Article
Immunology
Layan Abu Rahmoun, Maya Azrad, Avi Peretz
Summary: The study revealed an association between antibiotic resistance and biofilm production capacity, emphasizing the importance of antibiotic susceptibility testing for effective treatment. Additionally, differences in biofilm production capacity among different Sequence-types (ST) strains may aid in guiding treatment decisions for recurrent infections.
FRONTIERS IN CELLULAR AND INFECTION MICROBIOLOGY
(2021)
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
Jason Yamaki, Swati Chawla, Shirley Tong, Kate Alison Lozada, Sun Yang
Summary: Despite the benefits of RBC transfusion therapy, it can lead to iron overload which is associated with CDI. Excess iron stimulates the growth and toxin production of C. difficile, and increases its resistance to metronidazole. Iron chelators effectively reduce the impact of CDI.
Article
Infectious Diseases
Joana Darc Freitas Alves, Augusto Yamaguti, Joao Silva de Mendonca, Cristiano de Melo Gamba, Cibele Lefreve Fonseca, Daniela K. S. Paraskevopoulos, Alexandre Inacio de Paula, Nair Hosino, Silvia Figueiredo Costa, Thais Guimaraes
Summary: This retrospective cohort study analyzed CDI cases with a focus on treatment, finding that metronidazole is a good option for treating CDIs and severity score is the only independent risk factor for death. The study also revealed that 65.4% of patients had previous use of antimicrobials.
Article
Infectious Diseases
Chris A. Gentry, Darien L. Campbell, Riley J. Williams
Summary: This study aimed to investigate if moving away from metronidazole improved clinical outcomes of initial non-severe CDI episodes, but the conclusion showed that this change did not improve the composite of treatment failure or recurrence.
INTERNATIONAL JOURNAL OF ANTIMICROBIAL AGENTS
(2021)
Article
Clinical Neurology
Jordan S. Swindle, Charles H. Crawford, Luke T. Byerly, Steven D. Glassman, Jeffrey L. Gum, Leah Y. Carreon
Summary: The study aims to investigate whether prescribing empiric oral antibiotics for nonpurulent wound drainage is beneficial for preventing chronic infection or reoperation. The study design is a retrospective chart review, with patients calling the office with postsurgical wound concerns as the patient sample.
Review
Gastroenterology & Hepatology
Anne J. Gonzales-Luna, Travis J. Carlson, Kevin W. Garey
Summary: Human gut microbiota play a critical role in the development and recovery of Clostridioides difficile infection (CDI). Antibiotics, although necessary for CDI treatment, can further disrupt the gut microbiota, leading to dysbiosis and complicating recovery. Various microbiota-based treatment approaches, such as fecal microbiota transplantation (FMT) and newly approved live biotherapeutic products, have been developed to address disease- and treatment-associated dysbiosis and improve cure rates. This review aims to discuss the changes in the gut microbiome associated with CDI and the effectiveness of different microbiota-based treatments.
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
Immunology
Wiep Klaas Smits, Celine Harmanus, Ingrid M. J. G. Sanders, Lynn Bry, Grace A. Blackwell, Quinten R. Ducarmon, Eliane de Oliveira Ferreira, Ed J. Kuijper
Summary: The plasmid pCD-METRO is responsible for metronidazole resistance in different isolates of Clostridioides difficile. We found high sequence similarity among pCD-METRO plasmids from various sources and identified pCD-METRO and associated metronidazole-resistant isolates in clinical and veterinary reservoirs in the Americas. We suggest using PCR or genomic assays to detect pCD-METRO in metronidazole-resistant C. difficile.
EMERGING INFECTIOUS DISEASES
(2022)
Article
Infectious Diseases
Ronza Najjar-Debbiny, Alina Bazazhina, Naama Schwartz, Pninit Shaked, Walid Saliba, Gabriel Weber
Summary: There is no benefit of using vancomycin compared to metronidazole in terms of recurrence rate requiring hospitalization, in-hospital mortality, and mortality up to 4 and 8 weeks in non-severe first episode of CDI.
Article
Infectious Diseases
Fidelma Fitzpatrick, Nasia Safdar, Joffrey van Prehn, Sarah Tschudin-Sutter
Summary: Antibiotics are significant risk factors for CDI due to their impact on the gut microbiome. Managing CDI patients taking non-CDI antibiotics is challenging and can affect treatment outcomes and recurrence risk. Minimizing antibiotic use and switching to low-risk classes is recommended. Fidaxomicin may be preferred over vancomycin, but access may be limited. Prolonging anti-CDI therapy duration and concerns about microbiome disruption have insufficient evidence. Bezlotoxumab may be considered for high-risk recurrent CDI patients, but evidence is limited. Investigational approaches to minimize gut microbiome disruption from concomitant antibiotic use may enhance CDI treatment efficacy in the future.
