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‣ Clostridium difficile infection

Geller, Stephen A.; Campos, Fernando Peixoto Ferraz de
Fonte: Hospital Universitário da USP; São Paulo Publicador: Hospital Universitário da USP; São Paulo
Tipo: Artigo de Revista Científica
Português
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Clostridium difficile infection (CDI) is a significant and increasing medical problem, surpassing methicillin-resistant Staphylococcus aureus as the most common hospital-onset or facility-associated infection,1-3 and a key element in the challenging battle against hospital-acquired infections. This Gram-positive, anaerobic, spore-forming colonizes the intestinal tract after antibiotics have altered the normal intestinal flora.

‣ Aspectos clínicos e biológicos da diarréia por Clostridium difficile em pacientes hematológicos e transplantados de medula óssea; Biological and clinical aspects of diarrhea by Clostridium difficile in patients with hematological and bone marrow transplantation

Spadão, Fernanda de Souza
Fonte: Biblioteca Digitais de Teses e Dissertações da USP Publicador: Biblioteca Digitais de Teses e Dissertações da USP
Tipo: Dissertação de Mestrado Formato: application/pdf
Publicado em 27/03/2012 Português
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Introdução: A diarréia por Clostridium difficile é uma das principais causas de diarréia infecciosa associada à assistência à saúde. Objetivo: Descrever os casos e a incidência de diarréia por C. difficile em pacientes hematológicos e TCTH internados na enfermaria da Hematologia e do Transplante de Medula óssea do Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP). Métodos: Foi utilizada uma ficha para coleta de dados de todos os pacientes na unidade de hematologia e TCTH do HC-FMUSP que tinham resultado positivo para toxina A/B do C. difficile durante o período de janeiro 2007 a junho de 2011 e criado um banco de dados no programa Epiinfo. Os desfechos avaliados foram forma grave de doença e óbito até 14 dias da diarréia. Qui-quadrado para tendência foi usado para avaliar a incidência de diarréia por C. difficile durante o período do estudo. Resultados: Um total de 69 episódios foi identificado em 64 pacientes em 439 pacientes suspeitos. Na distribuição temporal o qui-quadrado para tendência evidenciou que o número de casos suspeitos de diarréia por C. difficile permaneceu estável (p=0,418), em contraste com o aumento do número de casos confirmados (p=0,0006). A incidência de diarréia por C. difficile por 1.000 pacientes variou de 0...

‣ Recent changes in Clostridium difficile infection

Silva Júnior,Moacyr
Fonte: Instituto Israelita de Ensino e Pesquisa Albert Einstein Publicador: Instituto Israelita de Ensino e Pesquisa Albert Einstein
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/03/2012 Português
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Clostridium difficile is the main cause of nosocomial diarrhea. Diarrhea associated with C. difficile has increased incidence, morbidity, and mortality in the last few years. The major related risk factors include use of antibiotics, elderly patients and prolonged hospital stay. Many patients receive combinations of antibiotics or multiple antibiotics, which represents the main risk to develop diarrhea associated to C. difficile or its recurrence. Therefore, interventions to improve antibiotic prescribing, as well as compliance with infection control measures can reduce hospital-acquired C. difficile infections. This review addresses the epidemiological changes in C. difficile disease and its treatment.

‣ Infection of hamsters with the UK Clostridium difficile ribotype 027 outbreak strain R20291

Buckley, Anthony M.; Spencer, Janice; Candlish, Denise; Irvine, June J.; Douce, Gillian R.
Fonte: Society for General Microbiology Publicador: Society for General Microbiology
Tipo: Artigo de Revista Científica
Publicado em /08/2011 Português
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Clostridium difficile is the main cause of antibiotic-associated disease, a disease of high socio-economical importance that has recently been compounded by the global spread of the 027 (BI/NAP1/027) ribotype. C. difficile cases attributed to ribotype 027 strains have high recurrence rates (up to 36 %) and increased disease severity. The hamster model of infection is widely accepted as an appropriate model for studying aspects of C. difficile host–pathogen interactions. Using this model we characterized the infection kinetics of the UK 2006 outbreak strain, R20291. Hamsters were orally given a dose of clindamycin, followed 5 days later with 10 000 C. difficile spores. All 100 % of the hamsters succumbed to infection with a mean time to the clinical end point of 46.7 h. Colonization of the caecum and colon were observed 12 h post-infection reaching a maximum of approximately 3×104 c.f.u. per organ, but spores were not detected until 24 h post-infection. At 36 h post-infection C. difficile numbers increased significantly to approximately 6×107 c.f.u. per organ where numbers remained high until the clinical end point. Increasing levels of in vivo toxin production coincided with increases in C. difficile numbers in organs reaching a maximum at 36 h post-infection in the caecum. Epithelial destruction and polymorphonuclear leukocyte (PMN) recruitment occurred early on during infection (24 h) accumulating as gross microvilli damage...

