Статті в журналах: "Clostridioides difficile infection"

1

Stewart, David B. "Clostridioides difficile Infection." Clinics in Colon and Rectal Surgery 33, no. 02 (February 25, 2020): 047–48. http://dx.doi.org/10.1055/s-0040-1701228.

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Hai, Zhao, Lei Peng Zhen, Ma Juan, Yang Fan, Cang Jin Rong, Liang Jing Yao, and Zhang Li Xia. "Extraintestinal Clostridioides difficile infection." IDCases 22 (2020): e00921. http://dx.doi.org/10.1016/j.idcr.2020.e00921.

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Guh, Alice Y., and Preeta K. Kutty. "Clostridioides difficile Infection (Japanese Version)." Annals of Internal Medicine 169, no. 7 (October 2, 2018): JITC49—JITC64. http://dx.doi.org/10.7326/istranslatedfrom_aitc201810020_japanese.

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Clarkin, Christina, Stephanie Quist, Renata Shamis, Amber E. King, and Bhavik M. Shah. "Management of Clostridioides difficile Infection." Critical Care Nurse 39, no. 5 (October 2019): e1-e12. http://dx.doi.org/10.4037/ccn2019841.

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Turner, Nicholas A., and Deverick J. Anderson. "Hospital Infection Control: Clostridioides difficile." Clinics in Colon and Rectal Surgery 33, no. 02 (February 25, 2020): 098–108. http://dx.doi.org/10.1055/s-0040-1701234.

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Abstract Clostridioides difficile remains a leading cause of healthcare-associated infection. Efforts at C. difficile prevention have been hampered by an increasingly complex understanding of transmission patterns and a high degree of heterogeneity among existing studies. Effective prevention of C. difficile infection requires multimodal interventions, including contact precautions, hand hygiene with soap and water, effective environmental cleaning, use of sporicidal cleaning agents, and antimicrobial stewardship. Roles for probiotics, avoidance of proton pump inhibitors, and isolation of asymptomatic carriers remain poorly defined.

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George Trad, Varun Sodhi, Matthew Brockway, Nazanin Sheikhan, Abdul Gader Gheriani, Olivia Astor, and Hatim Gemil. "Clostridioides (Clostridium) difficile infection: Review of literature." World Journal of Advanced Research and Reviews 14, no. 2 (May 30, 2022): 146–55. http://dx.doi.org/10.30574/wjarr.2022.14.2.0366.

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Clostridioides (Clostridium) difficile (C. difficile) is a gram-positive bacterium that infects the large intestine. The number of clostridium difficile infections has increased in the recent years due to multiple risk factors including frequent use of antibiotics and proton pump inhibitors. The virulence of C. difficile comes from its production of toxins. Treatment for C. difficile infection includes the use of antibiotics, monoclonal antibodies, or a fecal transplant.

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NIKOLAEVA, I. V., S. V. KHALIULLINA, G. Kh MURTAZINA, and V. A. ANOKHIN. "Clostridioides (Clostridium) difficile infection. Review of current clinical guidelines." Practical medicine 18, no. 6 (2020): 106–12. http://dx.doi.org/10.32000/2072-1757-2020-6-106-112.

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Clostridioides difficile (CDI) infection is a disease associated with a disruption of the gut microbiome with over-colonization of C. difficile, the toxins of which cause inflammation and damage to the colon. A dynamic assessment of the CDI prevalence indicates a significant increase in laboratory-confirmed cases of infection and a high mortality associated with it. C. difficile is recognized as the main causative agent of nosocomial infections in Europe, USA, Canada and Australia, which develops 48 hours after hospitalization in a medical facility and within 12 weeks after discharge. The severity of CDI is determined by the severity of infectious-toxic, diarrheal and abdominal syndromes. Severe CDI is characterized by manifestations of colitis, accompanied by severe leukocytosis, a decrease in albumin levels and an increase in serum creatinine levels. Development of fulminant forms, pseudomembranous colitis, toxic megacolon, intestinal perforation, sepsis is possible. The risk factors include in-hospital stay; recent use of antibiotics (within the previous 12 weeks, especially the use of fluoroquinolones, cephalosporins of III–IV generations, carbapenems and clindamycin), PPI and H2-histamine blockers; presence of inflammatory bowel diseases (ulcerative colitis, Crohn’s disease), immunodeficiency states, including iatrogenic; recent endoscopic examinations, surgical interventions on the gastrointestinal tract, tube feeding, enemas; possible contact with a family member who recently had a C..difficile infection. The «gold standard» for confirming the CDI diagnosis is the identification of the causative agent and/or toxins of C. difficile in the stool using specific laboratory research methods. Vancomycin or metronidazole are recommended as first-line therapy.

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Knežević, Darija, and Miroslav Petković. "Faecal transplantation and Clostridioides difficile infection." Scripta Medica 52, no. 3 (2021): 215–23. http://dx.doi.org/10.5937/scriptamed52-32752.

