Prevention and Treatment of Clostridium difficile-Associated Diarrhea in Solid Organ Transplant Recipients

Bring it on: Top five antimicrobial stewardship challenges in transplant infectious diseases and practical strategies to address them

“…Interventions aimed at restricting antimicrobial exposure and providing provider education and feedback have been highly successful. 75,76 Effective CDI antimicrobial stewardship practices are an interdisciplinary effort engaging diagnostic stewardship and infection prevention and control. 74,76 Active adaptation of these practices to the dynamic and unique factors of each transplant center is crucial for sustained progress in reducing CDI burden in this population.…”

“…75,76 Effective CDI antimicrobial stewardship practices are an interdisciplinary effort engaging diagnostic stewardship and infection prevention and control. 74,76 Active adaptation of these practices to the dynamic and unique factors of each transplant center is crucial for sustained progress in reducing CDI burden in this population. Stewardship areas of uncertainty include appropriate patient selection for testing, implications of asymptomatic screening, and the role of anti-CDI therapeutic prophylaxis.…”

Diarrhea in Transplant: Diagnosis and Management

“…The use of proton-pump inhibitors and unnecessary antibiotics should be avoided if possible as they are associated with increased risk of recurrence. In patients with multiple recurrences, fecal microbiota transplantation (FMT) may be considered, but it is unclear if restoration of the microbiome would be associated with more infectious complications (related to the bacterial translocation or to the procedure) and changes in pharmacodynamics of the immunosuppressive drugs [27,57]. In immunocompromised patients, most commonly reported adverse eventsnausea, vomiting, abdominal pain, and procedure-related diarrheawere self-limited.…”

“…Several factors were described as predictors of FMT failure: severe or fulminant colitis, presence of pseudomembranous colitis, and administration of antibiotics with no C. difficile activity at the time of FMT [56]. FMT, compared with different antibiotic regimens (metronidazole, vancomycin, and fidaxomicin), seems to be the most cost-effective treatment for recurrent C. difficile infections [57].…”

Antimicrobial stewardship in transplant patients

“…The global threat of antimicrobial resistance and other consequences of antimicrobial use, such as Clostridiodes difficile infection (CDI), gastrointestinal dysbiosis, hematologic complications, and central nervous system and other end-organ toxicities have been increasingly more recognized [1]. To address these patient safety issues in inpatient and outpatient healthcare settings, antimicrobial stewardship programs (ASPs) have been established and are required by regulatory bodies in multiple countries with specific recommendations from the WHO and the Centers for Disease Control and Prevention (CDC) [2,3].…”