LANCET INFECTIOUS DISEASES
(2022)
Article
Infectious Diseases
Teng Xu, Fenfen Zhou, Li Wang, Shi Wu, Haihui Huang
Summary: This study investigates the genomic and transcriptional changes associated with metronidazole resistance in Clostridioides difficile strains. The findings reveal an association between genomic variation and metronidazole resistance, and suggest that metronidazole resistance in C. difficile is influenced by factors such as metronidazole metabolism, cell wall thickness, and efflux pumps. These findings contribute to a better understanding of metronidazole resistance in C. difficile.
INTERNATIONAL JOURNAL OF ANTIMICROBIAL AGENTS
(2022)
Article
Public, Environmental & Occupational Health
Casey Morgan Luc, Danyel Olson, David B. Banach, Paula Clogher, James Hadler
Summary: The study aimed to assess the concordance of Connecticut medical providers with the 2017 CDI treatment update and its impact on recurrence risk. Findings showed an increase in concordance from 2018 to 2019, though it remained low in 2019. Recurrence risk was significantly associated with patients aged 65 and above, particularly those aged 75-84 years.
INFECTION CONTROL AND HOSPITAL EPIDEMIOLOGY
(2021)
Article
Immunology
Amy S. Gargis, Maria Karlsson, Ashley L. Paulick, Karen F. Anderson, Michelle Adamczyk, Nicholas Vlachos, Alyssa G. Kent, Gillian A. McAllister, Susannah L. McKay, Alison L. Halpin, Valerie Albrecht, Davina Campbell, Lauren Korhonen, Christopher A. Elkins, J. Kamile Rasheed, Alice Y. Guh, L. Clifford McDonald, Joseph D. Lutgring
Summary: Reference susceptibility testing revealed that elevated minimum inhibitory concentrations (MICs) to vancomycin and metronidazole were rare among US Clostridioides difficile isolates. Ribotype 027 was associated with increased MICs to several antibiotics including fluoroquinolones and clindamycin.
CLINICAL INFECTIOUS DISEASES
(2023)
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)
Article
Immunology
Stefan Gravenstein, Kevin W. McConeghy, Elie Saade, H. Edward Davidson, David H. Canaday, Lisa Han, James Rudolph, Nina Joyce, Issa J. Dahabreh, Vince Mor
Summary: Through a pragmatic cluster-randomized trial and exploratory analysis, it was found that there were 17-21% fewer influenza outbreaks in nursing homes with aTIV compared to TIV. The study suggests the use of aTIV vaccine in nursing homes to prevent influenza outbreaks.
CLINICAL INFECTIOUS DISEASES
(2021)
Article
Geriatrics & Gerontology
Elizabeth M. White, Elie A. Saade, Xiaofei Yang, David H. Canaday, Carolyn Blackman, Christopher M. Santostefano, Aman Nanda, Richard A. Feifer, Vincent Mor, James L. Rudolph, Stefan Gravenstein
Summary: This study found that vulnerable older adults can produce antibodies to SARS-CoV-2, with antibodies most likely to be detected within 15-30 days of diagnosis. Additionally, a large proportion of residents with no confirmed infection also showed antibody response, highlighting the complexity of identifying infecte in real time.
JOURNAL OF THE AMERICAN GERIATRICS SOCIETY
(2021)
Article
Immunology
Federico Perez, Roberto Viau Colindres, Brigid M. Wilson, Elie Saade, Robin L. P. Jump, Ritu Banerjee, Robin Patel, Scott R. Evans, Robert A. Bonomo
Summary: The study used the DOOR MAT approach to evaluate antibiotic treatment of E. coli and K. pneumoniae bloodstream infections in VHA patients across a decade. Over the 10-year period, resistance to certain antibiotics increased in E. coli but remained stable in K. pneumoniae. Discrepancy between empiric and definitive treatment desirability narrowed, with no negative impact on patient survival.
CLINICAL INFECTIOUS DISEASES
(2021)
Article
Public, Environmental & Occupational Health
Kathryn A. Martinez, Abhishek Deshpande, Laura Lipold, Michael B. Rothberg
Summary: The study found that physicians did not individualize screening decisions through shared decision making, and whether a patient received a mammogram was closely associated with their physician's past screening rate.
PATIENT EDUCATION AND COUNSELING
(2022)
Article
Public, Environmental & Occupational Health
Jennifer L. Cadnum, Basya S. Pearlmutter, Annette L. Jencson, Hanan Haydar, Michelle T. Hecker, Amy J. Ray, Myreen E. Tomas, Elie A. Saade, Curtis J. Donskey
Summary: The study revealed that surfaces in hospitals outside patient rooms and in outpatient facilities are frequently contaminated with healthcare-associated pathogens, indicating a need for improvements in cleaning and disinfection practices.
INFECTION CONTROL AND HOSPITAL EPIDEMIOLOGY
(2022)
Article
Health Care Sciences & Services
Elliott Bosco, Leon Hsueh, Kevin W. McConeghy, Stefan Gravenstein, Elie Saade
Summary: This study investigated the definitions of MACE when using administrative data in observational studies between 2010 and 2020. It found wide variability in the components of MACE endpoints and diagnostic codes used across observational studies, with issues of lack of validation and transparency.
