informatics Program, Boston Children’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Harvard School of Engineering and Applied Sciences, Cambridge, MA, USA
| | - A. T. Nguyen
- Harvard School of Engineering and Applied Sciences, Cambridge, MA, USA
| | - T. Louie
- Harvard School of Public Health, Boston, MA, USA
| | - A. Zink
- athenaResearch at athenahealth, Watertown, MA, USA
| | - J. Gray
- athenaResearch at athenahealth, Watertown, MA, USA
| | - I. Sung
- athenaResearch at athenahealth, Watertown, MA, USA
| | - J. S. Brownstein
- Computational Health Informatics Program, Boston Children’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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Wu K, O'Grady H, Workentine M, Poon K, Byrne B, Kim J, Louie T. Impact of Ascending Dosages of Cadazolid or Vancomycin on the Intestinal Microbiome During Treatment of Clostridium difficile Infection. Open Forum Infect Dis 2015. [DOI: 10.1093/ofid/ofv133.478] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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30
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Torres AU, Read R, Chu A, Zhang K, Gregson D, Louie T, Macdonald J, Delongchamp J, Ward L, Mcclure J, Conly J. Novel Findings in the Epidemiology of Staphylococcus aureus in Patients Attending Inner City Sexually Transmitted Infections (STI) and Community Clinics in Calgary. Open Forum Infect Dis 2015. [DOI: 10.1093/ofid/ofv133.841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Gerding DN, Hecht DW, Louie T, Nord CE, Talbot GH, Cornely OA, Buitrago M, Best E, Sambol S, Osmolski JR, Kracker H, Locher HH, Charef P, Wilcox M. Susceptibility of Clostridium difficile isolates from a Phase 2 clinical trial of cadazolid and vancomycin in C. difficile infection. J Antimicrob Chemother 2015; 71:213-9. [PMID: 26433782 PMCID: PMC4681371 DOI: 10.1093/jac/dkv300] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 08/23/2015] [Indexed: 12/18/2022] Open
Abstract
Objectives The aim of this study was to evaluate the susceptibilities of Clostridium difficile isolates to cadazolid, a novel antibiotic for the treatment of C. difficile infection. Methods Ribotyping and susceptibilities were determined for C. difficile isolates from a multicentre, double-blind, Phase 2 study of oral cadazolid in patients with C. difficile infection (NCT01222702, ClinicalTrials.gov; EudraCT 2010-020941-29, European Clinical Trials Database). Patients were randomized to receive 250, 500 or 1000 mg of cadazolid twice daily or 125 mg of vancomycin four times daily, for 10 days. MICs of cadazolid, vancomycin, fidaxomicin, linezolid and moxifloxacin were determined at baseline for all patients and post-baseline for patients with clinical failure or recurrence, using the agar dilution method. Results Seventy-eight of 84 patients had an evaluable toxigenic C. difficile isolate at baseline. The most frequent PCR ribotype was 027 (15.4%). Cadazolid MICs for baseline isolates (including epidemic strain 027) ranged from 0.06 to 0.25 mg/L. Baseline cadazolid MICs were similar to those of fidaxomicin and lower than those of vancomycin, linezolid and moxifloxacin. For each clinical outcome group (clinical cure, clinical failure, sustained clinical response and clinical failure or recurrence), the baseline cadazolid MIC range was 0.06–0.25 mg/L. Mean (min–max) cadazolid faecal concentration (μg/g) on day 5 was 884 (101–2710), 1706 (204–4230) and 3226 (1481–12 600) for the doses 250, 500 and 1000 mg, respectively. Conclusions For all cadazolid doses, the faecal concentration was in excess of several thousand-fold the MIC90 for C. difficile. The MIC of cadazolid for all C. difficile isolates, including epidemic strains, was low and in the same narrow range regardless of treatment outcome.