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Faecal microbiota transplantation (FMT), known equally well as faecal transplantation or faecal bacteriotherapy, is the process of implanting the faecal suspension containing balanced microbiota from a healthy donor to the colon of a recipient patient. Excessive growth of Clostridioides difficile (C difficile) in the intestinal microbiota resulting from antibiotic consumption is currently a rising threat to public health. FMT is one of the most important, newer approaches to treating C difficile infections. Since C difficile is regarded as an opportunistic bacterium triggering disease in conditions of disturbed homeostasis of the intestinal microbiota, restoration of healthy intestinal microflora facilitates suppression of toxic strain of C difficile by anaerobic bacteria of normal intestinal microflora with concomitant cure. Nurses have important role in caring for patients after faecal transplantation.

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9

Khanna, Sahil, and Ryan Pardi. "Clostridioides difficile infection: curbing a difficult menace." Therapeutic Advances in Gastroenterology 15 (January 2022): 175628482210899. http://dx.doi.org/10.1177/17562848221089906.

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Ohge, Hiroki, Toshiki Kajihara, and Hiroyuki Kitano. "V. Clostridioides Difficile Infection." Nihon Naika Gakkai Zasshi 107, no. 11 (November 10, 2018): 2261–68. http://dx.doi.org/10.2169/naika.107.2261.

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11

Jarmo, Oksi, Anttila Veli-Jukka, and Mattila Eero. "Treatment of Clostridioides (Clostridium) difficile infection." Annals of Medicine 52, no. 1-2 (December 13, 2019): 12–20. http://dx.doi.org/10.1080/07853890.2019.1701703.

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12

Novakova, Elena, Zuzana Stofkova, Vladimira Sadlonova, and Lukas Hleba. "Diagnostic Methods of Clostridioides difficile Infection and Clostridioides difficile Ribotypes in Studied Sample." Antibiotics 10, no. 9 (August 25, 2021): 1035. http://dx.doi.org/10.3390/antibiotics10091035.

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Background: Clostridioides (Clostridium) difficile is the most common nosocomial pathogen and antibiotic-related diarrhea in health-care facilities. Over the last few years, there was an increase in the incidence rate of C. difficile infection cases in Slovakia. In this study, the phenotypic (toxigenicity, antimicrobial susceptibility) and genotypic (PCR ribotypes, genes for binary toxins) patterns of C. difficile isolates from patients with CDI were analyzed, from July to August 2016, taken from hospitals in the Horne Povazie region of northern Slovakia. The aim of the study was also to identify hypervirulent strains (e.g., the presence of RT027 or RT176). Methods: The retrospective analysis of biological samples suspected of CDI were analyzed by GDH, anaerobic culture, enzyme immunoassay on toxins A/B, multiplex “real-time” PCR and PCR capillary-based electrophoresis ribotyping, and by MALDI TOF MS. Results: C. difficile isolates (n = 44) were identified by PCR ribotyping, which revealed five different ribotypes (RT001, 011, 017, 081, 176). The presence of hypervirulent RT027 was not identified. The C. difficile isolates (RT001, 011, 081, 176) were susceptible to metronidazole and vancomycin. One isolate RT017 had reduced susceptibility to vancomycin. A statistically significant difference between the most prevalent PCR ribotypes, RT001 and RT176, regarding variables such as albumin, CRP, creatinine, the length of hospitalization (p = 0.175), and glomerular filtration (p = 0.05) was not found. Conclusion: The results of PCR capillary-based electrophoresis ribotyping in the studied samples showed a high prevalence of RT176 and 001.

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Kiersnowska, Zofia Maria, Ewelina Lemiech-Mirowska, Michał Michałkiewicz, Aleksandra Sierocka, and Michał Marczak. "Detection and Analysis of Clostridioides difficile Spores in a Hospital Environment." International Journal of Environmental Research and Public Health 19, no. 23 (November 25, 2022): 15670. http://dx.doi.org/10.3390/ijerph192315670.

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Clostridioides difficile, due to its long survival time in a hospital environment, is considered to be one of the most frequent factors in healthcare-associated infections. Patient care requires not only rapid and accurate diagnosis, but also knowledge of individual risk factors for infections, e.g., with C. difficile, in various clinical conditions. The goal of this study was to analyse the degree of contamination of a hospital environment with C. difficile spores. Culturing was performed using C diff Banana BrothTM medium, which enables germination of the spores of these bacteria. Samples were collected from inanimate objects within a hospital environment in a specialist hospital in Poland. The results of the study demonstrated the presence of 18 positive samples of Clostridioides spp. (15.4%). Of these, C. difficile spores were detected in six samples, Clostridioides perfringens in eight samples, Clostridioides sporogenes in two samples and Clostridioides innocuum and Clostridioides baratii in one sample each. Among the six samples of C. difficile, a total of four strains which produce the B toxin were cultured. The binary toxin related to ribotype 027 was not detected in our study. Nosocomial infection risk management is a significant problem, mainly concerning the issues of hygiene maintenance, cleaning policy and quality control, and awareness of infection risk.