BMC MEDICAL RESEARCH METHODOLOGY
(2021)
Article
Immunology
Teny M. John, Abhishek Deshpande, Kyle Brizendine, Pei-Chun Yu, Michael B. Rothberg
Summary: This study revealed that E. coli is an under-recognized cause of community-acquired pneumonia, with higher mortality rates compared to pneumococcal pneumonia. Resistance to fluoroquinolones was high among E. coli isolates, suggesting caution when using empirical fluoroquinolones in these patients.
OPEN FORUM INFECTIOUS DISEASES
(2022)
Article
Public, Environmental & Occupational Health
Preethi Patel, Abhishek Deshpande, Pei-Chun Yu, Peter B. Imrey, Peter K. Lindenauer, Marya D. Zilberberg, Sarah Haessler, Michael B. Rothberg
Summary: This study aimed to examine the association between different antibiotic regimens and hospital-onset Clostridioides difficile infection (CDI). The results showed that CDI was uncommon among patients with community-acquired pneumonia (CAP) in US hospitals, and there was no significant association between the choice of empiric antibiotic therapy and the development of CDI.
INFECTION CONTROL AND HOSPITAL EPIDEMIOLOGY
(2023)
Article
Hematology
Elie A. Saade, Leila S. Hojat, Praveen Gundelly, Robert A. Salata
Summary: Patients with moderate to severe immunosuppression, especially those with hematologic malignancies and certain treatments, are at a higher risk for COVID-19. They should take extra precautions, such as avoiding crowded indoor places and wearing high-quality masks. Enhanced vaccination and prioritized therapeutic options are recommended for these patients.
BEST PRACTICE & RESEARCH CLINICAL HAEMATOLOGY
(2022)
Article
Public, Environmental & Occupational Health
Michael B. Rothberg, Sarah Haessler, Abhishek Deshpande, Pei-Chun Yu, Peter K. Lindenauer, Marya D. Zilberberg, Thomas L. Higgins, Peter B. Imrey
Summary: This study developed and validated a model for predicting resistance to first-line community-acquired pneumonia therapy. The model outperformed existing scoring systems and physician judgment in predicting infection with a resistant pathogen.
INFECTION CONTROL AND HOSPITAL EPIDEMIOLOGY
(2023)
Review
Immunology
Leila S. Hojat, Elie A. Saade, Adrian Hernandez, Curtis J. Donskey, Abhishek Deshpande
Summary: This systematic review and meta-analysis examined the use of clinical decision support (CDS) in the diagnosis of urinary tract infection (UTI). The findings showed that CDS was effective in reducing urine culture rates, with significant results.
OPEN FORUM INFECTIOUS DISEASES
(2023)
Article
Immunology
Abhishek Deshpande, Yiyun Chen, Eugenia Boye-Codjoe, Engels N. Obi
Summary: This study evaluated the use of updated CDI codes and found no delay in transitioning to the new codes. Treatment patterns for recurrent CDI and nonrecurrent CDI were consistent with guidelines, regardless of coding concordance.
OPEN FORUM INFECTIOUS DISEASES
(2022)
Article
Immunology
Abhishek Deshpande, Michael Klompas, Ning Guo, Peter B. Imrey, Andrea M. Pallotta, Thomas Higgins, Sarah Haessler, Marya D. Zilberberg, Peter K. Lindenauer, Michael B. Rothberg
Summary: Less than 6% of eligible inpatients with pneumonia were switched early, with no worse outcomes observed. Early switching was associated with fewer days on antibiotics. Hospitals should encourage evidence-based recommendations to switch therapy in stable patients.
CLINICAL INFECTIOUS DISEASES
(2023)
Review
Public, Environmental & Occupational Health
William M. Patterson, Jesse Fajnzylber, Neil Nero, Adrian V. Hernandez, Abhishek Deshpande
Summary: This study aimed to systematically review the methodology, performance, and generalizability of diagnostic models for predicting the risk of healthcare-facility-onset (HO) Clostridioides difficile infection (CDI) in adult hospital inpatients. The quality and utility of these models remain uncertain, with most studies showing a high risk of bias. The most common predictors across all models were advanced age, receipt of high-risk antibiotics, history of hospitalization, and history of CDI.
INFECTION CONTROL AND HOSPITAL EPIDEMIOLOGY
(2023)
Article
Medicine, Research & Experimental
Abhishek Deshpande, Ramara Walker, Rebecca Schulte, Andrea M. Pallotta, Larisa G. Tereshchenko, Bo Hu, Sameer S. Kadri, Michael Klompas, Michael B. Rothberg
Summary: This study aims to determine if identifying the etiological agent early and pharmacist-led de-escalation can safely reduce the use of extended-spectrum antibiotics in patients with community-acquired pneumonia. The study will be conducted through a randomized controlled trial across 12 hospitals and will enroll over 12,000 patients to evaluate the effects of these approaches on patient outcomes and healthcare costs.
