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Infection prevention and control
Published in Nicola Neale, Joanne Sale, Developing Practical Nursing Skills, 2022
In response to the significant media attention caused by large scale outbreaks of infection, national guidance was published on 2008 relating to the management of C. difficile infections (DH and HPA 2008). In 2013, PHE revised the section of this guidance relating to the management and treatment of Clostridium difficile infection to include updated recommendations for the clinical management of individuals with C. difficile infection (PHE 2013). Clostridioides difficile is a spore-forming bacterium, which is commonly found in the environment but which can colonise the gastrointestinal tract of approximately 3% of healthy adults and 66% of children. C. difficile infection occurs when the normal gut flora is altered, for example, after taking antibiotics, allowing the proliferation and production of two main toxins (A and B) that act on the bowel lining resulting in colitis and diarrhoea (NICE 2017b). C. difficile produces spores that are very resistant to normal cleaning processes and can survive in the environment for long periods of time potentially resulting in a significant reservoir for future cross-infection. In response to an increasing trend in the incidence of C. difficile, mandatory reporting of all cases in adults over 65 years old was implemented in 2007, since when there has been a significant reduction in the number of reported cases – a 77.9% reduction reported in 2018/19 from the base-line data collected in 2007/08 (PHE. 2019a).
Paper 1
Published in Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw, The Final FRCR, 2020
Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw
The typical inpatient and antibiotic history associated with Clostridioides difficile (previously known as Clostridium difficile) colitis does not fit with the history in this case. Furthermore, it tends to cause a diffuse colitis with gross mural thickening.
Clostridioides difficile
Published in Firza Alexander Gronthoud, Practical Clinical Microbiology and Infectious Diseases, 2020
Clostridium difficile, or now classified as Clostridioides difficile, is the most common cause of hospital-acquired diarrhoea, has high relapse rates of 20% and differentiation between colonization and disease can be challenging. It is therefore worthwhile to consider the following.
Adverse effects of antibiotics in children with cancer: are short-course antibiotics for febrile neutropenia part of the solution?
Published in Expert Review of Anti-infective Therapy, 2023
Coen Butters, Karin Thursky, Diane T Hanna, Theresa Cole, Andrew Davidson, Jim Buttery, Gabrielle Haeusler
Clostridioides difficile is a spore forming Gram-positive organism mostly associated with diarrhea but capable of a broad range of severe complications including dehydration, abdominal perforation, sepsis, and death [79]. C difficile infection (CDI) occurs through a series of events; disruption of the healthy intestinal microbiome, fecal-oral transmission of C difficile spores, colonization of the gastrointestinal tract, dominance of a toxigenic strain and production of C difficile toxins A and B [80,81]. CDI is common in children with cancer, occurring at a rate 15 times that of hospitalized children without cancer [82], and 10% of cases are complicated by severe colitis, ileus, or disease requiring surgery [83]. Children with cancer are especially susceptible to CDI due to broad-spectrum antibiotic exposure, immunosuppression, prolonged hospitalization, gastric acid suppression, and parenteral feeding [82,84]. In children with cancer or post-HSCT, CDI is associated with prolonged hospitalization, higher health-care costs, and increased risk of death [79,82], and recurrent disease occurs in 10–25% of cases [83,84].
Clostridioides difficile: innovations in target discovery and potential for therapeutic success
Published in Expert Opinion on Therapeutic Targets, 2021
Tanya M Monaghan, Anna M Seekatz, Benjamin H Mullish, Claudia C. E. R Moore-Gillon, Lisa F. Dawson, Ammar Ahmed, Dina Kao, Weng C Chan
Clostridioides difficile is a gram positive, strictly anaerobic, spore-forming bacterium capable of colonizing the gastrointestinal tract, and a leading worldwide cause of antibiotic-associated and healthcare-acquired infectious diarrhea [1]. Although the majority of Clostridioides difficile infection (CDI) cases are triggered by antibiotic exposure, other risk factors include older age, immunosuppression, inflammatory bowel disease, and chronic kidney disease [2–4]. The epidemiology of C. difficile is evolving, with increasing reports of community-acquired C. difficile infection (CDI) in persons who are young and otherwise healthy [5]. The clinical spectrum ranges from asymptomatic carriage, mild infection with diarrhea to toxic megacolon and multiorgan failure in fulminant cases [2], where attributable mortality rates range between 30% and 60% [6].
Advances in Clostridioides difficile therapeutics
Published in Expert Review of Anti-infective Therapy, 2021
Clostridioides difficile is an urgent public health threat by virtue of being the most common pathogen in hospitals and an increased risk of community-acquired infection [1]. The incidence of Clostridioides difficile infection (CDI) is increasing with a disproportionate rise in recurrent CDI seen in the United States. The primary risk factors for CDI are antibiotic exposure, advanced age, presence of comorbid conditions such as immunosuppression, inflammatory bowel disease, chronic kidney disease, amongst others [1]. The pathophysiology of both primary and recurrent CDI includes a disruption of the gut microbiota, i.e. dysbiosis. The clinical features of CDI range from diarrhea, abdominal pain, fever to fulminant colitis with severe sepsis. The cornerstone of the management of initial CDI is an antibiotic therapy and multiply recurrent CDI is managed with microbiome restoration therapies to restore gut dysbiosis [1]. This article discusses recent advances in the diagnosis and therapy of primary and recurrent CDI.