‣ Models for the study of Clostridium difficile infection

Best, Emma L.; Freeman, Jane; Wilcox, Mark H.
Fonte: Landes Bioscience Publicador: Landes Bioscience
Tipo: Artigo de Revista Científica
Publicado em 01/03/2012 Português
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Models of Clostridium difficile infection (C. difficile) have been used extensively for Clostridium difficile (C. difficile) research. The hamster model of C. difficile infection has been most extensively employed for the study of C. difficile and this has been used in many different areas of research, including the induction of C. difficile, the testing of new treatments, population dynamics and characterization of virulence. Investigations using in vitro models for C. difficile introduced the concept of colonization resistance, evaluated the role of antibiotics in C. difficile development, explored population dynamics and have been useful in the evaluation of C. difficile treatments. Experiments using models have major advantages over clinical studies and have been indispensible in furthering C. difficile research. It is important for future study programs to carefully consider the approach to use and therefore be better placed to inform the design and interpretation of clinical studies.

‣ Role of Microbiota and Innate Immunity in Recurrent Clostridium difficile Infection

Bibbò, Stefano; Lopetuso, Loris Riccardo; Ianiro, Gianluca; Di Rienzo, Teresa; Gasbarrini, Antonio; Cammarota, Giovanni
Fonte: Hindawi Publishing Corporation Publicador: Hindawi Publishing Corporation
Tipo: Artigo de Revista Científica
Português
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Recurrent Clostridium difficile infection represents a burdensome clinical issue whose epidemiology is increasing worldwide. The pathogenesis is not yet completely known. Recent observations suggest that the alteration of the intestinal microbiota and impaired innate immunity may play a leading role in the development of recurrent infection. Various factors can cause dysbiosis. The causes most involved in the process are antibiotics, NSAIDs, acid suppressing therapies, and age. Gut microbiota impairment can favor Clostridium difficile infection through several mechanisms, such as the alteration of fermentative metabolism (especially SCFAs), the alteration of bile acid metabolism, and the imbalance of antimicrobial substances production. These factors alter the intestinal homeostasis promoting the development of an ecological niche for Clostridium difficile and of the modulation of immune response. Moreover, the intestinal dysbiosis can promote a proinflammatory environment, whereas Clostridium difficile itself modulates the innate immunity through both toxin-dependent and toxin-independent mechanisms. In this narrative review, we discuss how the intestinal microbiota modifications and the modulation of innate immune response can lead to and exacerbate Clostridium difficile infection.

‣ The Epidemiology and Economic Burden of Clostridium difficile Infection in Korea

Choi, Hyung-Yun; Park, So-Youn; Kim, Young-Ae; Yoon, Tai-Young; Choi, Joong-Myung; Choe, Bong-Keun; Ahn, So-Hee; Yoon, Seok-Jun; Lee, Ye-Rin; Oh, In-Hwan
Fonte: Hindawi Publishing Corporation Publicador: Hindawi Publishing Corporation
Tipo: Artigo de Revista Científica
Português
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The prevalence of Clostridium difficile infection and the associated burden have recently increased in many countries. While the main risk factors for C. difficile infection include old age and antibiotic use, the prevalence of this infection is increasing in low-risk groups. These trends highlight the need for research on C. difficile infection. This study pointed out the prevalence and economic burden of C. difficile infection and uses the representative national data which is primarily from the database of the Korean Health Insurance Review and Assessment Service, for 2008–2011. The annual economic cost was measured using a prevalence approach, which sums the costs incurred to treat C. difficile infection. C. difficile infection prevalence was estimated to have increased from 1.43 per 100,000 in 2008 to 5.06 per 100,000 in 2011. Moreover, mortality increased from 69 cases in 2008 to 172 in 2011. The economic cost increased concurrently, from $2.4 million in 2008 to $7.6 million, $10.5 million, and $15.8 million in 2009, 2010, and 2011, respectively. The increasing economic burden of C. difficile infection over the course of the study period emphasizes the need for intervention to minimize the burden of a preventable illness like C. difficile infection.

