2019
DOI: 10.1056/nejmc1815711
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Low Incidence of Hospital-Onset Clostridium difficile Infection in Sickle Cell Disease

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Cited by 10 publications
(12 citation statements)
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“…These findings are consistent with the recent study of adult SCD patients and are surprising given the many potential risk factors for intestinal dysbiosis in SCD, including frequent antibiotic use, frequent hospitalization, iron overload, hypoxia, and altered gut permeability. 8,12,13 However, the low rates of CDI in both pediatric and adult SCD patients are consistent with the theory that SCD microbiome -likely due to changes in intestinal metabolome is potentially protective against C. difficile disease. 10,14,15 It is hypothesized that hypoxia-reperfusion injury in SCD alters intestinal microbiota and use of opioids impairs intestinal motility, both leading to bacterial overgrowth and subsequently increased concentrations of intestinal butyrate which inhibits the proliferation of C. difficile.…”
Section: To the Editorsupporting
confidence: 75%
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“…These findings are consistent with the recent study of adult SCD patients and are surprising given the many potential risk factors for intestinal dysbiosis in SCD, including frequent antibiotic use, frequent hospitalization, iron overload, hypoxia, and altered gut permeability. 8,12,13 However, the low rates of CDI in both pediatric and adult SCD patients are consistent with the theory that SCD microbiome -likely due to changes in intestinal metabolome is potentially protective against C. difficile disease. 10,14,15 It is hypothesized that hypoxia-reperfusion injury in SCD alters intestinal microbiota and use of opioids impairs intestinal motility, both leading to bacterial overgrowth and subsequently increased concentrations of intestinal butyrate which inhibits the proliferation of C. difficile.…”
Section: To the Editorsupporting
confidence: 75%
“…These three cases yielded a CDI incidence of 1.16/10,000 patient-days or 0.54 /1,000 admissions among SCD patients -significantly less than that identified among the non-SCD cohort (p=0.0113) and less than published rates of 2.7/1000 among hospitalized adults with SCD. 8 Additionally, in a subset analysis from 2015-2017, we found that there were no cases of CDI in the 957 SCD patients, including the 218 patients who were receiving daily penicillin prophylaxis.…”
Section: To the Editormentioning
confidence: 75%
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“…The absence of any differences in the abundance of Clostridiales in the intestinal microbial composition of our cohort of SCD when compared to that in controls (Lim et al, 2018a) points to the latter and supports the notion that intestinal bacterial overgrowth also occurs in SCD patients. A second observation supporting intestinal bacterial overgrowth in SCD patients is our finding that the incidence of Clostridium difficile infection (CDI) onset in healthcare facilities was significantly lower than in hospital-wide patient populations (Ahmed et al, 2019) despite numerous risks factors, such as recurrent hospitalization and frequent use of antibiotics for fever due to VOC. We have speculated that the lower incidence of CDI may be related to intestinal bacterial overgrowth, which forms a dense bacterial microfilm to prevent the colonization and proliferation of Clostridium difficile.…”
Section: Intestinal Pathophysiological and Microbial Changes In Scdmentioning
confidence: 96%
“…11 More recently, we found that, despite many risk factors such as altered intestinal microbial community, repeated hospitalizations, and frequent administration of antibiotics, the incidence of hospital-onset C. difficile infection (CDI) among SCD individuals was significantly lower than those in hospital-wide populations (2.7 per 10 000 patient-days vs 9.1 per 10 000 patient-days; P < 0.001). 12 To understand the microbial metabolomic mechanism conferring protection against hospital-onset CDI, we set out in the present study to measure the urinary 3-IS in a cohort of SCD individuals.…”
Section: Elevated Urinary 3-indoxyl Sulfate In Sickle Cell Diseasementioning
confidence: 99%