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Affiliation(s)
- D N Gerding
- Loyola University, Maywood, IL, USA Edward Hines Jr VA Hospital, Hines, IL, USA
| | - D W Hecht
- Loyola University, Maywood, IL, USA Edward Hines Jr VA Hospital, Hines, IL, USA
| | - T Louie
- University of Calgary, Calgary, Alberta, Canada
| | - C E Nord
- Karolinska Institute, Stockholm, Sweden
| | | | - O A Cornely
- Department of Internal Medicine, University Hospital of Cologne, Cologne, Germany Clinical Trials Centre Cologne, University of Cologne, Cologne, Germany Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
| | - M Buitrago
- Idaho Falls Infectious Diseases, Idaho Falls, ID, USA
| | - E Best
- Leeds General Infirmary, Leeds, UK
| | - S Sambol
- Loyola University, Maywood, IL, USA Edward Hines Jr VA Hospital, Hines, IL, USA
| | - J R Osmolski
- Loyola University, Maywood, IL, USA Edward Hines Jr VA Hospital, Hines, IL, USA
| | - H Kracker
- Actelion Pharmaceuticals Ltd, Allschwil, Switzerland
| | - H H Locher
- Actelion Pharmaceuticals Ltd, Allschwil, Switzerland
| | - P Charef
- Actelion Pharmaceuticals Ltd, Allschwil, Switzerland
| | - M Wilcox
- Leeds General Infirmary, Leeds, UK
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Wong H, De Grood J, Louie R, Ward L, Pearce C, Louie T. Terminal Cleaning Comparison of a Medical Surface Repair Patch on Hospital Mattresses. Am J Infect Control 2015. [DOI: 10.1016/j.ajic.2015.04.158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Weiss K, Louie T, Miller MA, Mullane K, Crook DW, Gorbach SL. Effects of proton pump inhibitors and histamine-2 receptor antagonists on response to fidaxomicin or vancomycin in patients with Clostridium difficile-associated diarrhoea. BMJ Open Gastroenterol 2015; 2:e000028. [PMID: 26462279 PMCID: PMC4599152 DOI: 10.1136/bmjgast-2014-000028] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 01/23/2015] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE It has been established that use of proton pump inhibitors (PPIs) is associated with an increased risk of acquiring Clostridium difficile-associated diarrhoea (CDAD). However, it is not known whether the use of PPIs or histamine-2 receptor antagonists (H2RAs) concurrently with CDAD-targeted antibiotic treatment affects clinical response or recurrence rates. DESIGN In two phase 3 trials, patients with toxin-positive CDAD were randomised to receive fidaxomicin 200 mg twice daily or vancomycin 125 mg four times daily for 10 days. Only inpatients with CDAD (due to complete medication record availability) were included in this post hoc analysis: 701 patients, of whom 446 (64%) used PPIs or H2RAs during study drug treatment or follow-up. Baseline factors that were statistically significant in univariate analyses were analysed in multivariate analyses of effects on clinical response and recurrence. RESULTS Multivariate analysis showed that leukocytosis, elevated creatinine and hypoalbuminemia, but not PPI or H2RA use, were significant factors associated with poor clinical responses. Treatment group was the single significant predictor of recurrence; the probability of recurrence after fidaxomicin therapy was half that following vancomycin therapy. CONCLUSIONS Acid-suppressing drugs, used by nearly two-thirds of inpatients with CDAD, did not worsen clinical response or recurrence when used concurrently with fidaxomicin or vancomycin. Therefore, development of CDAD does not require discontinuation of anti-acid treatment in patients who have an indication for continuing PPI or H2RA therapy, such as gastro-oesophageal reflux disease and risk of gastrointestinal bleed.