‣ Antibiotic Exposure and Risk of Clostridium difficile Infection: A Retrospective Cohort Study

Stevens, Vanessa W. ; van Wijngaarden, Edwin
Fonte: Universidade de Rochester Publicador: Universidade de Rochester
Tipo: Tese de Doutorado
Português
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Thesis (Ph.D.)--University of Rochester. School of Medicine & Dentistry. Dept. of Community and Preventive Medicine, 2010.; Clostridium difficile Infection (CDI) is a major cause of hospital-acquired diarrhea and is most commonly associated with changes in normal intestinal flora caused by administration of antibiotics. The recent emergence of strains of C. difficile demonstrating new antimicrobial resistance patterns may mean that antibiotics that have seldom been implicated in the past now confer a greater risk of CDI. Few studies have examined increases in the risk of CDI associated with total cumulative dose, duration, or number of antibiotics. Therefore, a retrospective cohort study was conducted to determine the incidence of CDI at Strong Memorial Hospital in 2005 among hospitalizations during which two or more consecutive days of antibiotics were prescribed, and to examine the class, total dose (measured in Defined Daily Doses (DDD)), days, and number of antibiotics in relation to CDI. 10,154 hospitalizations were included in the study. Dose-response relationships were observed, with increasing exposure conferring increasing CDI risk for all dose-related antibiotic measures evaluated. For instance, the risk of CDI for hospitalizations in the second...

‣ Sensibilidade in vitro de isolados de Clostridium difficile: comparação de duas metodologias (disco-difusão e ágar-diluição); Susceptibility in vitro of isolates of Clostridium difficile: comparison of two methodologies (disk-diffusion and agar-dilution)

Fraga, Edmir Geraldo de Siqueira
Fonte: Biblioteca Digitais de Teses e Dissertações da USP Publicador: Biblioteca Digitais de Teses e Dissertações da USP
Tipo: Dissertação de Mestrado Formato: application/pdf
Publicado em 16/07/2015 Português
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Introdução: O Clostridium difficile é um bacilo Gram-positivo, anaeróbio estrito, formador de esporos, que produz toxinas que podem causar diarreia, colite pseudomembranosa, dilatação do cólon, sepse e até morte. Nos últimos anos o quadro clínico e epidemiológico das infecções por Clostridium difficile tem se modificado e as limitações das opções terapêuticas tornaram-se mais evidentes. Objetivo Primário: Comparar as metodologias de disco-difusão e ágar-diluição na detecção de sensibilidade/resistência de isolados de Clostridium difficile. Objetivos Secundários: Avaliar prospectivamente o perfil de sensibilidade/resistência de isolados clínicos hospitalares de Clostridium difficile provenientes de seis hospitais terciários da cidade de São Paulo e fornecer evidências para fundamentar o diagnóstico e o tratamento empírico das diarreias causadas por Clostridium difficile. Métodos: utilizamos os métodos de disco-difusão e ágar-diluição, de acordo com os critérios estabelecidos pelo CLSI e EUCAST. Resultados: Os coeficientes de correlação observados entre os diâmetros dos halos de inibição e Concentração Inibitória Mínima foram abaixo do esperado tornando inviável o método de disco-difusão para determinação de sensibilidade aos antimicrobianos nitazoxanida...

‣ Outbreak of Clostridium difficile PCR ribotype 027-the recent experience of a regional hospital

