Consensus on the prevention, diagnosis, and treatment of Clostridium difficile infection

Abreu, A.T. Abreu y; Velasco, J.A. Velarde-Ruiz; Zavala-Solares, M.R.; Remes-Troche, J.M.; Carmona-Sánchez, Ramón; Aldana-Ledesma, J.M.; Camacho-Ortíz, Adrián; Contreras-Omaña, R.; Díaz-Seoane, R.; Elizondo-Vázquez, C.T.; Garza‐González, Elvira; Grajales-Figueroa, Guido; Gómez-Escudero, O.; Jacobo-Karam, J.S.; Morales-Arámbula, M.; Olivares-Guzmán, Laura; Sifuentes–Osornio, José; Siu-Moguel, A.G.; Soto-Solís, Rodrigo; Valdovinos-Garcia, Luis R.; Valdovinos-Díaz, M.A.; Vázquez-Elizondo, Genaro; Jasso, S.A. Lazo-de la Vega

doi:10.1016/j.rgmxen.2018.12.002

Cited by 10 publications

(15 citation statements)

References 93 publications

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“…18 Because no single test has a high enough sensitivity and specificity to reliably distinguish between an asymptomatic carrier and symptomatic CDI, 2-step testing is typically preferred using 2 enzyme immunoassays highly sensitive for glutamate dehydrogenase (GDH) and highly specific for C difficile toxins (ie, antigen recognition). 18,77,[84][85][86][87][88][89] These assays are inexpensive and rapid, in general, and achieve a specificity and sensitivity of greater than 90%. 35,85,90 An alternative to GDH-based testing, nucleic acid amplification testing (NAAT), targets chromosomal toxin genes and, in the past, these tests were expensive and time consuming; however, many facilities have adopted these as their primary testing modality.…”

Section: The Diagnosis Of CDI Should Include Laboratory Stoolmentioning

confidence: 99%

The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Clostridioides difficile Infection

Poylin

Hawkins

Bhama

et al. 2021

Diseases of the Colon &Amp; Rectum

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Section: The Diagnosis Of CDI Should Include Laboratory Stoolmentioning

confidence: 99%

The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Clostridioides difficile Infection

Poylin

Hawkins

Bhama

et al. 2021

Diseases of the Colon &Amp; Rectum

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“…The antimicrobial treatment failure, as indicated by clinical practice guidelines, persuaded the acting physicians to recommend FMT [20][21][22], whereas patients agreed on signing an informed consent. Fecal microbiota for transplant was prepared from screened, unrelated donors freely participating with the Microbiota Transplant Unit of University´s Faculty of Medicine, following 2017 European Consensus criteria and directions [21].…”

Section: Case Seriesmentioning

confidence: 99%

"Allogenic Fecal Microbiota Transplantation in Clostridioides Difficile Infection: A Case Series in Mexico"

López‐Vidal¹,

Soto-Hernández

Orduña

et al. 2021

BJSTR

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BackgroundClostridioides difficile has become the major cause of health care-associated diarrhea and a recognized causal agent of pseudomembranous colitis [1,2]. It is a primary infection with major recurrence rate among hospitalized patients; spore renders Clostridioides difficile, highly transmissible and resistant to antimicrobial treatment [1,3,4]. Infection is characterized by toxin production leading to intestinal barrier line up areas of cell necrosis and an intense local and/or systemic inflammatory response ARTICLE INFO ABSTRACTClostridioides difficile is a gram-positive, spore-forming bacterium that produces toxins capable of causing severe infectious diarrhea and pseudomembranous colitis in humans. We reviewed eight cases of antimicrobial therapy-resistant C. difficile infection (CDI) in patients with various pathologies. The diagnosis was confirmed by toxin detection and colonoscopy. Stool for fecal microbiota transplantation (FMT) was prepared from healthy selected donors; all cases received the FMT through retention enema. In most of the patients, CDI symptoms decreased within the first 24h post-FMT. We carried out short-, medium-, and long-term follow-up post-FMT, which showed an 88% of efficacy. Observed efficacy is similar to the current 80-100% reported frequently, whereas the main difference with previous reports lays on the fact that half of our patients showed baseline affectations involving surgery, neurological conditions or immune system deficiency. This study provides examples for establishing solid criteria for the FMT among patients with recurrent CDI and baseline affectations. This is a small case series and results should be considered within limitations; however, it is relevant to add all experiences to build a better knowledge on this clinical tool.

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“…GDH testing does not distinguish between toxigenic and nontoxigenic strains; therefore, a confirmatory test is needed for toxin analysis. The best test for detecting toxins is toxigenic culture (TC) due to its high Sn and Sp, but due to its turnaround times, other assays are preferred in the modern era [6][7][8]. The toxin A/B enzyme immunoassay (EIA) is a common confirmatory test that detects antibodies directed against both virulent clostridial toxins.…”

Section: Introductionmentioning

confidence: 99%

Testing and Diagnosis of Clostridioides difficile Infection in Special Scenarios: A Systematic Review

Singh,

Khouri,

Singh

et al. 2024

Cureus

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Introduction: Clostridioides difficile infection (CDI) is a clinical and laboratory diagnosis. Populations at higher risk of developing disease require a high clinical index of suspicion for laboratory testing to avoid incorrect assumptions of colonization. Common risk factors include recent antibiotic use, elderly (>65 years old), and immunocompromised patients. C. difficile assays should be ordered in an algorithm approach to diagnose an infection rather than colonization. Screening tests are widely available in hospital systems, but novel molecular testing may aid in diagnosis in patients with inconclusive or discordant antigen and toxin test results.Methods: Data was extracted from PubMed, Scopus, and Cumulative Index of Nursing and Allied Health Literature (CINAHL) databases based on the keywords "clostridioides difficile", "toxin assay", and "toxic megacolon". The data extracted is based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. A total of 27 reports were included in this systematic review.Results: Testing patients with a significant gastrointestinal surgical history, hypogammaglobulinemia, inflammatory bowel disease, intensive care unit, and immunocompromised patients for CDI is highly recommended. Diarrhea in these subsets of patients requires correlation of clinical context and an understanding of assay results to avoid over-and under-treating.Conclusion: CDI should be considered in all patients with traditional risk factors. Heightened clinical suspicion of CDI is required in patients with hypogammaglobulinemia, transplant recipients, patients with gastrointestinal surgical history, and inflammatory bowel disease. Testing should be limited to patients with clinical manifestations of CDI to ensure a high pretest probability for test interpretation. Healthcare workers should adhere to testing algorithms to optimize yield in the appropriate clinical context. Diagnostic assays should follow a sequential, stepwise approach to categorize the toxin expression status of the bacteria accurately.

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Consensus on the prevention, diagnosis, and treatment of Clostridium difficile infection

Cited by 10 publications

References 93 publications

The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Clostridioides difficile Infection

The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Clostridioides difficile Infection

"Allogenic Fecal Microbiota Transplantation in Clostridioides Difficile Infection: A Case Series in Mexico"

Testing and Diagnosis of Clostridioides difficile Infection in Special Scenarios: A Systematic Review

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