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14

Sukhina, M. A., Yu A. Shelygin, I. A. Lyagina, and S. A. Frolov. "Features of fecal microbiotes of Clostridioides difficile-associated infection." Experimental and Clinical Gastroenterology 160, no. 12 (December 2018): 51–57. http://dx.doi.org/10.31146/1682-8658-ecg-160-12-51-57.

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Connor, Kathryn A., and Kelly M. Conn. "Analysis of the impact of secondary prophylaxis on Clostridioides difficile recurrence in critically ill adults." SAGE Open Medicine 8 (January 2020): 205031212093089. http://dx.doi.org/10.1177/2050312120930898.

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Introduction: Clostridioides (formerly Clostridium) difficile infection recurrence in patients re-exposed to antibiotics for treatment of a non- Clostridioides difficile infection is high at approximately 33%. Low-dose per os vancomycin (e.g. 125 mg q12 h) or metronidazole (e.g. 500 mg intravenous/per osq8 h) may help prevent recurrences, but study of secondary prophylaxis in critically ill patients is needed. Objectives: To determine whether critically ill adults receiving low-dose per os vancomycin for secondary Clostridioides difficile infection prophylaxis have fewer recurrences of Clostridioides difficile infection in 90 days compared with patients receiving metronidazole for secondary Clostridioides difficile infection prophylaxis or control (no secondary prophylaxis). Methods: This was a retrospective, two-center, observational study in a large academic medical center and affiliated community hospital. Included patients had a history of Clostridioides difficile infection within 1 year of receiving antibiotics for clinical care. We compared patients receiving secondary prophylaxis with vancomycin or metronidazole and control patients; in addition, an unplanned fourth group (vancomycin/metronidazole combination) was identified and analyzed. The primary outcome was Clostridioides difficile infection recurrence within 90 days of a course of broad-spectrum antibiotic therapy. Fisher’s exact, analysis of variance, and Kruskal–Wallis tests were used to compare Clostridioides difficile infection recurrence with prophylaxis group and additional contributing factors. Results: Eighty-two patients were included: 38 control (46.3%), 20 metronidazole (24.4%), 17 vancomycin (20.7%), and 7 combination (8.5%). Ten of 82 patients (12.2%) had at least one Clostridioides difficile infection recurrence; 8/38 patients in the control group (21.1%), 1/7 patients in the combination group (14.3%), 1/17 patients in the per os vancomycin group (5.9%), and 0/20 in the metronidazole group (0%; p = 0.073). As a post hoc secondary analysis, the three prophylaxis groups were coalesced into one group and compared with control (4.5% vs 21%; p = 0.039). Additional factors (e.g. age, obesity, immunosuppression, acid suppression) were not significantly associated with Clostridioides difficile infection recurrence or with prophylaxis group. Conclusion: There was no difference in Clostridioides difficile infection recurrence between prophylaxis groups, however, given the low recurrence rate, prospective evaluation with a larger sample of critically ill patients is necessary.

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Aguirre, Andrea Martinez, Nazli Yalcinkaya, Qinglong Wu, Alton Swennes, Mary Elizabeth Tessier, Paul Roberts, Fabio Miyajima, Tor Savidge, and Joseph A. Sorg. "Bile acid-independent protection against Clostridioides difficile infection." PLOS Pathogens 17, no. 10 (October 19, 2021): e1010015. http://dx.doi.org/10.1371/journal.ppat.1010015.

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Clostridioides difficile infections occur upon ecological / metabolic disruptions to the normal colonic microbiota, commonly due to broad-spectrum antibiotic use. Metabolism of bile acids through a 7α-dehydroxylation pathway found in select members of the healthy microbiota is regarded to be the protective mechanism by which C. difficile is excluded. These 7α-dehydroxylated secondary bile acids are highly toxic to C. difficile vegetative growth, and antibiotic treatment abolishes the bacteria that perform this metabolism. However, the data that supports the hypothesis that secondary bile acids protect against C. difficile infection is supported only by in vitro data and correlative studies. Here we show that bacteria that 7α-dehydroxylate primary bile acids protect against C. difficile infection in a bile acid-independent manner. We monoassociated germ-free, wildtype or Cyp8b1-/- (cholic acid-deficient) mutant mice and infected them with C. difficile spores. We show that 7α-dehydroxylation (i.e., secondary bile acid generation) is dispensable for protection against C. difficile infection and provide evidence that Stickland metabolism by these organisms consumes nutrients essential for C. difficile growth. Our findings indicate secondary bile acid production by the microbiome is a useful biomarker for a C. difficile-resistant environment but the microbiome protects against C. difficile infection in bile acid-independent mechanisms.

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Fu, Yichun, Yuying Luo, and Ari M. Grinspan. "Epidemiology of community-acquired and recurrent Clostridioides difficile infection." Therapeutic Advances in Gastroenterology 14 (January 2021): 175628482110162. http://dx.doi.org/10.1177/17562848211016248.