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Affiliation(s)
- Karl Weiss
- Department of Infectious Diseases and Microbiology, University of Montreal, Montreal, Quebec, Canada
| | - Thomas Louie
- Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, Alberta, Canada
| | - Mark A Miller
- Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Kathleen Mullane
- Department of Medicine, Section of Infectious Diseases, University of Chicago, Chicago, Illinois, USA
| | - Derrick W Crook
- Nuffield Department of Clinical Medicine, Oxford University, Oxford, UK
| | - Sherwood L Gorbach
- Department of Public Health and Family Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA
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Rajapakse N, Vayalumkal J, Lam-Li D, Pearce C, Rees G, Kamhuka L, Peirano G, Pidhorney C, Ledgerwood D, Alfieri N, Hope K, Gregson D, Pitout J, Louie T, Conly J. Pilot testing of an out-of-country medical care questionnaire with screening and cost analysis of preemptive isolation for carbapenem-resistant Enterobacteriaceae in a large Canadian health region. Infect Control Hosp Epidemiol 2014; 35:450-1. [PMID: 24602958 DOI: 10.1086/675616] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Nipunie Rajapakse
- Department of Pediatrics, Alberta Children's Hospital, Alberta Health Services, Calgary, Alberta, Canada
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De Grood J, Ward L, Harman S, Duchscherer C, Ward M, McClure J, Hope K, Kim J, Vayalumkal J, Zhang K, Louie T, Conly J. O069: Efficacy of cleaning methods post-inoculation of pathogenic microorganisms of conventional and novel cleankeys computer keyboards. Antimicrob Resist Infect Control 2013. [PMCID: PMC3687830 DOI: 10.1186/2047-2994-2-s1-o69] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Miller MA, Louie T, Mullane K, Weiss K, Lentnek A, Golan Y, Kean Y, Sears P. Derivation and validation of a simple clinical bedside score (ATLAS) for Clostridium difficile infection which predicts response to therapy. BMC Infect Dis 2013; 13:148. [PMID: 23530807 PMCID: PMC3618004 DOI: 10.1186/1471-2334-13-148] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2012] [Accepted: 02/06/2013] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Clostridium difficile infection (CDI) continues to be a frequent and potentially severe infection. There is currently no validated clinical tool for use at the time of CDI diagnosis to categorize patients in order to predict response to therapy. METHODS Six clinical and laboratory variables, measured at the time of CDI diagnosis, were combined in order to assess their correlation with treatment response in a large CDI clinical trial database (derivation cohort). The final categorization scheme was chosen in order to maximize the number of categories (discrimination) while maintaining a high correlation with clinical cure assessed two days after the end of therapy. Validation of the derived scoring scheme was done on a second large CDI clinical trial database (validation cohort). A third comparison was done on the two pooled databases (pooled cohort). RESULTS In the derivation cohort, the best discrimination and correlation with cure was seen with a five-component ATLAS score (age, treatment with systemic antibiotics, leukocyte count, albumin and serum creatinine as a measure of renal function), which divided CDI patients into 11 groups (scores of 0 to 10 inclusive) and was highly correlated with treatment outcome (R(2) = 0.95; P<0.001). This scheme showed excellent prediction of cure in the validation cohort (overall Kappa = 95.2%; P<0.0001), as well as in the pooled cohort, regardless of treatment (fidaxomicin or vancomycin). CONCLUSIONS A combination of five simple and commonly available clinical and laboratory variables measured at the time of CDI diagnosis, combined into a scoring system (ATLAS), are able to accurately predict treatment response to CDI therapy. The ATLAS scoring system may be useful in stratifying CDI patients so that appropriate therapies can be chosen to maximize cure rates, as well as for categorization of patients in CDI therapeutic studies in order allow comparisons of patient groups.
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Affiliation(s)
- Mark A Miller
- Division of Infectious Diseases, Jewish General Hospital, 3755 Cote-Ste-Catherine Rd, Montreal, QC, Canada.
