Tag Archives: C. difficile treatments

Two UK Researchers, Prof.Alistair Leanord and Dr. David Enoch, Present CDI Data At the 27th European Congress of Clinical Microbiology and Infectious Diseases (ECCMID)

Repeated infection with the bacterium Clostridium difficile (C. difficile, C.diff.), which causes abdominal pain, fever, diarrhea is linked to higher death rates, as well as having a significant impact on health services in terms of cost and hospital beds occupied.

In the first of two presentations at the 27th European Congress of Clinical Microbiology and Infectious Diseases (ECCMID) (tomorrow (Saturday), Professor Alistair Leanord, from Glasgow University, UK, will say that in Scotland the extra impact on the health service from C. difficile infections amounted to 10,600 bed days a year. “This is the equivalent to a 30-bed hospital ward being fully occupied all year,” he will say.

He will tell the congress that the (median) average cost of a patient with C. difficile infection was £7,500 (€8,600 approximately) compared to £2,800 (€3,200 approx) for patients with other medical conditions. In Scotland over a one year period, from October 2015 to October 2016, there were 1,150 cases of C. difficile infection in patients aged 15 and over. This cost the National Health Service (NHS) in Scotland a total of £8,650,000. Out of this amount, the additional costs of treating C. difficile infection, over and above the basic cost of a hospital bed and normal medical care, was £1,955,000. The calculations were carried out at Strathclyde University, which is part of the Scottish Healthcare Associated Infection Prevention Institute (SHAIPI) research consortium.

Until now, little has been known about the impact on health service resources from C. difficile infections, and on patients in terms of recurrence of infection, readmission to hospital, length of stay and death rates.

Prof. Leanord and his colleagues in Scotland identified 3,304 patients with C. difficile in Scottish hospitals between 2010 and 2013 and matched them with 9,516 patients who did not have the infection (the control group). Approximately two-thirds of the C. difficile patients acquired the infection in hospital.

They found that patients with C. difficile infection had more than double the risk of dying from any cause within two months of being admitted to hospital; nearly a third of all C. difficile cases (29%) died within two months compared to 14% of patients in the control group. Patients with C. difficile stayed in hospital a (median) average 9.7 days longer than the patients without the infection. Of the 1,712 C. difficile patients who were discharged from hospital within 30 days of the first episode of infection, 59% were readmitted within six months; of the 626 cases discharged more than 30 days after the first episode 53% were readmitted within six months. Few of these re-admissions were directly related to C. difficile infection.

“However, nearly a sixth of patients (14%) who were cured of the initial infection recurred within three months, and nearly one third of them (29%) had a second recurrence within a year,” says Prof. Leanord.

Older people were more vulnerable to a recurrence. Among the patients with C. difficile infection, 22% were aged 85 or over, and patients aged 75 and over had approximately double the risk of a recurrence of the infection compared to those aged under 65. Patients aged between 65-74 had 1.5 times the risk of recurrence compared to younger patients.

Prof. Leanord will conclude: “Having a clear understanding of the nature of C. difficile infections in Scotland will allow the Scottish government to target resources at the most appropriate patients to try to reduce the overall burden of the disease on the health service. Our findings are very likely to be applicable to the rest of the UK and other countries as well.”

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In a second presentation on Saturday, Dr David Enoch, a consultant microbiologist and infection control doctor at the National Infection Service, Public Health England, Cambridge (UK), will report the outcomes of 6,874 patients who had acquired C. difficile infection in hospital between 2002 and 2013 in England. Of these, 1,141 (16.6%) had recurrences of the infection.

“We found that 49% of hospital patients who suffer a recurrent episode of C. difficile infection die within a year, compared to 38% of those who suffer an initial infection only,” he will say. “In addition, 21% of patients with a recurrence suffered other complications as well, such as dehydration, malnourished and sometimes even perforation of the bowel, compared to 18% of patients who did not have a recurrence.”