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Clostridioides difficile infection is a leading cause of healthcare-associated infections with significant morbidity and mortality. For the past decade, the bulk of infection prevention and epidemiologic surveillance efforts have been directed toward mitigating hospital-acquired C. difficile. However, the incidence of community-associated infection is on the rise. Patients with community-associated C. difficile tend to be younger and have lower mortality rate. Rates of recurrent C. difficile infection overall have decreased in the United States, but future research and public health endeavors are needed to standardize and improve disease detection, stratify risk factors in large-scale population studies, and to identify regional and local variations in strain types, reservoirs and transmission routes to help characterize and combat the changing epidemiology of C. difficile.

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Wang, Pei-Wen, Wei-Ting Lee, Ya-Na Wu, and Dar-Bin Shieh. "Opportunities for Nanomedicine in Clostridioides difficile Infection." Antibiotics 10, no. 8 (August 5, 2021): 948. http://dx.doi.org/10.3390/antibiotics10080948.

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Clostridioides difficile, a spore-forming bacterium, is a nosocomial infectious pathogen which can be found in animals as well. Although various antibiotics and disinfectants were developed, C. difficile infection (CDI) remains a serious health problem. C. difficile spores have complex structures and dormant characteristics that contribute to their resistance to harsh environments, successful transmission and recurrence. C. difficile spores can germinate quickly after being exposed to bile acid and co-germinant in a suitable environment. The vegetative cells produce endospores, and the mature spores are released from the hosts for dissemination of the pathogen. Therefore, concurrent elimination of C. difficile vegetative cells and inhibition of spore germination is essential for effective control of CDI. This review focused on the molecular pathogenesis of CDI and new trends in targeting both spores and vegetative cells of this pathogen, as well as the potential contribution of nanotechnologies for the effective management of CDI.

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Petrosillo, Nicola. "Clostridioides difficile Infection: A Never-Ending Challenge." Journal of Clinical Medicine 11, no. 14 (July 15, 2022): 4115. http://dx.doi.org/10.3390/jcm11144115.

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Nazareth, Cláudia, Inês Leitão, Ernestina Reis, Hugo Inácio, Filomena Martins, Elmano Ramalheira, Flávia Cunha, et al. "Epidemiology of Clostridioides difficile Infection in Portugal: A Retrospective, Observational Study of Hospitalized Patients." Acta Médica Portuguesa 35, no. 4 (April 1, 2022): 270. http://dx.doi.org/10.20344/amp.15890.

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Introduction: Clostridioides difficile is the main cause of healthcare-associated diarrhea in Europe and North America. The aim of this study was to characterize the epidemiology and clinical burden of Clostridioides difficile infection among hospitalized patients in Portugal.Material and Methods: Retrospective study conducted in six public hospital centers in Portugal. All primary Clostridioides difficile infection episodes and related recurrences occurring in 2017, as well as episodes developing two to eight weeks after the last episode diagnosed in that year, were documented. The National Reference Laboratory (National Institute of Health Dr. Ricardo Jorge) provided national surveillance data on Clostridioides difficile infection.Results: A total of 385 inpatients with at least one primary episode diagnosed in 2017 were included. Most patients were aged over 70 years-old (73.2%). The included patients developed 451 episodes during the observation period. Approximately 44% of primary episodes were community-associated. Most episodes (94.9%) occurred in patients with one or more risk factors, with recent antibiotic exposure being particularly common (86.0%). All-cause in-hospital mortality was 19.5%, being significantly higher in patients aged over 65 years-old versus those aged 18 to 64 years-old (22.4% vs 7.8%, respectively). Over 50 different ribotypes were observed among 206 Clostridioides difficile strains received by the National Reference Laboratory.Conclusion: In Portugal, hospitalized patients with Clostridioides difficile infection are mostly older patients presenting risk factors for the development of this infection, particularly recent antibiotic exposure. Mortality is disproportionately high among the older population. Community-associated Clostridioides difficile infection is common among inpatients with this infection.

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Moon, Chang Mo, and Sung Noh Hong. "Fecal Microbiota Transplantation beyond Clostridioides Difficile Infection." Clinical Endoscopy 54, no. 2 (March 30, 2021): 149–51. http://dx.doi.org/10.5946/ce.2021.068.

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Khanna, Sahil. "My Treatment Approach to Clostridioides difficile Infection." Mayo Clinic Proceedings 96, no. 8 (August 2021): 2192–204. http://dx.doi.org/10.1016/j.mayocp.2021.03.033.

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Tsigrelis, Constantine. "Recurrent Clostridioides difficile infection: Recognition, management, prevention." Cleveland Clinic Journal of Medicine 87, no. 6 (June 2020): 347–59. http://dx.doi.org/10.3949/ccjm.87gr.20001.

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Puro, Neeraj, Reena Joseph, Ferhat D. Zengul, Kenneth J. Cochran, Bernard C. Camins, and Midge Ray. "Predictors of Hospital-Acquired Clostridioides difficile Infection." Journal for Healthcare Quality 42, no. 3 (2020): 127–35. http://dx.doi.org/10.1097/jhq.0000000000000236.