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Guo B, Harstall C, Louie T, Veldhuyzen van Zanten S, Dieleman LA. Systematic review: faecal transplantation for the treatment of Clostridium difficile-associated disease. Aliment Pharmacol Ther 2012; 35:865-75. [PMID: 22360412 DOI: 10.1111/j.1365-2036.2012.05033.x] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Revised: 01/08/2012] [Accepted: 01/27/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND Management of recurrent Clostridium difficile-associated disease (CDAD), particularly in elderly patients, remains clinically challenging. Faecal transplantation (FT) may restore normal microbiota and break the cycle of recurrent CDAD. AIM To critically appraise the clinical research evidence on the safety and effectiveness of FT compared with standard care in the treatment of patients with CDAD. METHODS A comprehensive literature search was conducted by a research librarian to identify relevant studies published between 2000 and 2011. The Cochrane Library, PubMed, EMBASE, CINAHL, Biological Abstracts, BIOSIS Previews and Web of Science were searched using the following Medical Subject Headings (MeSH) terms and keywords, alone or in combination: Clostridium infections/Clostridium difficile/pseudomembranous/colitis/faeces/rectal/colon flora/gastrointestinal/nasogastric tube/enema/donor/transplant/infusion/bacteriotherapy/human probiotic infusion. Methodological quality of the included case series studies was assessed in terms of patient selection criteria, consecutive recruitment, prospective data collection, reporting of lost to follow-up, and follow-up rates. RESULTS No controlled studies were found. Based on the weak evidence from seven full-text case series studies of 124 patients with recurrent/refractory CDAD, FT appears to be a safe and effective procedure. In most cases (83%) symptoms improved immediately after the first FT procedure, and some patients stayed diarrhoea free for several months or years. CONCLUSIONS Although these results appear to be promising, the treatment effects of faecal transplantation cannot be determined definitively in the absence of a control group. Results from randomised controlled trials that compare faecal transplantation to oral vancomycin without or with a taper regimen will help to better define the role of faecal transplantation in the management of recurrent CDAD.
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Affiliation(s)
- B Guo
- Institute of Health Economics, Edmonton, Alberta, Canada.
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Bakken JS, Borody T, Brandt LJ, Brill JV, Demarco DC, Franzos MA, Kelly C, Khoruts A, Louie T, Martinelli LP, Moore TA, Russell G, Surawicz C. Treating Clostridium difficile infection with fecal microbiota transplantation. Clin Gastroenterol Hepatol 2011; 9:1044-9. [PMID: 21871249 PMCID: PMC3223289 DOI: 10.1016/j.cgh.2011.08.014] [Citation(s) in RCA: 641] [Impact Index Per Article: 49.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2011] [Revised: 07/26/2011] [Accepted: 08/18/2011] [Indexed: 02/07/2023]
Abstract
Clostridium difficile infection is increasing in incidence, severity, and mortality. Treatment options are limited and appear to be losing efficacy. Recurrent disease is especially challenging; extended treatment with oral vancomycin is becoming increasingly common but is expensive. Fecal microbiota transplantation is safe, inexpensive, and effective; according to case and small series reports, about 90% of patients are cured. We discuss the rationale, methods, and use of fecal microbiota transplantation.
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Affiliation(s)
| | - Thomas Borody
- Centre for Digestive Diseases, Five Dock NSW Australia
| | - Lawrence J. Brandt
- Division of Gastroenterology, Montefiore Medical Center/Albert Einstein College of Medicine, New York City, NY
| | | | | | | | | | - Alexander Khoruts
- Department of Medicine and Center for Immunology, University of Minnesota, Minneapolis, MN
| | | | | | - Thomas A. Moore
- Department of Infectious Diseases, Ochsner Health System, New Orleans, LA
| | | | - Christina Surawicz
- Division of Gastroenterology, Department of Medicine, University of Washington School of Medicine, Seattle, WA
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Tannock GW, Munro K, Taylor C, Lawley B, Young W, Byrne B, Emery J, Louie T. A new macrocyclic antibiotic, fidaxomicin (OPT-80), causes less alteration to the bowel microbiota of Clostridium difficile-infected patients than does vancomycin. Microbiology 2010; 156:3354-3359. [PMID: 20724385 DOI: 10.1099/mic.0.042010-0] [Citation(s) in RCA: 169] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Clostridium difficile infection (CDI) is the most common identifiable cause of diarrhoea in hospitalized patients. Current therapies rely on the administration of metronidazole or vancomycin, which reduce vegetative populations of C. difficile in the bowel. Recurrence of the disease when treatment with these antibiotics ceases indicates that metronidazole and vancomycin affect not only C. difficile but also commensal populations that normally mediate competitive exclusion. Fidaxomicin is a new antibiotic that inhibits C. difficile. Our study shows that fidaxomicin had little effect on the composition of the faecal microbiota in terms of its major phylogenetic clusters. Notably, clostridial clusters XIVa and IV, and Bifidobacterium, were much less affected by fidaxomicin compared to vancomycin treatment. These findings help to explain the substantially reduced rates of relapse following treatment of CDI with fidaxomicin in recent clinical trials.
