Article
Immunology
Nicholas A. Turner, Bobby G. Warren, Maria F. Gergen-Teague, Rachel M. Addison, Bechtler Addison, William A. Rutala, David J. Weber, Daniel J. Sexton, Deverick J. Anderson
Summary: Fidaxomicin and vancomycin are more effective in reducing C. difficile shedding and environmental contamination compared to metronidazole. Treatment choice may play a role in reducing healthcare-associated C. difficile transmission.
CLINICAL INFECTIOUS DISEASES
(2022)
Review
Infectious Diseases
Marcela Krutova, Mark Wilcox, Ed Kuijper
Summary: The recommendations for the treatment of Clostridioides difficile infection (CDI) have been updated recently. The drug of choice for CDI treatment should not only possess clinical efficacy, but also exhibit optimal antimicrobial stewardship by restoring the gut microbiota quickly to minimize the risk of infection relapses. Metronidazole, the current treatment option, has low concentration in stool and reduced antimicrobial bioactivity due to interactions with fecal microbiota. Elevated minimum inhibitory concentrations of metronidazole in epidemic C. difficile ribotypes and the emergence of resistance pose potential risks for treatment failure. Oral vancomycin and fidaxomicin, on the other hand, reach high concentrations in the stool and can effectively reduce C. difficile shedding. Facilities with higher CDI incidence and/or occurrence of epidemic ribotypes should avoid using metronidazole to prevent prolonged shedding and further transmission. Fidaxomicin, with its narrow spectrum of antimicrobial activity and persistence on spores, is the preferred option to reduce recurrent CDI rates.
INTERNATIONAL JOURNAL OF INFECTIOUS DISEASES
(2022)
Article
Infectious Diseases
Alice Annalisa Medaglia, Alessandro Mancuso, Chiara Albano, Giuseppe Zinna, Luca Pipito, Cinzia Cala, Rita Immordino, Raffaella Rubino, Silvia Bonura, Baldassare Canino, Giuseppe Calamusa, Claudia Colomba, Pier Luigi Almasio, Antonio Cascio
Summary: Clostridioides difficile infection (CDI) is a significant cause of morbidity and mortality, especially in frail patients. This study aimed to determine the incidence of CDI and identify risk factors for mortality and recurrence. The findings showed a significant increase in CDI incidence over the past decade and identified hemodialysis as a significant risk factor for mortality.
Article
Infectious Diseases
Sylvia Polivkova, Marcela Krutova, Vaclav Capek, Blanka Sykorova, Jiri Benes
Summary: This study demonstrates that fidaxomicin is superior to metronidazole or vancomycin in the treatment of the initial episode, first recurrence, and non-severe cases of Clostridioides difficile infection.
INTERNATIONAL JOURNAL OF INFECTIOUS DISEASES
(2021)
Article
Microbiology
Deiziane V. S. Costa, Natalie V. S. Pham, Rachel A. Hays, David T. Bolick, Sophia M. Goldbeck, Melinda D. Poulter, Sook C. Hoang, Jae H. Shin, Martin Wu, Cirle A. Warren
Summary: This study evaluated the antibiotic resistance of Clostridioides difficile isolates in a US hospital and found that strains positive for the binary toxin gene displayed decreased antimicrobial susceptibility. Decreased susceptibility to antibiotics was not directly associated with the severity or recurrence of CDI.
ANTIMICROBIAL AGENTS AND CHEMOTHERAPY
(2022)
Article
Immunology
Erik R. Dubberke, Justin T. Puckett, Engels N. Obi, Sachin Kamal-Bahl, Kaushal Desai, Bruce Stuart, Jalpa A. Doshi
Summary: After the guideline update, there was an increase in vancomycin use and a decrease in metronidazole use. Fidaxomicin use also increased but remained low. However, overall clinical outcomes did not improve.
OPEN FORUM INFECTIOUS DISEASES
(2022)
Article
Multidisciplinary Sciences
Nader S. Abutaleb, Mohamed N. Seleem
Summary: Clostridioides difficile infections are a significant public health threat globally, and auranofin shows potential as a new effective anti-CDI agent.