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Mateu, Lourdes, Gema Fernández-Rivas, and Nieves Sopena. "Diagnosis and treatment of Clostridioides difficile infection." Medicina Clínica (English Edition) 155, no. 1 (July 2020): 30–35. http://dx.doi.org/10.1016/j.medcle.2020.02.004.

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Abbas, Arwa, and Joseph P. Zackular. "Microbe–microbe interactions during Clostridioides difficile infection." Current Opinion in Microbiology 53 (February 2020): 19–25. http://dx.doi.org/10.1016/j.mib.2020.01.016.

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Cho, Janice M., Darrell S. Pardi, and Sahil Khanna. "Update on Treatment of Clostridioides difficile Infection." Mayo Clinic Proceedings 95, no. 4 (April 2020): 758–69. http://dx.doi.org/10.1016/j.mayocp.2019.08.006.

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Yamamura, Yoshiko, Tomoko Ohhira, Shigeki Ishii, Keigo Nakatani, and Kouji Nagata. "Fulminant Clostridioides difficile infection in an infant." Pediatrics International 62, no. 12 (November 17, 2020): 1401–3. http://dx.doi.org/10.1111/ped.14352.

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Parmar, Parmvir, Sarah Hosseini, Kathryn N. Suh, and Derek MacFadden. "Polymicrobial Clostridioides difficile lung empyema." Official Journal of the Association of Medical Microbiology and Infectious Disease Canada 6, no. 4 (December 1, 2021): 330–32. http://dx.doi.org/10.3138/jammi-2020-0040.

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Clostridioides (Clostridium) difficile is a well-known cause of enteritis and antibiotic-associated diarrhea. Extraintestinal C. difficile infection is uncommon, with most extraintestinal infections involving the intra-abdominal cavity and anatomic structures adjacent to the colon. Empyema secondary to C. difficile is especially rare, with only a handful of cases reported in the medical literature. A standard antibiotic treatment regimen for C. difficile empyema does not currently exist, and data chronicling successful treatment is limited. We present the case of an 80-year-old woman with a polymicrobial C. difficile empyema who was successfully treated with multiple chest tube insertions and intravenous vancomycin.

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Mu, Emily, Maggie Makar, Lauren R. West, John Guttag, David C. Rosenberg, and Erica S. Shenoy. "2387. Learning the Influence of Individual Clostridioides difficile Infections." Open Forum Infectious Diseases 6, Supplement_2 (October 2019): S824—S825. http://dx.doi.org/10.1093/ofid/ofz360.2065.

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Abstract Background Healthcare-associated Clostridioides difficile infection (C diff infection, or CDI) imposes a substantial burden on the healthcare system. The impact of an individual C diff infection on onward transmission is not well understood. We developed a model of incident infections using self-exciting stochastic processes, known as Hawkes processes. These models can be used to improve our understanding of the factors that affect the likelihood of new infections to result in additional infections. Methods All patients admitted to a large urban hospital between January 2013 and June 2014 were included. We used Hawkes processes to model the influence of each new CDI case (index infection) on transmission to other patients resulting in additional CDI. We developed separate Hawkes processes for each unit in the hospital to understand the differential impact of a C diff case across units. Units included both semi- and private-room wards, intensive care units, an emergency department, and specialty units such as oncology. Results The magnitude of influence of an index infection on additional infections in the 2 days prior to a C diff test being sent varied across units. Results for an oncology unit, the emergency department, and an all private-room unit are provided (Table 1). An index infection in the emergency department demonstrated the greatest influence, leading to the largest number of additional infections, and increasing in the days leading up to the C diff test being sent. The impact 2 days prior to sample collection was similar across all unit types, and remained constant for oncology unit patients. Conclusion We used Hawkes processes to model the impact of an index C diff infection on onward transmission. We identified differential impacts associated with the unit where the index patient was located in the days leading up to diagnosis. These differences, which could relate to unit-specific factors such as cleaning practices, patient turnover rates, use of portable medical equipment, antibiotic use, and other factors that vary across units, suggest that interventions aimed at controlling CDI may need to consider unit-specific approaches. Disclosures All authors: No reported disclosures.

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Orenstein, Robert, and Roberto L. Patron. "Clostridioides difficile therapeutics: guidelines and beyond." Therapeutic Advances in Infectious Disease 6 (January 2019): 204993611986854. http://dx.doi.org/10.1177/2049936119868548.

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Clostridioides difficile infection (CDI) has become an increasingly common infection both within and outside of the hospital setting. The management of this infection has been evolving as we learn more about the role of the human microbiota in protecting us from this gastrointestinal opportunist. For many years the focus of treatment had been on eradication of the vegetative, toxin-producing form of the organism, with little regard for its collateral impact on the host’s microbiota or risk of recurrence. With the marked increase in C. difficile disease, and, particularly, recurrent disease in the last decade, new guidelines are more focused on targeting and reducing collateral damage to the colonic microbiota. Immune-based strategies that manipulate the microbiota and provide a humoral response to toxins have now become mainstream. Newer strategies are needed to look beyond simply resolving the primary episode but are focused on delayed outcomes such as cure at 90 days, reduced morbidity and mortality, and patient quality of life. The purpose of this review is to familiarize readers with the most recent evidence-based guidelines for C. difficile management, and to describe the role of newer antimicrobials, immunological-, and microbiota-based therapeutics to prevent recurrence and improve the outcomes of people with CDI.