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Affiliation(s)
- Gerald W Tannock
- Department of Microbiology and Immunology, University of Otago, Dunedin, New Zealand
| | - Karen Munro
- Department of Microbiology and Immunology, University of Otago, Dunedin, New Zealand
| | - Corinda Taylor
- Department of Microbiology and Immunology, University of Otago, Dunedin, New Zealand
| | - Blair Lawley
- Department of Microbiology and Immunology, University of Otago, Dunedin, New Zealand
| | - Wayne Young
- Department of Microbiology and Immunology, University of Otago, Dunedin, New Zealand
| | - Brendan Byrne
- Department of Microbiology and Infectious Diseases, University of Calgary, Calgary, Canada
| | - Judy Emery
- Department of Microbiology and Infectious Diseases, University of Calgary, Calgary, Canada
| | - Thomas Louie
- Department of Microbiology and Infectious Diseases, University of Calgary, Calgary, Canada
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Hirota SA, Fines K, Ng J, Traboulsi D, Lee J, Ihara E, Li Y, Willmore WG, Chung D, Scully MM, Louie T, Medlicott S, Lejeune M, Chadee K, Armstrong G, Colgan SP, Muruve DA, MacDonald JA, Beck PL. Hypoxia-inducible factor signaling provides protection in Clostridium difficile-induced intestinal injury. Gastroenterology 2010; 139:259-69.e3. [PMID: 20347817 PMCID: PMC3063899 DOI: 10.1053/j.gastro.2010.03.045] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2009] [Revised: 03/09/2010] [Accepted: 03/17/2010] [Indexed: 12/15/2022]
Abstract
BACKGROUND & AIMS Clostridium difficile is the leading cause of nosocomial infectious diarrhea. Antibiotic resistance and increased virulence of strains have increased the number of C difficile-related deaths worldwide. The innate host response mechanisms to C difficile are not resolved; we propose that hypoxia-inducible factor (HIF-1) has an innate, protective role in C difficile colitis. We studied the impact of C difficile toxins on the regulation of HIF-1 and evaluated the role of HIF-1alpha in C difficile-mediated injury/inflammation. METHODS We assessed HIF-1alpha mRNA and protein levels and DNA binding in human mucosal biopsy samples and Caco-2 cells following exposure to C difficile toxins. We used the mouse ileal loop model of C difficile toxin-induced intestinal injury. Mice with targeted deletion of HIF-1alpha in the intestinal epithelium were used to assess the effects of HIF-1alpha signaling in response to C difficile toxin. RESULTS Mucosal biopsy specimens and Caco-2 cells exposed to C difficile toxin had a significant increase in HIF-1alpha transcription and protein levels. Toxin-induced DNA binding was also observed in Caco-2 cells. Toxin-induced HIF-1alpha accumulation was attenuated by nitric oxide synthase inhibitors. In vivo deletion of intestinal epithelial HIF-1alpha resulted in more severe, toxin-induced intestinal injury and inflammation. In contrast, stabilization of HIF-1alpha with dimethyloxallyl glycine attenuated toxin-induced injury and inflammation. This was associated with induction of HIF-1-regulated protective factors (such as vascular endothelial growth factor-alpha, CD73, and intestinal trefoil factor) and down-regulation of proinflammatory molecules such as tumor necrosis factor and Cxcl1. CONCLUSIONS HIF-1alpha protects the intestinal mucosa from C difficile toxins. The innate protective actions of HIF-1alpha in response to C difficile toxins be developed as therapeutics for C difficile-associated disease.
