Intestinal Colonization and Nosocomial Spread of Clostridium difficile in Pediatric Cancer Patients Under Long-term Hospitalization

Murabata, Mayumi; Kato, Haru; Yano, Hisako; Ogura, Masamichi; Shibayama, Junko; Wakimoto, Yukio; Arakawa, Yoshichika; Mizokami, Masashi

doi:10.11150/kansenshogakuzasshi1970.82.419

Cited by 10 publications

(15 citation statements)

References 12 publications

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“…CDI is a major medical and infection control problem in many health care facilities, including hospitals, long-term care facilities, and nursing homes around the world (8,20). Accurate and timely diagnosis is necessary both for appropriate clinical management of the patient and for the timely implementation of infection control and pharmacy measures (13,21).…”

Section: Discussionmentioning

confidence: 99%

“…haps more importantly, a significant number of active C. difficile carriers are undiagnosed, leading to unmitigated transmission in health care settings. Often one or more stool specimens are collected following the first EIA-negative result if the suspicion of CDI is high (10,20). Algorithms for C. difficile testing in the hospital setting have evolved due to the need for more-accurate assays to better detect those patients with CDI (26,31).…”

Section: Discussionmentioning

confidence: 99%

“…PCR assays for various targets have been developed as a potential replacement for the less-sensitive (EIA) and less-specific (GDH) assays for C. difficile detection (3,4,6,23,30). Such assays include both "home brew" PCR assays and FDA-cleared commercial assays (15,20,28,30). Cepheid (Sunnyvale, CA) has recently developed a GeneXpert cartridge-based assay for detection of the C. difficile toxin B gene (tcdB) directly from stool.…”

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confidence: 99%

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Clostridium difficile Testing in the Clinical Laboratory by Use of Multiple Testing Algorithms

Novak-Weekley¹,

Marlowe²,

Miller³

et al. 2010

J Clin Microbiol

205

147

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The incidence of Clostridium difficile infection (CDI) has risen almost 3-fold in the United States over the past decade, emphasizing the need for rapid and accurate tests for CDI. The Cepheid Xpert C. difficile assay is an integrated, closed, nucleic acid amplification system that automates sample preparation and real-time PCR detection of the toxin B gene (tcdB). A total of 432 stool specimens from symptomatic patients were tested by a glutamate dehydrogenase (GDH) assay, a toxin A and B enzyme immunoassay (EIA), the Xpert C. difficile assay, and a cell culture cytotoxicity neutralization assay (CCCN). The results of these methods, used individually and in combination, were compared to those of toxigenic culture. Results for the Xpert C. difficile assay alone showed a sensitivity, specificity, positive predictive value, and negative predictive value (NPV) of 94.4, 96.3, 84.0, and 98.8%, while the EIA alone gave corresponding values of 58.3, 94.7, 68.9, and 91.9%, respectively. An algorithm using the GDH assay and the EIA (plus the CCCN if the EIA was negative) showed corresponding values of 83.1, 96.7, 83.1, and 96.1%. The Xpert C. difficile assay was statistically superior to the EIA (P, <0.001 by Fisher's exact test) and to the GDH-EIA-CCCN algorithm (P, 0.0363). Combining the GDH and Xpert C. difficile assays lowered both the sensitivity and the NPV of the Xpert assay. The GDH-EIA-CCCN procedure required, on average, 2 days to complete testing on GDH-positive results, while testing by the Xpert C. difficile assay was completed, on average, in less than 1 h. Xpert C. difficile testing yielded the highest sensitivity and NPV, in the least amount of time, of the individual-and multiple-test algorithms evaluated in this study.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Clostridium difficile Testing in the Clinical Laboratory by Use of Multiple Testing Algorithms

Novak-Weekley¹,

Marlowe²,

Miller³

et al. 2010

J Clin Microbiol

205

147

View full text Add to dashboard Cite

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“…Mayumi and colleagues [24] clarified intestinal colonization and nosocomial spread of C. difficile in pediatric cancer patients undergoing antineoplastic therapy during long-term hospitalization They examined the stool specimens of 10 children with pediatric malignant diseases stool specimens when symptoms such as fever or diarrhea occurred after each course of treatment with antineoplastic chemotherapy. While C. difficile was detected from stool specimens of 8 of 10 children during their hospital stay, 6 of these 8 children were negative for C. difficile on the day of their admission.…”

Section: Pathogenesismentioning

confidence: 99%

Clostridium Difficile Infection Following Chemotherapy

Raza¹,

Baig²,

Russell³

et al. 2010

PRI

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Clostridium difficile infection (CDI) is a major concern for health care system and clinicians. Interest in C. difficile infection has increased recently due to an ongoing C. difficile epidemic with a hypervirulent strain and mortality. Disease due to C. difficile is responsible for substantial strain on the hospital system by increasing patients' length of stayand increasing costs. Present studies have demonstrated chemotherapeutic agents as an independent risk factor for CDI potentially leading towards serious morbidity and mortality. However, the current strategies lack randomized trials on management in chemotherapy-associated CDI. The changing face of the disease, emergence of more resistant strains, and the rising cancer incidence have heightened the need for identification of risk factors, rapid diagnosis including prompt identification of toxins, and management algorithms. This review focuses on recent insights on the epidemiology, diagnosis, current management, recent patents, and advances on treating strategies of CDI with reference to current studies.

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“…The source of C. difficile in neonates is believed to be either from the mother's vaginal flora or the health care environment. In older children, daycare reservoirs for acquisition of C. difficile have been described as the primary source of infection [38,39]. 1.…”

Section: B) Factors Associated With CDI In Pediatric Cancer Patientsmentioning

confidence: 99%

The Evolution of Clostridium difficile Infection in Cancer Patients: Epidemiology, Pathophysiology, and Guidelines for Prevention and Management

Khan

Raza

Batul

et al. 2012

PRI

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Clostridium difficile infection (CDI) has emerged as a significant challenge to the healthcare system. The availability of anti-cancer chemotherapeutic regimens has contemporaneously resulted in a larger population of patients who are susceptible to CDI. The outbreak of a novel, hypervirulent, resistant strain, NAP-1/027 as well as resistance to antibiotic therapy have further contributed to an increase in prevalence as well as in disease severity. Recent data show high fatality rates in cancer patients with CDI. In this review, we have discussed the incidence, epidemiology, pathophysiology, clinical signs and symptoms and therapeutic guidelines for patients who are on chemotherapy and present with CDI and highlighted clinical reports documenting severe CDI associated with chemotherapeutic agents such as methotrexate, 5FU, cisplatin, carboplatin, paclitaxel, vinorelbine and cyclophosphamide. The review article also has the discussion of patents pertaining to infections caused by Clostridium difficile in cancer patients. We underscore the urgent need for early recognition and diagnosis of CDI in cancer patients and for the design and implementation of randomized clinical trials of new treatment modalities in the management of chemotherapy- associated CDI.

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Intestinal Colonization and Nosocomial Spread of Clostridium difficile in Pediatric Cancer Patients Under Long-term Hospitalization

Cited by 10 publications

References 12 publications

Clostridium difficile Testing in the Clinical Laboratory by Use of Multiple Testing Algorithms

Clostridium difficile Testing in the Clinical Laboratory by Use of Multiple Testing Algorithms

Clostridium Difficile Infection Following Chemotherapy

The Evolution of Clostridium difficile Infection in Cancer Patients: Epidemiology, Pathophysiology, and Guidelines for Prevention and Management

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