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Mengoli, Mariachiara, Monica Barone, Marco Fabbrini, Federica D’Amico, Patrizia Brigidi, and Silvia Turroni. "Make It Less difficile: Understanding Genetic Evolution and Global Spread of Clostridioides difficile." Genes 13, no. 12 (November 24, 2022): 2200. http://dx.doi.org/10.3390/genes13122200.

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Clostridioides difficile is an obligate anaerobic pathogen among the most common causes of healthcare-associated infections. It poses a global threat due to the clinical outcomes of infection and resistance to antibiotics recommended by international guidelines for its eradication. In particular, C. difficile infection can lead to fulminant colitis associated with shock, hypotension, megacolon, and, in severe cases, death. It is therefore of the utmost urgency to fully characterize this pathogen and better understand its spread, in order to reduce infection rates and improve therapy success. This review aims to provide a state-of-the-art overview of the genetic variation of C. difficile, with particular regard to pathogenic genes and the correlation with clinical issues of its infection. We also summarize the current typing techniques and, based on them, the global distribution of the most common ribotypes. Finally, we discuss genomic surveillance actions and new genetic engineering strategies as future perspectives to make it less difficile.

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Masengill, Jennifer, and Calvin White. "Reduction of Laboratory Identified Clostridioides difficile Infections Standardized Infection Ratio." American Journal of Infection Control 50, no. 7 (July 2022): S36—S37. http://dx.doi.org/10.1016/j.ajic.2022.03.063.

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Petrosillo, Nicola, and Maria Adriana Cataldo. "Clostridioides difficile Infection: A Room for Multifaceted Interventions." Journal of Clinical Medicine 9, no. 12 (December 20, 2020): 4114. http://dx.doi.org/10.3390/jcm9124114.

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Krůtová, Marcela, Aleš Briksi, and Pavel Dřevínek. "Clostridioides difficile infection in children hospitalised in Motol University Hospital." Česko-slovenská pediatrie 77, no. 6 (December 8, 2022): 340–44. http://dx.doi.org/10.55095/cspediatrie2022/060.

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36

Sierocka, Aleksandra, Zofia Kiersnowska, Ewelina Lemiech-Mirowska, and Michał Marczak. "Costs Associated with the Treatment of Clostridioides Difficile Infections." International Journal of Environmental Research and Public Health 18, no. 14 (July 19, 2021): 7647. http://dx.doi.org/10.3390/ijerph18147647.

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Background: Clostridioides difficile, as the main cause of infectious diarrhoea in hospitalised patients, is a considerable challenge for medical personnel (hospital environment) who have direct contact with the patient, as well as being of interest to public health specialists. Financial issues related to the occurrence of the above-mentioned micro-organism are being increasingly raised. Due to the scale of the phenomenon, we are beginning to pay attention to the significant system costs caused by the diagnosis and treatment of CDI infection and its complications. Studies indicate that the nosocomial infection of C. difficile complicates hospitalisation, by increasing the cost by more than half and extending patient’s stay by an average of 3.6 days. Material and methods: The aim of this study was to attempt to calculate the estimated costs associated with the prolonged hospitalisation of patients with nosocomial CDI infection, using the example of a hospital in Lodz. A total of 53 completed hospitalisations of patients treated in the period of January–August 2018 were analysed, during which hospital Clostridioides difficile infection was identified. For the purposes of this study, statistical data collected in the hospital’s IT system were also analysed, covering 44,868 hospitalisations in the Jan–Aug 2018 period, during which no hospital infection occurred. They was a control group, in which the analysed cases were compared. The obtained data in the study determined how long each patient with Clostridioides difficile infection stayed in the hospital (from the moment infection was diagnosed until the day of hospital discharge), and which diagnosis related groups (DRG) (according to National Health Fund guidelines) were assigned. The average length of patient stay without infection within a given DRG group in each hospital ward was also determined. The collected materials became the initial point for the final analysis of hospital costs and the length of hospital stay caused by Clostridioides difficile infection. Results: Clostridioides difficile infection extended the hospital stay by an average of almost 12 days. The average cost of prolonged hospitalisation due to CDI infection (according to the average cost per person-day) was about PLN 7148 (1664 EUR), which gave a total value of about PLN 378,860.6 (88,240.5 EUR) in the examined period. At the same time, the average expenditure from the National Health Fund for hospitalisation due to CDI infections increased by about PLN 6627 (1542.8 EUR), which in the analysed period translated into over PLN 351,232.0 (81,505.5 EUR) (according to settlements with the National Health Fund). The outcome indicates that there is a clear relation between CDI and the anticipated length of hospitalisation of patients without an infection.