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Affiliation(s)
- Simon A. Hirota
- Department of Biochemistry & Molecular Biology, University of Calgary, Calgary, Canada,Department of Medicine, University of Calgary, Calgary, Canada
| | - Kyla Fines
- Department of Biochemistry & Molecular Biology, University of Calgary, Calgary, Canada,Department of Medicine, University of Calgary, Calgary, Canada
| | - Jeffery Ng
- Department of Medicine, University of Calgary, Calgary, Canada
| | - Danya Traboulsi
- Department of Biochemistry & Molecular Biology, University of Calgary, Calgary, Canada
| | - Josh Lee
- Department of Biochemistry & Molecular Biology, University of Calgary, Calgary, Canada
| | - Eikichi Ihara
- Department of Biochemistry & Molecular Biology, University of Calgary, Calgary, Canada
| | - Yan Li
- Department of Medicine, University of Calgary, Calgary, Canada
| | | | - Daniel Chung
- Gastrointestinal Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, USA
| | - Melanie M. Scully
- Mucosal Inflammation Program, Division of Gastroenterology, University of Colorado, Health Sciences Center, Denver, USA
| | - Thomas Louie
- Department of Medicine, University of Calgary, Calgary, Canada
| | - Sean Medlicott
- Department of Pathology, University of Calgary, Calgary, Canada
| | - Manigandan Lejeune
- Department of Microbiology & Infectious Diseases, University of Calgary, Calgary, Canada
| | - Kris Chadee
- Department of Microbiology & Infectious Diseases, University of Calgary, Calgary, Canada
| | - Glen Armstrong
- Department of Microbiology & Infectious Diseases, University of Calgary, Calgary, Canada
| | - Sean P. Colgan
- Mucosal Inflammation Program, Division of Gastroenterology, University of Colorado, Health Sciences Center, Denver, USA
| | | | - Justin A. MacDonald
- Department of Biochemistry & Molecular Biology, University of Calgary, Calgary, Canada
| | - Paul L. Beck
- Department of Medicine, University of Calgary, Calgary, Canada
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Ferrato C, Ward L, Roles A, Ceri H, Drinkwater D, Louie T, Louie M. P317 Impact of ultraviolet light sterilization (UVLS) on microbiological water quality in a newly designed hospital water distribution system (WDS). Int J Antimicrob Agents 2009. [DOI: 10.1016/s0924-8579(09)70536-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Ritchie P, Coppock D, Ward L, Ferrato C, Roles A, Ceri H, Drinkwater D, Louie T, Louie M. P166 Assessment of copper silver ionization (CSI) to control waterborne Legionella in Calgary Health Region (CHR) patient care settings. Int J Antimicrob Agents 2009. [DOI: 10.1016/s0924-8579(09)70385-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Wu K, Conly J, McClure JA, Elsayed S, Louie T, Zhang K. Caenorhabditis elegans as a host model for community-associated methicillin-resistant Staphylococcus aureus. Clin Microbiol Infect 2009; 16:245-54. [PMID: 19456837 DOI: 10.1111/j.1469-0691.2009.02765.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The nematode Caenorhabditis elegans has recently been developed as a host model for the study of Staphylococcus aureus virulence and pathogenesis. Here, the toxicity and virulence of representative clinical isolates of our methicillin-resistant S. aureus (MRSA) epidemic strains were studied using this model. The strains USA300 (associated with community infection outbreaks), USA400 (associated with sporadic community infections) and CMRSA2 (associated with both hospital and community infections), as well as the nematocidal reference strain NCTC8325, showed high nematocidal activity, both by killing the majority of the nematodes (> 90%) over 9 days, and by inhibiting second-generation nematode growth. By contrast, the typical hospital-associated MRSA strain CMRSA6, the colonization strain M92, and the non-pathogenic Staphylococcus epidermidis control strain ATCC12228 were non-toxic to the nematode, which behaved normally. The absence of nematocidal activity does not reflect lack of growth or reduced growth of the bacterial inoculum. The two non-nematocidal strains share similar genomic backgrounds, bacterial growth curve patterns and virulence gene profiles. However, the nematocidal strains each showed the same low maximum density growth curve patterns, but possessed distinct genetic profiles; no common virulence gene patterns or specific genes have been elucidated. Our findings demonstrate that community-associated MRSA strains are more pathogenic than hospital-associated MRSA in the C. elegans model and support the use of this model for studying the virulence of S. aureus strains.