Oleastro, M.; Coelho, M.; Gião, M.; Coutinho, S.; Mota, S.; Santos, A.; Rodrigues, J.; Faria, D.
Fonte: BioMed Central Publicador: BioMed Central
Tipo: Artigo de Revista Científica
Publicado em 17/04/2014 Português
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Background: Clostridium difficile infection (CDI) is the leading cause of healthcare-associated diarrhea, and several outbreaks with increased severity and mortality have been reported. In this study we report a C. difficile PCR ribotype 027 outbreak in Portugal, aiming to contribute to a better knowledge of the epidemiology of this agent in Europe. Methods: Outbreak report with retrospective study of medical records and active surveillance data of all inpatients with the diagnosis of CDI, from 1st January to 31th December 2012, in a Portuguese hospital. C. difficile isolates were characterized regarding ribotype, toxin genes and moxifloxin resistance. Outbreak control measures were taken, concerning communication, education, reinforcement of infection control measures, optimization of diagnosis and treatment of CDI, and antibiotic stewardship. Results: Fifty-three inpatients met the case definition of C. difficile-associated infection: 55% males, median age was 78.0 years (interquartile range: 71.0-86.0), 75% had co-morbidities, only 15% had a nonfatal condition, 68% had at least one criteria of severe disease at diagnosis, 89% received prior antibiotherapy, 79% of episodes were nosocomial. CDI rate peak was 13.89/10,000 bed days. Crude mortality rate at 6 months was 64.2% while CDI attributable cause was 11.3%. Worse outcome was related to older age (P = 0.022)...

‣ Clostridium-difficile-Nachweis bei CF-Patienten: Prävalenz, klinische und sonographische Befunde bei Patienten der Tübinger Universitäts-Kinderklinik; Clostridium-difficile-detection in CF-patients: prevalence, clinical and sonographical findings in patients of the Department of Paediatrics at the University of Tuebingen

Dietsche, Birgit
Fonte: Universität Tübingen Publicador: Universität Tübingen
Tipo: Dissertation; info:eu-repo/semantics/doctoralThesis
Português
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Patienten mit Zystischer Fibrose (CF) sind durch häufige Krankenhausaufenthalte und Antibiotikatherapien eine Risikogruppe für Clostridium difficile (CD)-Infektionen. Ob­wohl CF-Patienten älteren Studien zufolge keine erhöhte Inzidenz von symptomati­schen CD-Infektionen aufweisen, gab es jedoch immer wieder Berichte von schweren, teils auch atypisch (d.h. ohne Durchfall und mit variabler abdominaler Symptomatik) verlaufenden CD-Infektionen. Zudem treten bei CF-Patienten häufig Darmwandver­dickungen auf, deren Pathomechanismus bislang noch unklar ist und die möglicher­weise mit einer CD-Infektion in Verbindung stehen könnten. In dieser Studie sollte der Frage nach der CD-Prävalenz im Stuhl bei CF-Patienten und der klinischen Relevanz von CD-Infektionen sowie krankheitsspezifischen Auswirkungen auf den Darm bei CF-Patienten nachgegangen werden. In einer Querschnittstudie wurde zum einen die Prävalenz von CD-Stämmen und der CD-Toxin-Ausscheidung im Stuhl im Vergleich zu früheren Studien und zu anderen Risiko-Patienten aus demselben Klinikum ermittelt. Zum anderen wurden mögliche durch eine CD-Infektion assoziierte klinische Symptome und Risikofaktoren für eine CD-Infektion erfasst. In einer Längsschnittstudie wurde innerhalb von zwei Jahren die Häufigkeit von CD-assoziierten Kolitiden unter Antibiotikatherapie bestimmt. 65 Patienten der Tübinger CF-Ambulanz nahmen an der Querschnittuntersuchung teil. Sie wiesen im Vergleich zu einer Kontrollgruppe (29 Patienten der hämato-onkologi­schen Ambulanz Tübingen) eine signifikant höhere Prävalenz von CD auf (63% vs. 7%). Dabei nahm die Besiedlungsrate mit zunehmendem Alter ab (>80% im ersten LJ. auf 25% im 18. LJ). Die insgesamt sehr hohe CD-Prävalenz zeigte sich unabhängig von einer aktuellen Antibiotikagabe und Aufenthalt in stationären Einrichtungen inner­halb der letzten zwei Jahre. Der Einfluss von Antibiotika war zusätzlich in der Längs­schnittstudie an 19 Patienten genauer untersucht worden: Bemerkenswerterweise zeigte sich auch unter Antibiose eine relative Konstanz im CD-Besiedlungsstatus...

