Elevated lactoferrin is associated with moderate to severe Clostridium difficile disease, stool toxin, and 027 infection

Boone, James H.; DiPersio, J R; Tan, Michael J.; Salstrom, Sara Jane; Wickham, K. N.; Carman, Robert J.; Totty, Heather; Albert, Rachel; Lyerly, David M.

doi:10.1007/s10096-013-1905-x

Cited by 34 publications

(26 citation statements)

References 38 publications

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“…Fecal lactoferrin, a fecal material derived from neutrophils, has been shown to correlate with CDI severity [9]. In addition, mRNA of C-X-C motif chemokine 5 (CXCL-5) and mRNA and protein of interleukin (IL)-8 correlated with clinical outcome [10], whereas positive guaiac-based fecal occult blood (FOB) showed low sensitivity in diagnosing CDI [11].…”

Section: Introductionmentioning

confidence: 99%

Fecal Calprotectin Level Reflects the Severity of Clostridium difficile Infection

Kim

et al. 2017

Ann Lab Med

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Clostridium difficile is a significant nosocomial and community-acquired pathogen, and is the leading cause of antibiotic-induced diarrhea associated with high morbidity and mortality. Given that the treatment outcome depends on the severity of C. difficile infection (CDI), we aimed to establish an efficient method of assessing severity, and focused on the stool biomarker fecal calprotectin (FC). FC directly reflects the intestinal inflammation status of a patient, and can aid in interpreting the current guidelines, which requires the integration of indirect laboratory parameters. The distinction of 80 patients with CDI versus 71 healthy controls and 30 severe infection cases versus 50 mild cases was possible using FC as a marker. The area under the receiver operating characteristic curves were 0.821 and 0.746 with a sensitivity of 75% and 70% and specificity of 79% and 80%, for severe versus mild cases, respectively. We suggest FC as a predictive marker for assessing CDI severity, which is expected to improve the clinical management of CDI.

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Section: Introductionmentioning

confidence: 99%

Fecal Calprotectin Level Reflects the Severity of Clostridium difficile Infection

Kim

et al. 2017

Ann Lab Med

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“…Fecal lactoferrin concentration was determined using IBD-SCAN (TechLab, Inc., Blacksburg, VA). Elevated level of fecal lactoferrin was defined as ≥ 7.25 µg/mL [16,19]. A frozen fecal specimen from enrolled subjects on day of CDI diagnosis was shipped to TechLab, Inc., Blacksburg, VA for C. difficile isolation and PCR ribotyping [20].…”

Section: Methodsmentioning

confidence: 99%

Quantitative Fecal Lactoferrin as a Biomarker for Severe Clostridium difficile Infection in Hospitalized Patients

Archbald-Pannone¹

2014

J Geriatr Palliat Care

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Background The incidence and severity of Clostridium difficile infection (CDI) have increased over the past decade, especially among hospitalized patients. In this study, we determined the value of published criteria for severe CDI in predicting 3 month mortality, as well as the utility of fecal lactoferrin as a biomarker for severe CDI. Methods Pilot Year 1 of IRB approved (HSR-IRB# 13630) prospective cohort study of hospitalized patients with CDI at US academic medical center (10/08–4/10). Medical records of hospitalized patients with clinically diagnosed CDI, via toxin assay, were evaluated to objectively define severe CDI based on current guidelines. A stool sample from CDI diagnosis was analyzed for amount of fecal lactoferrin (IBD-SCAN, TechLab, Inc.). Data was analyzed using SPSS for student’s t-test and chi-squared, significance p ≤ 0.05. Results 79 subjects consented and enrolled, mean age was 64 years (standard deviation, sd, 17.2), 48 (61%) female, and average Charlson co-morbidity score was 5.8 (sd 3.8). Subjects with severe CDI were 5 times more likely to die within 3 months of diagnosis (Odds Ratio 5.66 (95% Confidence Interval 2.03–15.79), p=0.001) and had significantly more fecal lactoferrin (580.0 (sd 989.0) vs. 181.7 (sd 244.2) µg/mL, p=0.018), compared to those that did not meet severe CDI criteria. Conclusion In this pilot study, subjects who meet defined criteria for severe CDI had higher mortality and more intestinal inflammation. These preliminary results were, however, underpowered to show a direct association of lactoferrin with mortality. Larger cohort studies are needed to optimize a criterion for severe CDI and evaluate a direct association of lactoferrin and mortality in hospitalized patients with CDI.

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“…). Elevated levels of fecal lactoferrin and increased WBC count have been shown to be associated with increased CDI severity . Utilizing rat intestinal epithelia cells (IEC‐6), Otake et al .…”

Section: Areas For Improvement and Targets For Emerging Therapiesmentioning

confidence: 99%

“…Elevated levels of fecal lactoferrin and increased WBC count have been shown to be associated with increased CDI severity. 64 Utilizing rat intestinal epithelia cells (IEC-6), Otake et al showed that lactoferrin has the potential to reduce the cytotoxic damage of C. difficile toxin B. 65 In an in vitro chemostat gut model, Chilton et al showed that lactoferrin delays C. difficile growth and reduces toxin production.…”

Section: Prevention Of CDImentioning

confidence: 99%

Novel therapies and preventative strategies for primary and recurrent Clostridium difficile infections

Dieterle

Rao

Young

2018

Annals of the New York Academy of Sciences

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Clostridium difficile is the leading infectious cause of antibiotic-associated diarrhea and colitis. Clostridium difficile infection (CDI) places a heavy burden on the health care system, with nearly half a million infections yearly and an approximate 20% recurrence risk after successful initial therapy. The high incidence has driven new research on improved prevention such as the emerging use of probiotics, intestinal microbiome manipulation during antibiotic therapies, vaccinations, and newer antibiotics that reduce the disruption of the intestinal microbiome. While the treatment of acute C. difficile is effective in most patients, it can be further optimized by adjuvant therapies that improve the initial treatment success and decrease the risk of subsequent recurrence. Lastly, the high risk of recurrence has led to multiple emerging therapies that target toxin activity, recovery of the intestinal microbial community, and elimination of latent C. difficile in the intestine. In summary, CDIs illustrate the complex interaction among host physiology, microbial community, and pathogen that requires specific therapies to address each of the factors leading to primary infection and recurrence.

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Elevated lactoferrin is associated with moderate to severe Clostridium difficile disease, stool toxin, and 027 infection

Cited by 34 publications

References 38 publications

Fecal Calprotectin Level Reflects the Severity of Clostridium difficile Infection

Fecal Calprotectin Level Reflects the Severity of Clostridium difficile Infection

Quantitative Fecal Lactoferrin as a Biomarker for Severe Clostridium difficile Infection in Hospitalized Patients

Novel therapies and preventative strategies for primary and recurrent Clostridium difficile infections

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