Treatment compliance with European guidelines and prognosis of Clostridium difficile infection according to age

Lauda-Maillen, M.; Liuu, Évelyne; Catroux, M.; Caupenne, A.; Priner, M.; Cazenave‐Roblot, F.; Burucoa, Christophe; Ingrand, Pierre; Pocard, Marc

doi:10.1016/j.medmal.2018.08.001

Cited by 5 publications

(6 citation statements)

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“…Guidelines are also often modified or applied inconsistently in clinical practice ( 7 , 19 , 30 , 39 ). There may be good reasons for doing so, but this merits further research.…”

Section: Resultsmentioning

confidence: 99%

“…For example, Turner et al ( 30 ) note that there can be a risk of clinicians prescribing treatment for CDI based on a positive result from a single test, as opposed to the recommended 2–3-step algorithm of multiple tests ( 30 ). A lack of adherence to guidelines may also be in part affected by a lack of auditing practices on adherence ( 34 ) or due to a lack of a local policies and protocols on CDI treatment ( 39 ). Although meriting further research, not all clinicians necessarily read updated CDI guidelines in detail due to their length (expert workshops).…”

Section: Resultsmentioning

confidence: 99%

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Improving care for patients with Clostridioides difficile infection: A clinical practice and healthcare systems perspective

et al. 2023

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IntroductionArriving at a C. difficile infection (CDI) diagnosis, treating patients and dealing with recurrences is not straightforward, but a comprehensive and well-rounded understanding of what is needed to improve patient care is lacking. This manuscript addresses the paucity of multidisciplinary perspectives that consider clinical practice related and healthcare system-related challenges to optimizing care delivery.MethodsWe draw on narrative review, consultations with clinical experts and patient representatives, and a survey of 95 clinical and microbiology experts from the UK, France, Italy, Australia and Canada, adding novel multi-method evidence to the knowledge base.Results and discussionWe examine the patient pathway and variations in clinical practice and identify, synthesize insights on and discuss associated challenges. Examples of key challenges include the need to conduct multiple tests for a conclusive diagnosis, treatment side-effects, the cost of some antibiotics and barriers to access of fecal microbiota transplantation, difficulties in distinguishing recurrence from new infection, workforce capacity constraints to effective monitoring of patients on treatment and of recurrence, and ascertaining whether a patient has been cured. We also identify key opportunities and priorities for improving patient care that target both clinical practice and the wider healthcare system. While there is some variety across surveyed countries’ healthcare systems, there is also strong agreement on some priorities. Key improvement actions seen as priorities by at least half of survey respondents in at least three of the five surveyed countries include: developing innovative products for both preventing (Canada, Australia, UK, Italy, and France) and treating (Canada, Australia, and Italy) recurrences; facilitating more multidisciplinary patient care (UK, Australia, and France); updating diagnosis and treatment guidelines (Australia, Canada, and UK); and educating and supporting professionals in primary care (Italy, UK, Canada, and Australia) and those in secondary care who are not CDI experts (Italy, Australia, and France) on identifying symptoms and managing patients. Finally, we discuss key evidence gaps for a future research agenda.

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“…Guidelines are also often modified or applied inconsistently in clinical practice ( 7 , 19 , 30 , 39 ). There may be good reasons for doing so, but this merits further research.…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Improving care for patients with Clostridioides difficile infection: A clinical practice and healthcare systems perspective

et al. 2023

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“…Outro artigo obtido a partir de outra fonte de pesquisa e que atendia aos critérios de Outro mecanismo utilizado por esses fármacos é o bloqueio da bomba de prótons nas células parietais, ativando a proteína de choque térmico (HSP70), e o fator transformador de crescimento beta (TGF-β), culminando no alívio dos sintomas e a cicatrização de úlceras pépticas (LAUDA-MAILLEN et al, 2019;PAZ et al, 2020).…”