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Affiliation(s)
- K Wu
- Centre for Antimicrobial Resistance, Calgary Health Region, Calgary Laboratory Services, University of Calgary, AB, Canada
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Chen-Kiang S, Di Liberto M, Louie T, Liang J, Jayabalan DS, Ely S, Moore MA, Niesvizky R, Huang X. Targeting Cdk4/6 in combination therapy of chemoresistant multiple myeloma. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.8503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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McClure JA, Conly JM, Lau V, Elsayed S, Louie T, Hutchins W, Zhang K. Novel multiplex PCR assay for detection of the staphylococcal virulence marker Panton-Valentine leukocidin genes and simultaneous discrimination of methicillin-susceptible from -resistant staphylococci. J Clin Microbiol 2006; 44:1141-4. [PMID: 16517915 PMCID: PMC1393128 DOI: 10.1128/jcm.44.3.1141-1144.2006] [Citation(s) in RCA: 229] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We developed a new multiplex PCR assay for detection of Panton-Valentine leukocidin virulence genes and simultaneous discrimination of methicillin-susceptible from -resistant staphylococci. This assay is simple, rapid, and accurate and offers the potential for prompt detection of newly emerging community-associated methicillin-resistant Staphylococcus aureus.
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Affiliation(s)
- Jo-Ann McClure
- Centre for Antimicrobial Resistance, Calgary Health Region/Calgary Laboratory Services/University of Calgary, Calgary, Alberta, Canada
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Zhang K, McClure JA, Elsayed S, Louie T, Conly JM. Novel multiplex PCR assay for characterization and concomitant subtyping of staphylococcal cassette chromosome mec types I to V in methicillin-resistant Staphylococcus aureus. J Clin Microbiol 2005; 43:5026-33. [PMID: 16207957 PMCID: PMC1248471 DOI: 10.1128/jcm.43.10.5026-5033.2005] [Citation(s) in RCA: 775] [Impact Index Per Article: 40.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Staphylococcal cassette chromosome mec (SCCmec) typing is essential for understanding the molecular epidemiology of methicillin-resistant Staphylococcus aureus (MRSA). SCCmec elements are currently classified into types I to V based on the nature of the mec and ccr gene complexes, and are further classified into subtypes according to their junkyard region DNA segments. Previously described traditional SCCmec PCR typing schemes require multiple primer sets and PCR experiments, while a previously published multiplex PCR assay is limited in its ability to detect recently discovered types and subtypes such as SCCmec type V and subtypes IVa, b, c, and d. We designed new sets of SCCmec type- and subtype-unique and specific primers and developed a novel multiplex PCR assay allowing for concomitant detection of the methicillin resistance (mecA gene) (also serving as an internal control) to facilitate detection and classification of all currently described SCCmec types and subtypes I, II, III, IVa, b, c, d, and V. Our assay demonstrated 100% sensitivity and specificity in accurately characterizing 54 MRSA strains belonging to the various known SCCmec types and subtypes, when compared with previously described typing methods. Further application of our assay in 453 randomly selected local clinical isolates confirmed its feasibility and practicality. This novel assay offers a rapid, simple, and feasible method for SCCmec typing of MRSA, and may serve as a useful tool for clinicians and epidemiologists in their efforts to prevent and control infections caused by this organism.
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Affiliation(s)
- Kunyan Zhang
- Centre for Antimicrobial Resistance, Calgary health Region/Calgary Laboratory services/University of Calgary, Calgary, Alberta, Canada T2L 2K8.