‣ L’expérience de l’isolement de contact à l’hôpital pour des personnes âgées lors d’une infection au Clostridium difficile

Larivière, Nathalie
Fonte: Université de Montréal Publicador: Université de Montréal
Tipo: Thèse ou Mémoire numérique / Electronic Thesis or Dissertation
Português
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Sommaire La situation actuelle des infections nosocomiales dans les établissements de santé est préoccupante. En ce qui concerne le Clostridium difficile (C. difficile), son émergence et son impact sur la morbidité et la mortalité sont bien connus. De plus, la population vieillissante est à risque élevé d’avoir des diarrhées associées au C. difficile et, de ce fait, de se retrouver en isolement de contact. Les personnes âgées sont déjà vulnérables au moment d’une hospitalisation, alors qu’en est-il lors d’un isolement de contact relié à une infection au C. difficile? Dans cette perspective, les connaissances sur l’expérience des personnes âgées lors d’un isolement étant peu développées, cette étude s’est intéressée au vécu des personnes âgées durant l’isolement de contact et aux effets de cet isolement sur leur vécu. Le but de cette étude phénoménologique, prenant appui sur la Théorie de l’humain en devenir de Parse (2003), était de décrire et comprendre l’expérience de personnes âgées de 75 ans et plus lors d’un isolement de contact en milieu hospitalier causé par une infection au C. difficile. Ainsi, des entrevues semi-structurées furent réalisées auprès de cinq personnes âgées qui ont accepté de participer à l’étude...

‣ Factores asociados a la infección para Clostridium difficile en un hospital universitario de Bogotá

Marín, Juliana
Fonte: Facultad de Medicina Publicador: Facultad de Medicina
Tipo: info:eu-repo/semantics/bachelorThesis; info:eu-repo/semantics/acceptedVersion Formato: application/pdf
Publicado em 07/07/2014 Português
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Introducción La infección por Clostridium difficile, es una de las causas más frecuentes de diarrea nosocomial con una alta morbimortalidad, con un aumento exponencial en su incidencia, en Estados Unidos se duplicó, de 261 casos x 100.000 en 1993 pasó a 546 x 100.000 en 2003 2, y en Canadá se encontraron datos similares con un aumento de 4.5 veces, en 1991 de 35.6 casos x 100.000 a 156.3 casos por 100.000 en 2004 3 . Se han descrito varios factores asociados Materiales y Métodos Se trata de un estudio descriptivo de tipo serie de casos en el que se evaluaron pacientes con diagnóstico de infección por C. Difficile y los factores asociados en un Hospital Universitario entre febrero de 2010 hasta septiembre de 2011 Resultados Se recolectaron 31 pacientes la edad promedio fue de 58 años con un rango entre 18 y 93 años, de los cuales 19 (61%) fueron mujeres y 12 (39%) hombres. El factor asociado a la infección por C. Difficile más frecuentemente encontrado fue el uso de inhibidores de bomba de protones con 54.84% (n=17) .No se encontraron pacientes VIH positivos o con diagnóstico de enfermedad inflamatoria intestinal. Ningún paciente presentó complicaciones asociadas a la infección ni mortalidad alguna. Conclusión El factor asociado que más se presentó fue el uso de antimicrobianos en los quince dias previos al inicio del cuadro en el 74% de los pacientes lo que coincide con lo presentado en la literatura mundial.; Introduction Infection with Clostridium difficile ...

‣ What Is the Current Role of Algorithmic Approaches for Diagnosis of Clostridium difficile Infection?▿

Fonte: American Society for Microbiology (ASM) Publicador: American Society for Microbiology (ASM)
Tipo: Artigo de Revista Científica
Português
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With the recognition of several serious outbreaks of Clostridium difficile infection in the industrialized world coupled with the development of new testing technologies for detection of this organism, there has been renewed interest in the laboratory diagnosis of C. difficile infection. Two factors seem to have driven much of this interest. First, the recognition that immunoassays for detection of C. difficile toxins A and B, for many years the most widely used tests for C. difficile infection diagnosis, were perhaps not as sensitive as previously believed at a time when attributed deaths to C. difficile infections were showing a remarkable rise. Second, the availability of FDA-approved commercial and laboratory-developed PCR assays which could detect toxigenic strains of C. difficile provided a novel and promising testing approach for diagnosing this infection. In this point-counterpoint on the laboratory diagnosis of C. difficile infection, we have asked two experts in C. difficile infection diagnosis, Ferric Fang, who has recently published two articles in the Journal of Clinical Microbiology advocating the use of PCR as a standalone test (see this author's references 12 and 28), and Mark Wilcox, who played a key role in developing the IDSA/SHEA guidelines on Clostridium difficile infection (see Wilcox and Planche's reference 1)...