SCIENTIFIC REPORTS
(2021)
Article
Multidisciplinary Sciences
Michael A. Johnstone, Matthew A. Holman, William T. Self
Summary: Clostridioides difficile infections are a major cause of antibiotic-associated diarrhea, but treatment options are limited. Auranofin, a gold-containing anti-rheumatic drug, has shown antimicrobial activity against C. difficile. In this study, we found that C. difficile mutants lacking selenoproteins are still sensitive to auranofin, and selenite supplementation dampens its activity, suggesting that auranofin's mechanism against C. difficile may not be related to selenium deficiency.
SCIENTIFIC REPORTS
(2023)
Article
Chemistry, Medicinal
Yuanyuan Qian, Biruk T. Birhanu, Jingdong Yang, Derong Ding, Jeshina Janardhanan, Shahriar Mobashery, Mayland Chang
Summary: Clostridioides difficile infection (CDI) caused by dysbiosis after broad-spectrum antibiotic treatment is a major concern. In this study, an oxadiazole antibiotic compound, 3-(4-(cyclopentyloxy)phenyl)-5-(4-nitro-1H-imidazol-2-yl)-1,2,4-oxadiazole (compound 57), was found to exhibit potent and selective bactericidal activity against C. difficile.
JOURNAL OF MEDICINAL CHEMISTRY
(2023)
Review
Microbiology
Chetna Dureja, Abiola O. Olaitan, Julian G. Hurdle
Summary: Antimicrobial resistance in Clostridioides difficile has significantly impacted patient care, but there are still many knowledge gaps in understanding the mechanisms of resistance.
CURRENT OPINION IN MICROBIOLOGY
(2022)
Article
Medicine, General & Internal
Paul Feuerstadt, Thomas J. Louie, Bret Lashner, Elaine E. L. Wang, Liyang Diao, Jessica A. Bryant, Matthew Sims, Colleen S. Kraft, Stuart H. Cohen, Charles S. Berenson, Louis Y. Korman, Christopher B. Ford, Kevin D. Litcofsky, Mary-Jane Lombardo, Jennifer R. Wortman, Henry Wu, John G. Aunins, Christopher W. J. McChalicher, Jonathan A. Winkler, Barbara H. McGovern, Michele Trucksis, Matthew R. Henn, Lisa von Moltke
Summary: SER-109 microbiome therapy is superior to placebo in reducing the risk of recurrent C. difficile infection, and has a similar safety profile as placebo.
NEW ENGLAND JOURNAL OF MEDICINE
(2022)
Editorial Material
Immunology
Noah Fang, David Ha, Kimberly Dong, Thomas Leung, Sydney Lee, Marisa Holubar, Lina Meng
Summary: This study reviewed the discharge of Clostridioides difficile-positive patients treated with fidaxomicin after local adoption of the 2021 CDI guidelines. From June 14 to October 3, 2021, 80% (12/15) of the patients had copayments ranging from $0 to $35, and 27% (4/15) required prior authorization. The 30-day CDI recurrence rate was 7%.
CLINICAL INFECTIOUS DISEASES
(2022)
Article
Infectious Diseases
Anne J. Gonzales-Luna, Andrew M. Skinner, Carolyn D. Alonso, Emilio Bouza, Oliver A. Cornely, Tim G. J. de Meij, Richard J. Drew, Kevin W. Garey, Dale N. Gerding, Stuart Johnson, Stacy A. Kahn, Haru Kato, Ciaran P. Kelly, Colleen R. Kelly, Larry K. Kociolek, Ed J. Kuijper, Thomas Louie, Thomas Riley, Thomas J. Sandora, Maria J. G. T. Vehreschild, Mark H. Wilcox, Erik R. Dubberke
Summary: 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.
LANCET INFECTIOUS DISEASES
(2023)
Article
Immunology
Deanna Buehrle, Cornelius J. Clancy
Summary: Based on the analysis of June 2021 data, oral vancomycin and fidaxomicin are widely used treatments for Clostridioides difficile, but only a small percentage of enrollees have easy access to them.