Section: Metodologiaunclassified

Toxicologia: uma abordagem multidisciplinar – Volume I

Bachur¹

2021

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Desde os períodos mais remotos, nas civilizações primitivas, substâncias presentes na natureza eram utilizadas para fins diversos, como a caça e extermínio de inimigos. Com a evolução da humanidade, muitos esforços têm sido feitos para o avanço no conhecimento acerca do uso seguro de substâncias presentes em diversos contextos da vida, através da identificação e caracterização do potencial tóxico e das condições de exposição a estas substâncias que podem repercutir em perigo para os seres vivos. Deste modo, o objetivo principal destes avanços consiste em prevenir agravos relacionados ao contato ou exposição com substâncias potencialmente tóxicas. Em nosso cotidiano, estamos constantemente expostos a potenciais agentes tóxicos, mesmo que não percebamos, a exemplo dos medicamentos, alimentos, substâncias presentes nos meios ocupacional e ambiental, além das substâncias produzidas e usadas intencionalmente por exercer atividades tóxicas no organismo, como as drogas de abusos lícitas e ilícitas. Assim, a Toxicologia surge como a ciência que, em suas diferentes áreas de atuação, busca compreender a natureza, os mecanismos das ações tóxicas e as alterações biológicas resultantes da exposição de um organismo vivo a diferentes substâncias químicas. No contexto da saúde humana, o papel principal desta ciência é a avaliação de risco e o estabelecimento de medidas preventivas e corretivas para a utilização segura destas substâncias pelo homem. O estudo acerca de acidentes por animais peçonhentos também se enquadra no escopo da Toxicologia. A Organização Mundial de Saúde (OMS) estima que ocorrem 5 milhões de acidentes por picada de serpente por ano, resultando em 2,5 milhões de envenenamentos e em, pelo menos, 100.000 mortes. Portanto, tanto as intoxicações exógenas como os envenenamentos por animais peçonhentos correspondem a relevantes situações de risco à saúde que requerem atendimento especializado, constituindo um sério problema sanitário mundial. De modo agudo, as intoxicações e envenenamentos ocorrem em diversos contextos, como intenção suicida, acidentes, abuso de substâncias, prescrições médicas equivocadas, dentre outros. Porém, também a exposição crônica a substâncias com potencial tóxico pode desencadear consequências deletérias ao organismo a longo prazo, a exemplo da mutagênese e da carcinogênese. Este cenário requer a formação aaaaa LLLLLLLLLIIIII de profissionais de diferentes áreas do conhecimento, especialmente da área da saúde, com visão integrada, multidisciplinar e abrangente sobre Toxicologia. Neste contexto, a proposta da obra “Toxicologia: uma abordagem multidisciplinar” é trazer, ao leitor, estudos que contemplam as diversas áreas da Toxicologia demonstrando o impacto de diferentes tipos de substâncias sobre a saúde humana.

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“…1 Recommended first line therapy is vancomycin, fidaxomicin or metronidazole. [2][3][4][5][6][7][8][9][10][11][12][13][14][15] The risk of recurrence is approximately 20%, increasing to 60% after the third episode. 1,16 FMT has emerged as a clinically effective treatment for recurrent CDI (rCDI).…”

Section: Introductionmentioning

confidence: 99%

“…Clostridioides difficile infection (CDI) is the most common nosocomial infectious diarrhoea, and usually occurs after antibiotic use 1 . Recommended first line therapy is vancomycin, fidaxomicin or metronidazole 2–15 . The risk of recurrence is approximately 20%, increasing to 60% after the third episode 1,16 …”

Section: Introductionmentioning

confidence: 99%

Faecal microbiota transplantation for recurrent C. difficile infections: challenges and improvement opportunities for clinical practice and healthcare systems

Hocking

Ianiro

Leong

et al. 2022

Aliment Pharmacol Ther

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Summary Background There is growing interest in faecal microbiota transplantation (FMT) as a treatment for recurrent Clostridioides difficile infection (CDI), but evidence on the diverse requirements for safe, effective and accessible services is fragmented and limited. Aims To identify key components of FMT provision relating to the patient care pathway, stool donor pathway and wider healthcare system, and to explore variation in practice Methods We conducted a narrative review of the literature and consultations with key clinical experts in the field. Evidence is drawn from high‐income country contexts, with an emphasis on Australia, Canada, Italy and the United Kingdom as case example countries. Results We identify and discuss key challenges to do with healthcare capacity (workforce, FMT and stool banking facilities), donors and donations, patient access and choice of FMT delivery routes, regulation, costs and reimbursement. We also identify improvement opportunities to increase awareness of FMT and referral processes, physician training, maintaining patient registries and outcome monitoring metrics, in‐country regulatory harmonisation and tackling reimbursement challenges and discuss future research needs. Conclusion Effectively bringing FMT to patients in a healthcare system requires much more than just the existence of a clinically effective procedure. With FMT being a potentially effective treatment option for recurrent CDI for many patients, a well‐rounded understanding of how appropriate FMT capacity can be built and nurtured is important for both healthcare providers and policymakers seeking to improve patient care.

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Treatment compliance with European guidelines and prognosis of Clostridium difficile infection according to age

Cited by 5 publications

References 29 publications

Improving care for patients with Clostridioides difficile infection: A clinical practice and healthcare systems perspective

Improving care for patients with Clostridioides difficile infection: A clinical practice and healthcare systems perspective

Toxicologia: uma abordagem multidisciplinar – Volume I

Faecal microbiota transplantation for recurrent C. difficile infections: challenges and improvement opportunities for clinical practice and healthcare systems

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