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Signorette, Juliana Peloso, Rômulo Tadeu Dias de Oliveira, José Maria Montiel, and Priscila Larcher Longo. "Applications of Fecal Microbiota Transplantation: Emphasis on Clostridioides difficile Infections." International Journal of Nutrology 14, no. 01 (March 2021): 016–20. http://dx.doi.org/10.1055/s-0040-1718996.

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Abstract Objective This study aimed to perform a comprehensive review of clinical trials using fecal microbiota transplantation in cases of Clostridioides difficile infection. Methods This manuscript reviews clinical studies published from 2003 to 2020 at the Scientific Electronic Library Online (SciELO Brazil), Latin American and Caribbean Health Sciences Literature (LILACS) and US National Library of Medicine (MedLine/PubMed) databases using the descriptors antibiotic/antimicrobial, Clostridium difficile/Clostridioides difficile, intestinal microbiota/intestinal microbiome and fecal transplantation. Results Interventions on microbiota include the use of probiotics, prebiotics, and fecal microbiota transplantation as therapeutic methods. Results show that fecal microbiota transplantation is an excellent alternative for the treatment of recurrent C. difficile infections.

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Chiu, Sarwal, Feinstein, and Hennessey. "Effective Dosage of Oral Vancomycin in Treatment for Initial Episode of Clostridioides difficile Infection: A Systematic Review and Meta-Analysis." Antibiotics 8, no. 4 (October 1, 2019): 173. http://dx.doi.org/10.3390/antibiotics8040173.

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Background: Oral vancomycin is a first line treatment for an initial episode of Clostridioides difficile infection. However, the comparative efficacy of different dosing regimens is lacking evidence in the current literature. Methods: We searched PubMed, Embase, Cochrane Library, and ClinicalTrials.gov. from inception to May 2019. Only articles published in English are reviewed. This meta-analysis compares the effects of low dose oral vancomycin (<2 g per day) versus high dose vancomycin (2 g per day) for treatment of initial Clostridioides difficile infection. Results: One randomized controlled trial and two retrospective cohort studies are included. A total of 137 patients are identified, 53 of which were treated with low dose oral vancomycin (39%) and 84 with high dose oral vancomycin (61%). There is no significant reduction in recurrence rates with high dose vancomycin compared to low dose vancomycin for treating initial episodes of non-fulminant Clostridioides difficile infection ((odds ratio (OR) 2.058, 95%, confidence interval (CI): 0.653 to 6.489). Conclusions: Based on limited data in the literature, low dose vancomycin is no different than high dose vancomycin for treatment of an initial episode of Clostridioides difficile infection in terms of recurrence rate. Additional large clinical trials comparing the different dosages of vancomycin in initial Clostridioides difficile infection are warranted.

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Radhakrishnan, Parvathi, Manini Vishwanath, Douglas Shemin, Joao Filipe G. Monteiro, and Erika M. C. D’Agata. "Clostridioides difficile Infection Among Patients Requiring Maintenance Hemodialysis." Kidney Medicine 3, no. 3 (May 2021): 467–70. http://dx.doi.org/10.1016/j.xkme.2021.02.005.

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Sood, Anshul. "Cephamycins: Treatment Option for Recurrent Clostridioides difficile Infection." Journal of Gastrointestinal Infections 9, no. 1 (2019): 57–58. http://dx.doi.org/10.5005/jp-journals-10068-3029.

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Rohde, Jeffrey M., Karen Jones, Norma Padron, Russell N. Olmsted, Vineet Chopra, and Erik R. Dubberke. "A Tiered Approach for Preventing Clostridioides difficile Infection." Annals of Internal Medicine 171, no. 7_Supplement (October 1, 2019): S45. http://dx.doi.org/10.7326/m18-3444.

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42

Negrut, Nicoleta, Simona Bungau, Tapan Behl, Shamim Ahmad Khan, Cosmin Mihai Vesa, Cristiana Bustea, Delia Carmen Nistor-Cseppento, Marius Rus, Flavia-Maria Pavel, and Delia Mirela Tit. "Risk Factors Associated with Recurrent Clostridioides difficile Infection." Healthcare 8, no. 3 (September 21, 2020): 352. http://dx.doi.org/10.3390/healthcare8030352.

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Clostridioides difficile (CD) is responsible for nosocomial diarrhea syndrome with possible severe progression. Recurrence of the disease induces higher health system costs, as well as exposes patients to additional health risks. Patients with recurrence of this disease are difficult to identify, so the purpose of this study is to quantify various demographic, clinical, and treatment factors that could prevent further progression to recurrence of the disease. In the period 2018–2019, about 195 patients were diagnosed with more than one episode of CDI in the three months following the first episode. The recurrence rate for CDI was 53.84% (60.95% for one episode and 39.05% for multiple episodes). Most commonly afflicted were 60–69-year-old patients, or those with higher Charlson Comorbidity Index (CCI). Multiple analyses associated cardiovascular (odds ratios (OR) = 3.02, 95% confidence intervals (CI) = 1.23–7.39, p = 0.015), digestive (OR = 3.58, 95% CI = 1.01–12.63, p = 0.047), dementia (OR = 3.26, 95% CI = 1.26–8.41, p = 0.014), immunosuppressive (OR = 3.88, 95% CI = 1.34–11.21, p = 0.012) comorbidities with recurrences. Risk factor identification in the first episode of CDI could lead to the implementation of treatment strategies to improve the patients’ quality of life affected by this disease.