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Zhang K, Sparling J, Chow BL, Elsayed S, Hussain Z, Church DL, Gregson DB, Louie T, Conly JM. New quadriplex PCR assay for detection of methicillin and mupirocin resistance and simultaneous discrimination of Staphylococcus aureus from coagulase-negative staphylococci. J Clin Microbiol 2005; 42:4947-55. [PMID: 15528678 PMCID: PMC525205 DOI: 10.1128/jcm.42.11.4947-4955.2004] [Citation(s) in RCA: 228] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Major challenges in diagnostic molecular microbiology are to develop a simple assay to distinguish Staphylococcus aureus from the less virulent but clinically important coagulase-negative staphylococci (CoNS) and to simultaneously determine their antibiotic resistance profiles. Multiplex PCR assays have been developed for the detection of methicillin- and mupirocin-resistant S. aureus and CoNS but not for the simultaneous discrimination of S. aureus from CoNS. We designed a new set of Staphylococcus genus-specific primers and developed a novel quadriplex PCR assay targeting the 16S rRNA (Staphylococcus genus specific), nuc (S. aureus species specific), mecA (a determinant of methicillin resistance), and mupA (a determinant of mupirocin resistance) genes to identify most staphylococci, to discriminate S. aureus from CoNS and other bacteria, and to simultaneously detect methicillin and mupirocin resistance. Validation of the assay with 96 ATCC control strains and 323 previously characterized clinical isolates, including methicillin- and mupirocin-sensitive and -resistant S. aureus and CoNS isolates and other bacteria, demonstrated 100% sensitivity, specificity, and accuracy. This assay represents a simple, rapid, accurate, and reliable approach for the detection of methicillin- and mupirocin-resistant staphylococci and offers the hope of preventing their widespread dissemination through early and reliable detection.
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Affiliation(s)
- Kunyan Zhang
- Center for Antimicrobial Resistance, Calgary Health Region-Calgary Laboratory Services-University of Calgary, Alberta, Canada T2L 2K8.
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Abstract
HIV postexposure prophylaxis (PEP) is now a well-established part of the management of health care workers after occupational exposures to HIV. Use of PEP for adults exposed to HIV after sexual contact or injection drug use in nonoccupational settings remains controversial with limited data available. There is even less information available concerning HIV PEP for children and adolescents after accidental needlestick injuries or sexual assault. The objective was to describe the current practice of and associated problems with HIV PEP for children and adolescents at an urban academic pediatric emergency department. A retrospective review of all children and adolescents offered HIV PEP between June 1997-June 1998 was conducted. Ten pediatric and adolescent patients were offered HIV PEP, six patients after sexual assault, four patients after needle stick injuries. There were two small children 2 and 3 years of age and eight adolescents. Of these 10 patients, eight were started on HIV PEP. The regimens used for PEP varied; zidovudine, lamivudine, and indinavir were prescribed for in seven patients and zidovudine, lamivudine, and nelfinavir for one other. All 10 patients were HIV negative by serology at baseline testing and all available for follow-up testing (5 of 10) remained HIV negative at 4 to 28 weeks. Only two patients completed the full course of 4 weeks of antiretroviral therapy. Financial concerns, side effects, additional psychiatric and substance abuse issues as well as the degree of parental involvement influenced whether PEP and clinical follow-up was completed. HIV PEP in the nonoccupational setting for children and adolescents presents a medical and management challenge, and requires a coordinated effort at the initial presentation to the health care system and at follow-up. The difficulties encountered in the patients in our series need to be considered before initiating prophylaxis. A provisional management approach to HIV PEP in children and adolescents is proposed.
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Affiliation(s)
- F E Babl
- Division of Pediatric Emergency Medicine, Boston University School of Medicine, Boston Medical Center, MA 02118, USA.
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Affiliation(s)
- T Louie
- Department of Medicine, Veterans Affairs Medical Center, Baltimore, Maryland, USA
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Ilogu N, Daidone P, Stefan T, Louie T, Deak S, Gartenberg G. Neurosyphilis and syphilitic gumma of the adrenal gland. Clin Infect Dis 1998; 26:224-5. [PMID: 9455562 DOI: 10.1086/517034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- N Ilogu
- Department of Internal Medicine, St. Peters Medical Center/Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
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