Present and past perspectives on Clostridium difficile infection

Álvarez-Hernández, Diego Abelardo; González-Chávez, Antonio; González-Hermosillo-Cornejo, D.; Franyuti-Kelly, G.A.; Díaz-Girón-Gidi, Alejandro; Vázquez-López, Rosalino

doi:10.1016/j.rgmxen.2017.07.016

Cited by 8 publications

(1 citation statement)

References 46 publications

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“…and that the C. difficile-associated disease (CDAD)-related ageadjusted case-fatality rate rose from 1.2% in 2000 to 2.2% in 2004 [23,24]. In that the best antimicrobial treatment available fails in at least two of every eight patients [25], it is clear that a solution for restoring gut microbiota function and breaking the chronic pattern is of utmost importance [7,26].…”

Section: Discussionmentioning

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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Section: Discussionmentioning

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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Structural and Mechanistic Investigation of the Unusual Metabolism of Nifurtimox

Lang

Schulz

Piel

et al. 2022

Chem. Res. Toxicol.

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The oral antiparasitic drug nifurtimox has been used to treat Chagas disease for more than 50 years. Historical studies determined that very little nifurtimox is excreted unchanged, but contemporaneous preclinical studies of radiolabeled nifurtimox found almost all of the radiolabel was rapidly excreted, suggesting that metabolism is extensive. Attempts to study nifurtimox metabolism have had limited success, yet this knowledge is fundamental to characterizing the pharmacokinetics and pharmacodynamics of the drug. We conducted in vitro studies using hepatic and renal sources with 14 C-labeled nifurtimox as substrate and obtained samples of urine, plasma, and feces from rats administered 2.5 mg/kg [ 14 C]-nifurtimox, and samples of human urine and plasma from phase 1 clinical studies in which participants received a single dose of 120 mg nifurtimox. Analysis of metabolites was done by high-performance liquid chromatography (HPLC)high-resolution mass spectrometry (HRMS) and HRMS/MS with offline liquid scintillation counting of radiolabeled samples. Surprisingly, only traces of a few metabolites were identified from in vitro incubations with hepatocytes and subcellular fractions, but more than 30 metabolites were identified in rat urine, mostly with atypical mass changes. We developed an HRMS scouting method for the analysis of human samples based on the sulfur atom in nifurtimox and the natural abundance of 34 S, as well as a characteristic tandem mass spectrometry (MS/MS) fragmentation of nifurtimox and metabolites. Fragmentation patterns on HRMS/MS were used to propose structures for 18 metabolites (22 including stereoisomers), and based on these structures, the six most abundant products were synthesized and the structures of the synthetic forms were confirmed by HRMS and two-dimensional nuclear magnetic resonance (2D NMR). Overall, we determined that the metabolism of nifurtimox is almost certainly not mediated by typical hepatic and renal drug-metabolizing enzymes, and instead is rapidly metabolized mainly by reduction or nucleophilic attack, with some evidence of oxidation. Knowledge of the most abundant metabolites of nifurtimox affords the possibility of future studies to investigate levels of exposure and possible drug−drug interactions.

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Clostridioides difficile: a review of relevant topics for nursing practice and infection prevention and control

Furtado

2022

Gastrointestinal Nursing

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Clostridioides difficile infection is a serious medical and epidemiological problem, with severe consequences. It can divert essential resources and thus represent a considerable burden for healthcare systems, impacting their normal functioning and the provision of safe and effective care. Prevention, proper diagnosis, adequate treatment and effective control measures are the core elements required to reduce the risk of this disease, prevent the infection from spreading and diminish probability of recurrence. This update on disease management is focused on epidemiology, pathophysiology and risk factors, as well as diagnosis, treatment, prevention and infection control measures. This review draws on a great diversity of sources to enabled the integration of the best available evidence regarding Clostridioides difficile infection (CDI) prevention and control, reflecting recommendations and guidelines from regional, national and international entities and specialised bodies. Nurses play a paramount role in prevention and management of CDI. They take part in all stages of care, by identifying high-risk patients and the disease's first signs and symptoms, monitoring its evolution, implementing effective infection-control measures and providing patient and family education.

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Present and past perspectives on Clostridium difficile infection

Cited by 8 publications

References 46 publications

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

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

Structural and Mechanistic Investigation of the Unusual Metabolism of Nifurtimox

Clostridioides difficile: a review of relevant topics for nursing practice and infection prevention and control

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