‣ Asymptomatic Clostridium difficile colonization: epidemiology and clinical implications

Furuya-Kanamori, Luis; Marquess, John; Yakob, Laith; Riley, Thomas V; Paterson, David L; Foster, Niki F; Huber, Charlotte A; Clements, Archie C A
Fonte: BioMed Central Publicador: BioMed Central
Tipo: Artigo de Revista Científica Formato: 11 pages
Português
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BACKGROUND The epidemiology of Clostridium difficile infection (CDI) has changed over the past decades with the emergence of highly virulent strains. The role of asymptomatic C. difficile colonization as part of the clinical spectrum of CDI is complex because many risk factors are common to both disease and asymptomatic states. In this article, we review the role of asymptomatic C. difficile colonization in the progression to symptomatic CDI, describe the epidemiology of asymptomatic C. difficile colonization, assess the effectiveness of screening and intensive infection control practices for patients at risk of asymptomatic C. difficile colonization, and discuss the implications for clinical practice. METHODS A narrative review was performed in PubMed for articles published from January 1980 to February 2015 using search terms ‘Clostridium difficile’ and ‘colonization’ or ‘colonisation’ or ‘carriage’. RESULTS There is no clear definition for asymptomatic CDI and the terms carriage and colonization are often used interchangeably. The prevalence of asymptomatic C. difficile colonization varies depending on a number of host, pathogen, and environmental factors; current estimates of asymptomatic colonization may be underestimated as stool culture is not practical in a clinical setting. CONCLUSIONS Asymptomatic C. difficile colonization presents challenging concepts in the overall picture of this disease and its management. Individuals who are colonized by the organism may acquire protection from progression to disease...

‣ Clostridium difficile infection

Geller, Stephen A.; Campos, Fernando Peixoto Ferraz de
Fonte: Universidade de São Paulo. Hospital Universitário Publicador: Universidade de São Paulo. Hospital Universitário
Tipo: info:eu-repo/semantics/article; info:eu-repo/semantics/publishedVersion; Peer-reviewed Article Formato: application/pdf
Publicado em 26/06/2014 Português
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Clostridium difficile infection (CDI) is a significant and increasing medical problem, surpassing methicillin-resistant Staphylococcus aureus as the most common hospital-onset or facility-associated infection, and a key element in the challenging battle against hospital-acquired infections. This Gram-positive, anaerobic, spore-forming colonizes the intestinal tract after antibiotics have altered the normal intestinal flora.

‣ Clostridium difficile infection: molecular and epidemiology study

Isidro, Joana Vanessa Duarte
Fonte: Universidade de Lisboa Publicador: Universidade de Lisboa
Tipo: Dissertação de Mestrado
Publicado em //2015 Português
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Tese de mestrado, Biologia (Biologia Molecular e Genética), Universidade de Lisboa, Faculdade de Ciências, 2015; Clostridium difficile is the leading cause of antibiotic-associated diarrhea in developed countries. Elderly hospitalized patients taking antibiotics are the main group at risk of infection. Since 2000, several countries have reported an increased incidence and severity of CDI associated with the emergence of the epidemic RT027. This clone produces Toxin A (TcdA), Toxin B (TcdB) and an additional binary toxin, Clostridium difficile transferase (CDT), has a deletion at position 117 in the tcdC gene (negative regulator of toxin production) and is highly resistant to fluoroquinolones. However, CDI epidemiology is highly variable, as other hypervirulent RTs have also started to emerge, and is still largely unknown in our country. In the present study, 286 C. difficile strains sent from 22 Portuguese hospitals were characterized regarding PCR ribotype, toxin profile, tcdC mutations, antimicrobial susceptibility to MXF, VAN, MTZ, IMP, RIF and TGC, and mechanisms of antimicrobial resistance. Most patients (73.4%) were aged ≥65 years and at least 54.9% had taken antibiotics in the previous months; 76.5% of the cases were healthcare facility-associated (HCFA) and 12.6% were community-associated (CA). Among the 84 distinct RTs found...