CLINICAL INFECTIOUS DISEASES
(2022)
Review
Microbiology
Taryn B. Bainum, Kelly R. Reveles, Ronald G. Hall, Kelli Cornell, Carlos A. Alvarez
Summary: Clostridioides difficile is a problematic pathogen causing significant morbidity and mortality, particularly in immunocompromised patients. Recent guideline updates provided by various medical societies offer recommendations for the prevention and treatment of C. difficile infection (CDI). The literature review highlights disagreements between the guidelines and discusses available options for primary prophylaxis, including probiotics and antibiotics. Secondary prophylaxis focuses on non-antimicrobial options, such as fecal microbiota transplantation and newer agents like RBX2660 and bezlotoxumab. Further studies are needed to determine the optimal therapies for CDI prophylaxis.
Article
Infectious Diseases
Karin Bakran-Lebl, Jeremy V. Camp, Jolanta Kolodziejek, Pia Weidinger, Peter Hufnagl, Adriana Cabal Rosel, Andreas Zwickelstorfer, Franz Allerberger, Norbert Nowotny
Summary: Through monitoring at the largest international airport in Austria for two years, it was found that in 2018, West Nile virus and Usutu virus were detected in mosquito pools, primarily caused by Culex mosquitoes. In 2019, no viral nucleic acids were detected in any mosquito pools. The study suggests that airports may serve as focal points for arbovirus activity, especially during epidemic years, and should be taken into consideration when designing mosquito control and arbovirus monitoring programs.
TRANSBOUNDARY AND EMERGING DISEASES
(2022)
Article
Clinical Neurology
Louise Kelly, Jennifer Walsh, Mairead Skally, Binu Dinesh, Karen Burns, Karina O'Connell, Stephen MacNally, Hilary Humphreys, Fidelma Fitzpatrick
Summary: This study aimed to review the diagnosis, management, and outcome of Candida meningitis/ventriculitis in our hospital over the past ten years. The results showed that Candida meningitis/ventriculitis is an uncommon infection associated with devices, requiring prolonged treatment and leading to increased morbidity, length of stay, and disability.
BRITISH JOURNAL OF NEUROSURGERY
(2023)
Article
Infectious Diseases
Daan W. Notermans, Annelot F. Schoffelen, Fabian Landman, Cornelia C. H. Wielders, Sandra Witteveen, Varisha A. Ganesh, Marga Van Santen-Verheuvel, Sabine C. de Greeff, Ed J. Kuijper, Antoni P. A. Hendrickx
Summary: Urine-associated Escherichia coli ST38 producing OXA-244 harboring putative uropathogenicity factors emerged in the Netherlands.
JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY
(2022)
Letter
Public, Environmental & Occupational Health
J. Lowry, N. McEvoy, K. O'Connell, K. Burns, B. Dinesh, S. O'Donnell, G. F. Curley, F. Fitzpatrick
JOURNAL OF HOSPITAL INFECTION
(2023)
Article
Pathology
James Alan Donnelly, Miriam Russell, Gemma O'Brien, Ian O'Neill, Fidelma Fitzpatrick, Karina O'Connell
Summary: Point-of-care testing (POCT) provides rapid and accurate results for diagnosis and patient management. It is especially valuable for infectious agents as it allows timely interventions for infection prevention and control. However, careful governance is required for POCT implementation due to limited education of staff on laboratory quality control and assurance processes.
JOURNAL OF CLINICAL PATHOLOGY
(2023)
Editorial Material
Public, Environmental & Occupational Health
C. De Santi, G. L. Cavalleri, S. W. Kerrigan, F. Fitzpatrick, K. McGrogan, J. Gilroy, R. Baxter, V. Quadu, K. Ryan, H. Humphreys
JOURNAL OF HOSPITAL INFECTION
(2023)
Article
Public, Environmental & Occupational Health
M. Skally, K. Bennett, K. Burns, R. Brennan, C. Finn, K. O'Connell, B. Dinesh, S. O'Donnella, W. Fawley, M. Wilcox, H. Humphreys, F. Fitzpatrick
Summary: This retrospective study investigated the data of hospitalized patients with Clostridioides difficile infection (CDI) in an Irish tertiary hospital over 10 years. CDI remained a major cause of healthcare-associated diarrhea, with a recurrent rate of 9%. Most infections occurred during hospitalization, and there was a higher likelihood of infection in female patients. Despite key events and increased hospital activity, there was no significant change in the incidence of healthcare-associated CDI, while community-associated CDI reached its highest point in a decade in 2021.
