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
Ronald G. Hall, Travis J. Cole, Chip Shaw, Carlos A. Alvarez
Summary: Fidaxomicin was found to be associated with a significantly lower risk of CDI recurrence compared to vancomycin in a matched cohort study.
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
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)
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
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
Surgery
Emmanuel Nwachuku, Yizhi Shan, Prabhu Senthil-Kumar, Todd Braun, Ryan Shadis, Orlando Kirton, Thai Q. Vu
Summary: This case series reports 9 surgical patients with CDI who did not experience diarrhea prior to diagnosis. While all patients tested positive for C. difficile toxin, some presented with minimal bowel movements or constipation instead. These findings highlight the importance of considering CDI as a potential diagnosis in patients with atypical gastrointestinal symptoms even in the absence of diarrhea.
AMERICAN JOURNAL OF SURGERY
(2021)
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
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
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)
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)
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.
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
Infectious Diseases
Nobuaki Mori, Jun Hirai, Wataru Ohashi, Nobuhiro Asai, Yuichi Shibata, Hiroshige Mikamo
Summary: This study compared the therapeutic effects of fidaxomicin (FDX) and oral metronidazole (MNZ) for Clostridioides difficile infection (CDI), finding that FDX had a higher clinical cure rate and lower recurrence rate compared to MNZ, although the difference was not significant. However, caution is needed due to medication changes necessary for MNZ failure.
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)