Dr Enoch estimates that there are approximately 125,000 cases of C. difficile infection in Europe each year, and between 15-30% of these recur. “Cases in the UK have been coming down since 2008, which is most probably due to improvements in antibiotic prescribing and cleaning regimens in hospitals. This is encouraging but more still needs to be done.”

The average age of the patients was 77 and the average length of stay in hospital was 38 days.

“The main risk factor for developing C. difficile infection is prior antibiotic use. These patients are often already ill from some other underlying illness, which explains why they needed antibiotics in the first place. Older people are at greater risk of C. difficile infection as they are often sicker, have other illnesses or conditions, and so need more antibiotics,” he will say.

Dr Enoch continues: “Although much has been done, particularly in the UK, to try to prevent C. difficile infection, strict adherence to antibiotic guidelines by clinicians and thorough cleaning of the hospital environment are crucial in ensuring that patients don’t develop C. difficile infection in the first place. Treatment with a new drug called fidaxomicin has also been shown to reduce the risk of recurrence in patients who are unfortunate enough to develop an infection. However, we still have a lot to learn, particularly about how C. difficile infection occurs in the community, and how best to treat it.”

Treatments for recurrences of C. difficile infection  —–  include stopping the antibiotic that made the patient susceptible to the infection and starting a different antibiotic that is effective against C. difficile infection. These antibiotics include metronidazole, vancomycin and fidaxomicin. Supportive therapy, such as extra fluids, and surgery in serious or life-threatening cases may also be necessary. Faecal transplantation is emerging as a promising option; this is a process in which the good bacteria that the gut needs but which has been killed off by antibiotics is transplanted into the patient from a healthy donor.

(CDF:  Consider contacting an organization conducting Clinical Trials to Treat and Prevent.  Click on the following link for more information :  https://cdifffoundation.org/clinical-trials-2/

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Abstract no: #1672, presented by Prof. Alistair Leanord in the “Clostridium difficile infections: epidemiology and outcome” oral session, 16.30-18.30 hrs, Saturday 22 April, Hall A.

Abstract no: #883, presented by Dr Enoch in the “Clostridium difficile: guts and glory” e-poster mini-oral session, 15.30-16.30 hrs, Saturday 22 April, ePoster Arena 4.

 

To read the article in its entirety – please click on the following link:

https://www.eurekalert.org/pub_releases/2017-04/esoc-cdi041917.php

Clostridium difficile (C. diff. ) Review: Early Diagnosis, Prevention, and Treatment

C. difficile Review: Early Diagnosis, Prevention, and Treatment

March 2016

NewsSpeaker

An update on the 2011 comparative effectiveness review on the early diagnosis, prevention, and treatment of Clostridium difficile was released to aid healthcare professionals, patients, policymakers, and others in well-informed decision-making.Researchers aimed to highlight the differences in accuracy of diagnostic tests and the effects of interventions to prevent and treat C. diff infection (CDI) in adults. Data was analyzed from searches in Medline, the Cochrane Clinical Trials Registry, and Embase from 2010–April 2015 as well as referenced studies and recent systematic reviews.Studies for inclusion looked at sensitivity and specificity for diagnostic tests in at-risk patients for CDI. Randomized controlled studies or high-quality cohort studies that evaluated adults with CDI or suspected CDI for treatment interventions were included. A total of 37 diagnostic studies and 56 prevention or treatment intervention studies were included for the review update.

RELATED: 6 Antibiotic-Resistant Threats Examined in CDC’s New Superbug Report

High-strength evidence indicated that nucleic amplification tests were sensitive and specific for CDI when cultures were used as the reference standard. High-strength evidence also showed that in treating CDI, vancomycin was more effective than metronidazole and the effect did not vary by severity (moderate-strength).

Fidaxomicin remained noninferior to vancomycin for initial CDI cure (moderate-strength) but proved superior in the prevention of recurrent CDI (high-strength).