JOURNAL OF HOSPITAL INFECTION
(2023)
Article
Immunology
Marta Kierzkowska, Anna Majewska, Konrad Karlowicz, Hanna Pituch
Summary: The aim of this study was to determine the prevalence of cfiA-positive isolates in B. fragilis infections and investigate the carbapenemase activity in B. fragilis strains through the Carba NP test. The study found that 5.2% of B. fragilis isolates were phenotypically resistant to meropenem and 6.1% of B. fragilis isolates carried the cfiA gene. The meropenem minimum inhibitory concentrations were significantly higher in cfiA-positive strains.
MEDICAL MICROBIOLOGY AND IMMUNOLOGY
(2023)
Article
Microbiology
Ishani Wickramage, Zhong Peng, Soumyadeep Chakraborty, Celine Harmanus, Ed J. Kuijper, Sally Alrabaa, Wiep Klaas Smits, Xingmin Sun
Summary: Clostridioides difficile has a complex relationship with antibiotics, as they can both increase the risk of infection and be the primary treatment for C. difficile infection (CDI). This study identified two clinical isolates of C. difficile with elevated resistance to vancomycin and rifaximin, as well as mutations related to resistance. The findings highlight the importance of surveillance in understanding antibiotic resistance and developing effective treatment strategies.
MICROBIOLOGY SPECTRUM
(2023)
Article
Public, Environmental & Occupational Health
Lisa Domegan, Carina Brehony, Fidelma Fitzpatrick, Karina O'Connell, Binu Dinesh, Jacqueline Cafferkey, Karen Burns
Summary: This study investigated the transmission patterns of a nosocomial carbapenemase-producing Enterobacterales (CPE) outbreak using social network analysis and genomics. The analysis revealed high-resolution transmission patterns involving two related OXA-48 plasmids, multiple species/genotypes, and potential super-spreading. Interventions successfully prevented intra-hospital spread. The findings highlight the importance of integrating social network analysis and genomics in the management of complex nosocomial outbreaks.
INFECTION PREVENTION IN PRACTICE
(2023)
Editorial Material
Infectious Diseases
Judith Strawbridge, John Heritage, Marcela Krutova, Benoit Guery, Kerrie Davies, Fidelma Fitzpatrick, Jane Freeman
CLINICAL MICROBIOLOGY AND INFECTION
(2023)
Letter
Infectious Diseases
Emily Glynn, Fidelma Fitzpatrick, Binu Dinesh, Conor Mulrooney, Siobhain Kelly, Karen Burns, Karina O'Connell, Sinead O'Donnell, Ciara O'Connor
JOURNAL OF INFECTION
(2023)
Letter
Gastroenterology & Hepatology
Joffrey van Prehn, Fidelma Fitzpatrick, Ed J. Kuijper
LANCET GASTROENTEROLOGY & HEPATOLOGY
(2023)
Article
Clinical Neurology
Mairead Skally, Maeve Leonard, Philip J. O'Halloran, Ben Husien, Kathleen Bennett, Karen Burns, Binu Dinesh, Hilary Humphreys, Fidelma Fitzpatrick
Summary: CDI in neurosurgery patients differs from the wider hospital, with greater awareness of CDI testing. Longer LOS impacted bed utilization with limited capacity. Robust surveillance supports proactive antimicrobial stewardship programs in this vulnerable population.
ACTA NEUROCHIRURGICA
(2023)
Article
Microbiology
P. M. C. Klein Klouwenberg, W. van der Kuil, A. J. van Griethuysen, M. Hendriks, E. J. Kuijper, D. W. Notermans, A. F. Schoffelen, ISIS AR Study Grp
Summary: Using data from the Dutch national surveillance system for antimicrobial resistance, this study found discrepancies in minimum inhibitory concentrations of aminoglycosides measured by the automated testing systems VITEK2 and Phoenix. The Phoenix system showed higher MICs and an annual increase in resistance for certain species. These findings have implications for the clinical treatment of sepsis patients.
MICROBIOLOGY SPECTRUM
(2023)
