An Observational Cohort Study of
            <i>Clostridium difficile</i>
            Ribotype 027 and Recurrent Infection

Rao, Krishna; Higgins, Peter; Young, Vincent B.

doi:10.1128/msphere.00033-18

Cited by 25 publications

(25 citation statements)

References 39 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Models based solely on detection of stool toxins A/B (10) or microbiome composition (45) were not able to predict severe CDI or recurrence. Peripheral eosinopenia (44) was identified as an independent predictor of mortality, as was infection with ribotype 027 strain (46). Therefore, an advance from this work is the demonstration that immune profiling adds value to the prediction of mortality in patients with CDI.…”

Section: Discussionmentioning

confidence: 79%

Immune Profiling To Predict Outcome of Clostridioides difficile Infection

Abhyankar

Jennie

Scully

et al. 2020

mBio

View full text Add to dashboard Cite

There is a pressing need for biomarker-based models to predict mortality from and recurrence of Clostridioides difficile infection (CDI). Risk stratification would enable targeted interventions such as fecal microbiota transplant, antitoxin antibodies, and colectomy for those at highest risk. Because severity of CDI is associated with the immune response, we immune profiled patients at the time of diagnosis. The levels of 17 cytokines in plasma were measured in 341 CDI inpatients. The primary outcome of interest was 90-day mortality. Increased tumor necrosis factor alpha (TNF-α), interleukin 6 (IL-6), C-C motif chemokine ligand 5 (CCL-5), suppression of tumorigenicity 2 receptor (sST-2), IL-8, and IL-15 predicted mortality by univariate analysis. After adjusting for demographics and clinical characteristics, the mortality risk (as indicated by the hazard ratio [HR]) was higher for patients in the top 25th percentile for TNF-α (HR = 8.35, P = 0.005) and IL-8 (HR = 4.45, P = 0.01) and lower for CCL-5 (HR = 0.18, P ≤ 0.008). A logistic regression risk prediction model was developed and had an area under the receiver operating characteristic curve (AUC) of 0.91 for 90-day mortality and 0.77 for 90-day recurrence. While limited by being single site and retrospective, our work resulted in a model with a substantially greater predictive ability than white blood cell count. In conclusion, immune profiling demonstrated differences between patients in their response to CDI, offering the promise for precision medicine individualized treatment. IMPORTANCE Clostridioides difficile infection is the most common health care-associated infection in the United States with more than 20% patients experiencing symptomatic recurrence. The complex nature of host-bacterium interactions makes it difficult to predict the course of the disease based solely on clinical parameters. In the present study, we built a robust prediction model using representative plasma biomarkers and clinical parameters for 90-day all-cause mortality. Risk prediction based on immune biomarkers and clinical variables may contribute to treatment selection for patients as well as provide insight into the role of immune system in C. difficile pathogenesis.

show abstract

Section: Discussionmentioning

confidence: 79%

Immune Profiling To Predict Outcome of Clostridioides difficile Infection

Abhyankar

Jennie

Scully

et al. 2020

mBio

View full text Add to dashboard Cite

show abstract

“…Healthcare-acquired CDI was associated with rCDI in univariate analyses of 5/10 studies, and in multivariable analyses of 2/4 studies (9,14,111,125,128,141,144,145,149,150). This is also reflected by the correlation of prior hospitalization (<3 months) with a recurrent episode of CDI (13,15,125,128,133,138,143,149).…”

Section: Prognostic Factors For Recurrent CDImentioning

confidence: 92%

“…Eight studies reported on non-CDI antibiotic use after initial CDI diagnosis as a risk factor, but results were inconsistent (12,123,129,136,141,145,146,148); 4/6 studies found an association between non-CDI antibiotic use and rCDI in univariate analysis, and 2/5 studies in multivariable analysis. A high-quality prospective study showed no significant association between antibiotic use and rCDI in both uni-and multivariate analysis (136).…”

Section: Prognostic Factors For Recurrent CDImentioning

confidence: 99%

GRADING prognostic factors for severe and recurrentClostridioides difficileinfection: expected and unexpected findings. A systematic review

et al. 2021

Preprint

View full text Add to dashboard Cite

BackgroundClostridioides difficile infection (CDI), its subsequent recurrences (rCDI), and severe CDI (sCDI) provide a significant burden for both patients and the healthcare system. Treatment consists of oral antibiotics. Fidaxomicin, bezlotoxumab and fecal microbiota transplantion (FMT) reduce the number of recurrences compared to vancomycin, but are more costly. Identifying patients diagnosed with initial CDI who are at increased risk of developing sCDI/rCDI could lead to more cost-effective therapeutic choices.ObjectivesIn this systematic review we aimed to identify clinical prognostic factors associated with an increased risk of developing sCDI or rCDI.MethodsPubMed, Embase, Emcare, Web of Science and COCHRANE Library databases were searched from database inception through March, 2021. Study selection was performed by two independent reviewers on the basis of predefined selection criteria; conflicts were resolved by consensus. Cohort and case-control studies providing an analysis of clinical or laboratory data to predict sCDI/rCDI in patients ≥18 years diagnosed with CDI, were included. Risk of bias was assessed with the Quality in Prognostic Research (QUIPS) tool and the quality of evidence by the Grading of Recommendations Assessment, Development and Evaluation (GRADE) tool, modified for prognostic studies. Overview tables of prognostic factors were constructed to assess the number of studies and the respective direction of an association (positive, negative, or no association).Results and conclusions136 studies were included for final analysis. Higher age and the presence of multiple comorbidities were prognostic factors for sCDI. Identified risk factors for rCDI were higher age, healthcare-associated CDI, prior hospitalization, PPIs started during/after CDI diagnosis and previous rCDI. Some variables that were found as risk factors for sCDI/rCDI in previous reviews were not confirmed in the current review, which can be attributed to differences in methodology. Risk stratification for sCDI/rCDI may contribute to a more personalized and optimal treatment for patients with CDI.

show abstract

“…Patients with congestive heart failure have a 2.36-fold increased risk of CDI recurrence (OR = 2.36, 95% CI = 1.02-5.45, p = 0.044). In a study published in 2016 by Mamic P. et al,in 5,851,582 patients with heart failure from the United States, it was revealed that this type of comorbidity was more frequently associated with CDI (OR = 1.13, 95% CI = 1.10-1.16) [45].…”

Section: Clinical Factorsmentioning

confidence: 99%

“…However, the medical literature is contradictory. Thus, Krishna Rao et al, in a study of 927 patients from Michigan, USA, claims that only ribotype 027 increases the risk of recurrence, whereas age, proton pump inhibitors, or antibiotics do not [5].…”

Section: Introductionmentioning

confidence: 99%

Risk Factors Associated with Recurrent Clostridioides difficile Infection

et al. 2020

View full text Add to dashboard Cite

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.

show abstract

An Observational Cohort Study of Clostridium difficile Ribotype 027 and Recurrent Infection

Cited by 25 publications

References 39 publications

Immune Profiling To Predict Outcome of Clostridioides difficile Infection

Immune Profiling To Predict Outcome of Clostridioides difficile Infection

GRADING prognostic factors for severe and recurrentClostridioides difficileinfection: expected and unexpected findings. A systematic review

Risk Factors Associated with Recurrent Clostridioides difficile Infection

Contact Info

Product

Resources

About