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Krishna, Amar, and Teena Chopra. "Prevention of Infection due to Clostridium (Clostridioides) difficile." Infectious Disease Clinics of North America 35, no. 4 (December 2021): 995–1011. http://dx.doi.org/10.1016/j.idc.2021.07.009.

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Jain, Mayank. "Clostridioides difficile Infection in Patients with COVID-19." Gastroenterology, Hepatology and Endoscopy Practice 2, no. 2 (2022): 78. http://dx.doi.org/10.4103/ghep.ghep_48_21.

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45

Khanna, S. "Ridinilazole. Antibacterial drug, Treatment of Clostridioides difficile infection." Drugs of the Future 44, no. 5 (2019): 349. http://dx.doi.org/10.1358/dof.2019.44.5.2978058.

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46

Turner, Nicholas A., Becky A. Smith, and Sarah S. Lewis. "Novel and emerging sources of Clostridioides difficile infection." PLOS Pathogens 15, no. 12 (December 19, 2019): e1008125. http://dx.doi.org/10.1371/journal.ppat.1008125.

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47

Haber, Stacy L., Carrington R. K. Raney, Trent L. Larson, and Jennifer Park Lau. "Fecal microbiota transplantation for recurrent Clostridioides difficile infection." American Journal of Health-System Pharmacy 76, no. 13 (June 18, 2019): 935–42. http://dx.doi.org/10.1093/ajhp/zxz078.

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48

Carlson, Travis J., Bradley T. Endres, Eugénie Bassères, Anne J. Gonzales-Luna, and Kevin W. Garey. "Ridinilazole for the treatment of Clostridioides difficile infection." Expert Opinion on Investigational Drugs 28, no. 4 (February 26, 2019): 303–10. http://dx.doi.org/10.1080/13543784.2019.1582640.

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Radhakrishnan, Parvathi, Manini Vishwanath, Douglas Shemin, Joao Filipe G. Monteiro, and Erika M. C. D’Agata. "783. Clostridioides difficile Infection among Maintenance Hemodialysis Patients." Open Forum Infectious Diseases 7, Supplement_1 (October 1, 2020): S436. http://dx.doi.org/10.1093/ofid/ofaa439.973.

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Abstract Background Patients on maintenance hemodialysis (MHD) are 2-2.5 times more likely to develop Clostridioides difficile infection (CDI) with mortality rates 2-fold higher compared to the general population. The goal of this study was to determine factors and outcomes associated with severe/fulminant CDI among MHD patients. Methods A retrospective cohort study was performed among MHD patients admitted to 2 tertiary care hospitals, with first episodes of CDI between January 2015 and December 2018. MHD patients who had CDI at admission were identified through Theradoc® and confirmed by electronic medical records review. Using the Infectious Diseases Society of America criteria, non-severe CDI was defined as a white blood cell count ≤ 15000 cells/mL and severe/fulminant CDI was defined as a white blood cell count of ≥ 15000 cells/mL, hypotension, shock, megacolon and/or ileus. Creatinine values were not included. Patient demographics, comorbidities, antimicrobial exposure and 60-day mortality were collected on all patients. Results A total of 103 MHD patients with CDI were identified during the study period, of whom 68 (66%) had non-severe CDI and 35 (34%) had severe/fulminant CDI. The average age at admission was 65.3 years, 48.5% were female, and 59.2% were Caucasian. The average albumin level was 3.1 g/dL, and the average Charlson comorbidity index was 6.8. On univariate analyses, risk factors associated with severe/fulminant CDI as compared to non-severe CDI were older age at admission, elevated white blood cell count, exposure to extended-spectrum penicillins in the previous 90 days, and 60-day mortality after the first CDI (p-value ≤0.05). On multivariable logistic regression analysis, three factors remained significantly associated with severe/fulminant CDI (adjusted odds ratio [aOR], 95% confidence interval): 1] age ≥65 years (aOR=6.3 [2.25-17.45]), 2] extended-spectrum penicillins (aOR=2.7 [1.05-6.85], and 3] 60-day mortality after the first CDI (aOR=3.6 [1.11-11.74]). Conclusion A substantial proportion of patients requiring MHD with CDI present with severe/fulminant disease and are at increased risk of death. Reducing exposure to extended-spectrum penicillins may prevent severe/fulminant CDI in this patient population. Disclosures Joao Filipe G Monteiro, PhD, Brown Medicine (Consultant)

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Lyerly, David M., James H. Boone, Robert J. Carman, and Glenn S. Tillotson. "Clostridioides difficile Infection: The Challenge, Tests, and Guidelines." ACS Infectious Diseases 6, no. 11 (September 22, 2020): 2818–29. http://dx.doi.org/10.1021/acsinfecdis.0c00290.

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