Recommendations and guidelines for the treatment of Clostridioides difficile infection in Taiwan

Wu, Kuan-Sheng; Syue, Ling-Shan; Cheng, Aristine; Yen, Ting‐Yu; Chen, Hsien-Meng; Chiu, Yu‐Hsin; Hsu, Yu-Lung; Chiu, Chong‐Chi; Su, Ting-Yi; Tsai, Wan-Lin; Chen, Wei-Yu; Huang, Chung-Hao; Hung, Huei-Min; Huang, Ling-Ju; Kuo, Hong-Jie; Lin, Pei‐Chin; Yang, Chung-Tu; Hong, Pi-Lien; Lee, Susan Shin-Jung; Chen, Yao-Shen; Liu, Yung‐Ching; Huang, Liming

doi:10.1016/j.jmii.2020.02.002

Cited by 23 publications

(10 citation statements)

References 123 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Clostridioides difficile is the leading cause of nosocomial infectious diarrhea, with clinical symptoms ranging from mild diarrhea to pseudomembranous colitis and toxic megacolon (1)(2)(3)(4)(5)(6)(7). Increased virulence of the C. difficile NAP-1/027 epidemic clone in Quebec is known to be associated with increased production of toxins A and B, fluoroquinolone resistance, and production of binary toxins (8).…”

Section: Introductionmentioning

confidence: 99%

The Role of Toll-Like Receptor-2 in Clostridioides difficile Infection: Evidence From a Mouse Model and Clinical Patients

et al. 2021

View full text Add to dashboard Cite

BackgroundClostridioides difficile is the leading cause of nosocomial infectious diarrhea. Toll-like receptors (TLRs) are the major components of innate immunity that sense pathogens. The relationship between TLRs and C. difficile infection (CDI) was analyzed in clinical patients and a mouse model.Materials and MethodsA prospective investigation was conducted in medical wards of Tainan Hospital, Ministry of Health and Welfare, Tainan, Taiwan, from January 2011 to January 2013. Adult patients were followed up for the development of CDI. Single nucleotide polymorphisms (SNPs) of TLR2 and TLR4 were analyzed to assess the relationship between genetic polymorphisms and the development of CDI. A mouse model of CDI was used to investigate the pathogenic role of TLRs in CDI, TLR2 and TLR4 knockout (Tlr2-/- and Tlr4-/-) mice.ResultsIn the prospective study, 556 patients were enrolled, and 6.5% (36) of patients, accounting for 3.59 episodes per 1000 patient-days, developed CDI. Of 539 patients with available blood samples, the TLR2 rs3804099 polymorphism was more often noted in those with CDI than in those without CDI (64.5% vs. 46.1%; P = 0.046) but was not significant in multivariate analysis. Because the TLR2 rs3804099 polymorphism was moderately associated with CDI, the role of TLR2 and TLR4 was further evaluated in a mouse model. Both Tlr2-/- and Tlr4-/- mice showed more severe CDI disease than wild-type mice in terms of body weight change and fecal content five days after oral challenge with C. difficile. Furthermore, Tlr2-/- mice suffered from more severe disease than Tlr4-/- mice, as evidenced by stool consistency, cecum weight, and survival rate.ConclusionThe TLR2 rs3804099 polymorphism is marginally associated with the development of CDI, and the pathogenic role of TLR2 is further supported by a mouse model.

show abstract

Section: Introductionmentioning

confidence: 99%

The Role of Toll-Like Receptor-2 in Clostridioides difficile Infection: Evidence From a Mouse Model and Clinical Patients

et al. 2021

View full text Add to dashboard Cite

show abstract

“…The germinated spores are vulnerable to these glycopeptide antibiotics, which inhibit spore outgrowth. Although teicoplanin is functionally similar to vancomycin, its potent activity at relatively low concentration on vegetative cells and spore outgrowth may contribute to the lower recurrence rate in clinical trials [ 19 , 30 , 31 , 32 , 33 ]. Furthermore, transition from spores to vegetative cells is important and involves various metabolic changes.…”

Section: Discussionmentioning

confidence: 99%

Teicoplanin Suppresses Vegetative Clostridioides difficile and Spore Outgrowth

et al. 2021

View full text Add to dashboard Cite

In recent decades, the incidence of Clostridioides difficile infection (CDI) has remained high in both community and health-care settings. With the increasing rate of treatment failures and its ability to form spores, an alternative treatment for CDI has become a global priority. We used the microdilution assay to determine minimal inhibitory concentrations (MICs) of vancomycin and teicoplanin against 30 distinct C. difficile strains isolated from various host origins. We also examined the effect of drugs on spore germination and outgrowth by following the development of OD600. Finally, we confirmed the spore germination and cell stages by microscopy. We showed that teicoplanin exhibited lower MICs compared to vancomycin in all tested isolates. MICs of teicoplanin ranged from 0.03–0.25 µg/mL, while vancomycin ranged from 0.5–4 µg/mL. Exposure of C. difficile spores to broth supplemented with various concentrations of antimicrobial agents did not affect the initiation of germination, but the outgrowth to vegetative cells was inhibited by all test compounds. This finding was concordant with aberrant vegetative cells after antibiotic treatment observed by light microscopy. This work highlights the efficiency of teicoplanin for treatment of C. difficile through prevention of vegetative cell outgrowth.

show abstract

“…Further clinical studies showed that FMT successfully cured patients with recurrent CDI and attenuated CDI-associated diarrhea [ 76 , 77 ]. According to preclinical and clinical data, FMT in combination with vancomycin was recommended as the primary therapy for multiple recurrent CDIs (rCDIs) [ 78 , 79 ]. FMT not only restores healthy gut flora in CDI patients but also interferes with C. difficile spore germination [ 80 ].…”

Section: Advancements In the Treatment Of C Difficile Infectionmentioning

confidence: 99%

Opportunities for Nanomedicine in Clostridioides difficile Infection

Wang

Lee

et al. 2021

Antibiotics

View full text Add to dashboard Cite

Clostridioides difficile, a spore-forming bacterium, is a nosocomial infectious pathogen which can be found in animals as well. Although various antibiotics and disinfectants were developed, C. difficile infection (CDI) remains a serious health problem. C. difficile spores have complex structures and dormant characteristics that contribute to their resistance to harsh environments, successful transmission and recurrence. C. difficile spores can germinate quickly after being exposed to bile acid and co-germinant in a suitable environment. The vegetative cells produce endospores, and the mature spores are released from the hosts for dissemination of the pathogen. Therefore, concurrent elimination of C. difficile vegetative cells and inhibition of spore germination is essential for effective control of CDI. This review focused on the molecular pathogenesis of CDI and new trends in targeting both spores and vegetative cells of this pathogen, as well as the potential contribution of nanotechnologies for the effective management of CDI.

show abstract

Recommendations and guidelines for the treatment of Clostridioides difficile infection in Taiwan

Cited by 23 publications

References 123 publications

The Role of Toll-Like Receptor-2 in Clostridioides difficile Infection: Evidence From a Mouse Model and Clinical Patients

The Role of Toll-Like Receptor-2 in Clostridioides difficile Infection: Evidence From a Mouse Model and Clinical Patients

Teicoplanin Suppresses Vegetative Clostridioides difficile and Spore Outgrowth

Opportunities for Nanomedicine in Clostridioides difficile Infection

Contact Info

Product

Resources

About