Low-strength evidence suggested that fecal microbiota transplantation (FMT) may exert a significant effect on reducing recurrent CDI. In addition, lactobaccilus strains and multiorganism probiotic can also reduce recurrent CDI. Saccharomyces boulardii, however, did not prove more effective than placebo in the prevention of recurrent CDI.

The review was prepared by the Minnesota Evidence-based Practice Center for the Agency for Healthcare Research and Quality of the U.S. Department of Health and Human Services.

 

To access the .pdf report format please click on the link below:

https://www.effectivehealthcare.ahrq.gov/search-for-guides-reviews-and-reports/?pageaction=displayproduct&productID=2208

 

To read the article in its entirety please click on the link below:

http://www.empr.com/news/updated-review-includes-new-c-diff-diagnosis-treatment-guidance/article/486399/

Clostridium difficile Infection (CDI, C. diff. ) for Healthcare Providers

Patients admitted to an ICU for Clostridium difficile infection were at risk for developing subsequent C. difficile infections, according to recent research.

To read this article in its entirety:

http://www.healio.com/infectious-disease/gastrointestinal-infections/news/online/%7Be22ec9f0-c474-4753-9b95-2084d4f9b177%7D/icu-patients-admitted-with-c-difficile-colonization-at-risk-for-subsequent-infections

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Patients with Clostridium difficile infection (CDI) warranting admission to the ICU may benefit from a treatment regimen of combined oral vancomycin and IV metronidazole, according to recent findings.

To read article in its entirety: 

http://www.healio.com/infectious-disease/gastrointestinal-infections/news/online/%7B86429037-44a1-4ac3-9241-b2a8f31d9312%7D/c-difficile-patients-benefit-from-oral-vancomycin-iv-metronidazole-combination

In a retrospective, observational, comparative study, researchers evaluated 88 critically ill adult patients with C. difficile who were admitted to the ICU at Wake Forest Baptist Medical Center between June 2007 and September 2012. All patients were treated for CDI with oral vancomycin, and those in the combination therapy group received concomitant metronidazole intravenously for a minimum of 72 hours. Patients were matched and equally placed within either the combination or vancomycin-only groups using the Acute Physiology and Chronic Health Evaluation II (APACHE II) metric. The patients were clinically and demographically comparable, although the combination therapy group had a higher prevalence of moderate-to-severe renal disease.

The study’s primary outcome was in-hospital death, and secondary outcomes included clinical success at days 6, 10 and 21; hospital length of stay after diagnosis of CDI; and duration of ICU stay after diagnosis of CDI. Multivariable analysis was used to identify factors independently correlated with survival.

University of Virginia School of Medicine; Promising New Antibiotic to combat C. difficile

* In the news *

A new antibiotic being developed at the University of Virginia School of Medicine to combat the dangerous C. difficile superbug also appears effective against a wide array of other pathogens, including the Helicobacter pylori bacterium, a new study suggests.

With antibiotic resistance a growing concern – and an alarming shortage of new antibiotics in development – the drug is notable because it works in a way that prevents microbes from becoming resistant to it.

U.Va.’s new findings challenge conventional wisdom that the best way to develop new treatments for Clostridium difficile, a growing problem in health care settings nationwide, is to target that infection specifically and to use an antibiotic that concentrates in the gut. U.Va.’s drug, Amixicile, does neither – yet early testing suggests it could be significantly more effective than existing options.

Sparing Good Gut Bacteria

Amixicile may prove particularly effective against C. difficile because, unlike other antibiotics, it spares beneficial probiotic and other beneficial bacteria. There is growing evidence to suggest that probiotic bacteria help prevent C. difficile re-infection and relapse, so antibiotics that concentrate in the gut and kill off the intestinal flora indiscriminately make it easier for

C. difficile to regain a toehold. Mice infected with C. difficile that were treated with other antibiotics commonly relapsed and died, but there were no relapses in mice treated with Amixicile, the researchers report.