‣ Trasplante de microbiota fecal en infección recurrente por Clostridium difficile: Experiencia local a partir de un caso clínico

Moscoso,Felipe; Simian,Daniela; Rivera,Daniela; Acuña,Guillermo; Quera,Rodrigo
Fonte: Sociedad Médica de Santiago Publicador: Sociedad Médica de Santiago
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/04/2015 Português
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Fecal microbiota transplantation (FMT) has an incomparable efficacy to treat recurrent Clostridium difficile infection, with near 90% of success. We report a 57 years old woman who developed an antibiotic associated diarrhea with a positive polymerase chain reaction test for Clostridium Difficile toxin. She was successfully treated with Vancomycin trice but diarrhea recurred. Therefore a fecal microbiota transplant was performed using solid stools from a relative, diluted in saline and instilled in the distal ileon, with a good clinical response, without recurrence of diarrhea, during a 6-month follow-up.

‣ Diagnóstico de diarrea por Clostridium difficile: en busca de un enfoque clínico más eficiente

Alvarez L,Manuel; González D,Robinson; Briceño L,Isabel; Cofre D,Colomba; Labarca L,Jaime; Vial C,Pablo; García C,Patricia
Fonte: Sociedad Médica de Santiago Publicador: Sociedad Médica de Santiago
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/06/2001 Português
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Background: The clinical parameters for the suspicion of Clostridium difficile infections, namely the use of antimicrobials and diarrhea, have a low predictive value for the diagnosis. Aim: To search other clinical variables and determine a clinical prediction model for (Clostridium difficile diarrhea. Patients and methods: All patients to whom a Clostridium difficile study was requested, were prospectively studied during 5 months. Clinical variables of these patients were registered. The diagnosis of Clostridium difficile was done using the cytotoxicity test in fibroblast cultures. Results: Ninety two patients were analyzed and in 26, the diagnosis of Clostridium difficile was confirmed. A logistic regression model disclosed an age over 60 years old, the presence of mucus in the stools and a temperature over 37.8 °C in the previous 24 h, as significant predictors of the infection. The correlation of the model, between the predicted probability and the observed condition, was 81.5%. Conclusions: The presence of the clinical variables identified in this study are associated with a high probability of an infection by Clostridium difficile in patients with diarrhea and the recent use of antimicrobials (Rev Méd Chile 2001; 129: 620-625)

‣ Initial experience with fecal microbiota transplantation in Clostridium difficile infection: transplant protocol and preliminary results

Ponte,Ana; Pinho,Rolando; Mota,Margarida; Silva,Joana; Vieira,Nuno; Oliveira,Rosa; Pinto-Pais,Teresa; Fernandes,Carlos; Ribeiro,Iolanda; Rodrigues,Jaime; Lopes,Paulo; Teixeira,Tiago; Carvalho,João
Fonte: Revista Española de Enfermedades Digestivas Publicador: Revista Española de Enfermedades Digestivas
Tipo: info:eu-repo/semantics/article; journal article; info:eu-repo/semantics/publishedVersion Formato: text/html; application/pdf
Publicado em 01/07/2015 Português
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Background and aims: Clostridium difficile infection (CDI) constitutes an important cause of antibiotic-associated diarrhea. Recurrence after first-line treatment with antibiotics is high and fecal microbiota transplantation (FMT) may be effective for refractory and recurrent CDI. This series aims to describe the efficacy of FMT in the treatment of refractory and recurrent CDI. Methods: A prospectively recorded single-centre case series of patients with persistent or recurrent CDI treated with FMT between June 2014 and March 2015 was analyzed. Primary and secondary outcomes were defined as resolution of diarrhea without recurrence of CDI within 2 months after one or more FMT, respectively. A descriptive analysis was performed. Results: 8 FMT were performed in 6 patients, 3 with refractory CDI and 3 with recurrent CDI. The median age of recipients was 71 years and 66.7% were women. One FMT was delivered through colonoscopy and the remaining 87.5% through esophagogastroduodenoscopy. One upper FMT was excluded due to recurrence of CDI after antibiotic exposure for a respiratory infection. The overall cure rate of FMT was total with lower route and 83.3% with upper route. Primary cure rate was achieved in 83.3% of patients and secondary cure rate was achieved in all patients. Median time to resolution of diarrhea after FMT was 1 day and no complications were reported during follow-up. Conclusion: FMT appears to constitute a safe and effective approach in the management of refractory and recurrent CDI. Difference between primary and secondary cure rates may result of insufficient restoration of intestinal microbiota with a single FMT.