Clostridium difficile Infection: Unmet Needs and Unsolved Questions: Part II

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Infectious Diseases".

Deadline for manuscript submissions: closed (25 April 2024) | Viewed by 1538

Special Issue Editors


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Guest Editor
Infection Prevention & Control and Infectious Disease Unit, University Hospital "Campus Bio-Medico", 00128 Rome, Italy
Interests: severe infections; infective endocarditis; emerging infections; infections in transplanted patients
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Guest Editor
Clinical and Research Department, National Institute for Infectious Diseases “L. Spallanzani” IRCCS, Rome, Italy
Interests: Clostridioides difficile infection; antimicrobial resistance; antimicrobial treatment; immune response; host-pathogen interaction; human gut microbiota; infection control
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The first volume of the Special Issue “Clostridium difficile Infection: Unmet Needs and Unsolved Questions” was published in 2021. It was a successful Special Issue, with 10 published research papers that shed light on several grey areas in our knowledge on Clostridioides difficile infection (CDI) management.

Major issues still affect the management of CDI, including the high rate of CDI underdiagnosis, the unacceptably high rate of CDI recurrence, and the difficulties faced in reducing the spread of CD among hospitalized patients.

The underdiagnosis of CDI is a current issue, either because of suboptimal laboratory diagnostic methods or because of the absence of clinical suspicion. There are unsolved questions, such as why the rate of underdiagnosis differs among countries and among hospitals in the same country, and there is a need to elucidate the reasons for its high rate. In this regard, community-acquired CDI is increasingly represented in the literature, but in “real life” it is poorly studied, and its underdiagnosis has been hypothesized.

No less important is the high recurrence rate observed with the currently available CDI therapy. The alarming rate of CDI recurrence urges the proposal and evaluation of innovative therapeutic approaches.

Undeniably, more efforts are needed in order to reduce the spread of CDI, especially among hospitalized patients. Asymptomatic CD carriers might represent a “submerged iceberg” that significantly contributes to CD hospital spread. Understanding the role that asymptomatic carriers play in perpetuating CD transmission as well as the routes of in-hospital and community CD transmission is crucial but also particularly challenging to examine.

As a continuation of the Special Issue published in 2021, this second part will also deliver a compendium of the latest studies on any aspects concerning CDI management.

Dr. Nicola Petrosillo
Dr. Guido Granata
Guest Editors

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Keywords

  • Clostridioides difficile infection
  • infection control
  • contact isolation
  • community-aquired CDI
  • CDI recurrence
  • recurrence prevention
  • rCDI
  • host and microbiota interaction
  • antimicrobial treatment
  • microbiota transplant
  • underdiagnosis

Published Papers (2 papers)

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14 pages, 287 KiB  
Article
Retrospective Analysis of Clostridioides difficile Infection Rates and Outcomes in Hospitalized Patients during the COVID-19 Pandemic: A Unicenter Study in Reus, Spain
by Simona Iftimie, Ana F. López-Azcona, Mireia Corchero-Valverde, Antonio Peralta-Vázquez, Laia Revuelta López-Cordón, Carles García-Cervera, Luís Manuel Fernández-Domínguez, Jordi Camps, Jorge Joven and Antoni Castro
J. Clin. Med. 2024, 13(10), 2799; https://doi.org/10.3390/jcm13102799 - 9 May 2024
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Abstract
Background: Clostridioides difficile infections (CDI) vary in severity from mild diarrhea to life-threatening conditions like pseudomembranous colitis or toxic megacolon, often leading to sepsis and death. The COVID-19 pandemic prompted changes in healthcare practices, potentially affecting CDI incidence, though reported data are [...] Read more.
Background: Clostridioides difficile infections (CDI) vary in severity from mild diarrhea to life-threatening conditions like pseudomembranous colitis or toxic megacolon, often leading to sepsis and death. The COVID-19 pandemic prompted changes in healthcare practices, potentially affecting CDI incidence, though reported data are inconclusive. We studied factors influencing CDI incidence and outcomes at a university hospital throughout the COVID-19 pandemic years. Methods: We conducted a retrospective study on all adult hospitalized CDI cases from 1 January 2020 to 31 December 2022 in Hospital Universitari de Sant Joan in Reus. We collected demographic information, comorbid conditions, and concurrent infections. Results: While overall CDI and COVID-19 rates decreased in 2022, a notable increase in CDI infections was observed among oncological patients and those undergoing some aggressive treatments, such as colonoscopies or gastroscopies. The prevalence of comorbidities remained unmodified, and there were declines in prior gastrointestinal surgeries and proton pump inhibitor prescriptions. Factors associated with patient fatality or prolonged hospitalization included older age, cancer, chronic kidney disease, higher Charlson and McCabe indices, elevated C-reactive protein, and low albumin concentrations. Conclusions: Our study shows the evolving landscape of CDI during the COVID-19 pandemic and emphasizes the impact of delayed diagnoses and treatments exacerbated by telemedicine adoption. Identified risk factors for CDI-related mortality or prolonged hospital stays underscore the importance of targeted interventions in high-risk populations. Full article

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11 pages, 636 KiB  
Systematic Review
Clostridioides difficile and Enterococci’s Interplay in the Human Gut: Bacterial Alliance or Competition? A Systematic Literature Review
by Guido Granata, Francesco Schiavone, Fabrizio Taglietti and Nicola Petrosillo
J. Clin. Med. 2023, 12(15), 4997; https://doi.org/10.3390/jcm12154997 - 29 Jul 2023
Cited by 2 | Viewed by 834
Abstract
Clostridioides difficile and Enterococcus spp. are two common bacterial pathogens populating the human microbiota. We possess scant data on how Clostridioides difficile interacts with Enterococcus spp. in the gut microbiota in subjects colonized with Clostridioides difficile or during a Clostridioides difficile infection. We [...] Read more.
Clostridioides difficile and Enterococcus spp. are two common bacterial pathogens populating the human microbiota. We possess scant data on how Clostridioides difficile interacts with Enterococcus spp. in the gut microbiota in subjects colonized with Clostridioides difficile or during a Clostridioides difficile infection. We carried out a systematic review of studies on Enterococcus spp. and Clostridioides difficile’s interaction in the gut microbiota and on the effect of Enterococcus spp. gut colonization on CDI development. Studies on Enterococcus spp. and Clostridioides difficile’s interaction in the gut microbiota and on the effect of Enterococcus spp. gut colonization on CDI were searched using the search terms “clostridium”, “clostridioides”, “difficile” and “enterococcus” on the MEDLINE and SCOPUS databases. PubMed was searched until 1 May 2023. An English language restriction was applied. The risk of bias in the included studies was not assessed. Quantitative and qualitative information was summarized in textual descriptions. Fourteen studies, published from August 2012 to November 2022, on Clostridioides difficile and Enterococcus spp.’s interaction in the gut microbiota met the inclusion criteria. The studies included in our systematic review reported evidence that the Enterococcus spp. intestinal burden represents a risk factor for the occurrence of CDI. There is supporting evidence that Enterococcus spp. play a role in CDI development and clinical outcomes. Full article
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