Unlike other C. difficile therapeutics,  Amixicile concentrates in the bloodstream, rather than in the gut, and emerges only at infected sites. Thus, Amixicile may be useful in treatment of systemic anaerobic and parasitic infections as well as gastric infections caused by H. pylori. More broadly, because of its low toxicity and immunity to mutation-based drug resistance, it potentially could be used as a lifelong prophylactic to prevent flare-ups of chronic diseases such as Crohn’s disease and ulcerative colitis. It may even prove effective against anaerobes associated with periodontal disease.

“If the drug works even half as well as what we’ve found to date, there would be nothing like it in the existing antimicrobials,” said Paul S. Hoffman of the U.Va.  Division of Infectious Diseases and International Health and the Department of Microbiology, Immunology and Cancer Biology.

Overcoming Drug Resistance

Amixicile avoids the problem of mutation-based drug resistance by its unusual mechanism of action. Amixicile targets the function of the vitamin B1 cofactor of pyruvate, ferredoxin oxidoreductase, an enzyme uniquely found in anaerobic pathogens and not present in humans or in the probiotic beneficial gut bacteria.

The vitamin cofactor, a small molecule, is not susceptible to mutation, offering a remarkably reliable – and therefore very attractive – target. Because the target won’t change, the risk of bacteria becoming resistant to the antibiotic is lessened dramatically.

Next Steps

More preclinical work needs to be done before the researchers can gain FDA approval to begin testing Amixicile in people. They next intend to evaluate maximum tolerable doses in animals and examine whether the drug has any genetic or mutagenic effects. If all goes well, they will eventually proceed to human testing.

The researchers’ latest findings have been published online by Antimicrobial Agents and Chemotherapy, a journal of the American Society for Microbiology, and will appear in the August issue. The article’s credited authors are Hoffman; Alexandra M. Bruce of U.Va.’s    Department of Chemistry; Igor Olekhnovich, Cirle A. Warren and Stacey L. Burgess of U.Va.’s Division of Infectious Diseases and International Health; Raquel Hontecillas, Monica Viladomiu and Josep Bassaganya-Riera of the Virginia Bioinformatics Institute at Virginia Tech; Richard L. Guerrant of U.Va.’s Division of Infectious Diseases; and Timothy L. Macdonald of U.Va.’s Department of Chemistry.

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C. difficile infection, C Diff Foundation’s “Raising C Diff Awareness” program offered

It is with great pleasure to share the news that the C Diff Foundation’s, “Raising C Diff Awareness” program is being offered to over 500 facilities and 1,000 members of the Florida Health Care Association.  On-site scheduling is in progress and can be arranged by contacting the C Diff Foundation office toll free at:

1 – 844 – FORCDIF

Established in 1954, Florida Health Care Association is celebrating its 60th anniversary in 2014. FHCA is a federation representing over 1,000 members and over 500 facilities which provide skilled nursing, post-acute and sub-acute care, short-term rehab, assisted living and other services to the frail elderly and individuals with disabilities in Florida. FHCA membership also includes more than 400 Associate Members, or companies, that provide valuable products and services to long term care providers.

FHCA_60thAnniversaryLogoA(2)

FHCA is the state affiliate of the American Health Care Association/National Center for Assisted Living in Washington, DC. Governed by a Board of Directors, the mission of FHCA is to advance the quality of services, image, professional development and financial stability of its members. FHCA maintains reimbursement, regulatory, clinical and media/public relations experts on staff and makes its legal, business and labor consultants available to all members. FHCA members benefit from a strong, unified presence in the state Capitol, quality improvement and survey support, up-to-date information and continuing education opportunities. Together, these member services work to support member providers and assist the interests of government, the greater health care community and the general public.

To become a member or for additional FHCA information please visit their website:

http://www.fhca.org