C Diff Treatment

Enteral administration of vancomycin is the standard treatment for Clostridioides difficile (Clostridium difficile) colitis and is presumed to have no systemic absorption. In critically ill patients, however, especially with multi-organ failure, enteral absorption of vancomycin is unpr …

Objective The objective of this study is to investigate the predisposing factors, disease course, potential complications, role of primary prophylaxis, and overall clinical outcomes of Clostr...

This study is registered with ClinicalTrials.gov as NCT06030219.

Recurrent Clostridioides difficile infection (rCDI) is a major cause of increased morbidity, mortality, and healthcare costs. Fecal-microbiota-based therapies are recommended for rCDI on completion of standard-of-care (SoC) antibiotics to prevent further recurrence: these therapies include conventio …

Objective The objective of this study is to investigate the predisposing factors, disease course, potential complications, role of primary prophylaxis, and overall clinical outcomes of Clostridioides difficile infection (CDI) in cancer patients. Methods The study was conducted at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan. We analyzed the medical records of cancer patients diagnosed with CDI from July 2015 to July 2024 and collected data about demographic characteristics, clinical presentation, predisposing factors, treatment, complications, and mortality rates. We used SPSS version 25 (IBM Corp., Armonk, NY) for data analysis. Results Out of 61 patients, 55.7% (n=34) were men, and most of the patients belonged to the age group of 41-65 years (49.1%; n=30). Of the patients, 34.4% (n=21) had underlying hematological malignancy, while the majority of patients (63.9%; n=39) had underlying solid organ malignancy. A total of 45.9% (n=28) of patients had mild severity, whereas 16.3% (n=10) and 6.55% (n=4) were at severe and fulminant stages of CDI, respectively. The creatinine levels of 80.3% (n=49) of patients were less than 1.5 mg/dL. We also observed the prior antimicrobial use, previous hospitalization within the last four weeks, recent chemotherapy, and use of proton pump inhibitors (PPIs)/H2 antagonists in the past four weeks as predisposing factors in 78.6% (n=48), 72.1% (n=44), 55.7% (n=34), and 75.4% (n=46) of patients, respectively. A greater proportion of patients (68.8%; n=42) had hospital/ICU stays of less than 15 days. Of the patients, 29.6% (n=18) had comorbid conditions such as diabetes mellitus (DM), chronic kidney disease (CKD), hypertension (HTN), ischemic heart disease (IHD), hepatitis, and atrial fibrillation. Oral vancomycin was administered as the primary treatment in 78.6% (n=48) of patients. We noted the resolution of symptoms in 91.8% (n=56) of patients, while 83.6% (n=51) of patients developed no complications. Additionally, the radiological findings of the patients were negative for toxic megacolon. Moreover, 4.91% (n=3) of patients had recurrent infections, whereas all-cause 30-day mortality was 13.1% (n=8). The mortality rate was higher in patients with solid organ tumors (17.9%; n=7) as compared to those having hematological malignancy (4.76%; n=1). Regression analysis showed that recent chemotherapy had an odds ratio (OR) of 11.550 (95% confidence interval {CI}: 1.332-100.9; p=0.998). Conclusion Cancer patients, especially those with solid tumors presenting with symptoms suggestive of CDI and prior chemotherapy exposure, need careful evaluation and preemptive treatment as CDI-related mortality is higher in cancer patients. Early diagnosis and treatment in this population can be lifesaving. Moreover, all cancer patients should receive CDI prophylaxis when indicated.

Clostridiodes difficile is a gram-positive, spore-forming obligate anaerobe bacillus found in the intestines of healthy individuals without signs of disease. It may cause diarrhea after antibiotic use due to the eradication of the normal gut flora. Most cases resolve with proper treatment, but complications may arise. This case report is about a hospitalized patient who acquired a C. difficile infection after taking ceftriaxone, vancomycin, and linezolid for a cellulitis infection. During his hospitalization, the patient developed dyspnea with decreased breath sounds in the right lower lung lobe. A large pleural effusion in the right lung was observed on imaging, and analysis of the pleural fluid after thoracentesis revealed an exudative pleural effusion likely resulting from the C. difficile infection. The possible physiopathological mechanisms of pleural effusion in the setting of C. difficile infection are discussed.

Larry Sutton, MD, PhD, discussed how oxygen affects C. difficile and provides anti-inflammatory effects in the gut, with potential applications for gastrointestinal diseases.

spanbBackground/Objective/b: Tedizolid (TZD), an oxazolidinone, causes fewer adverse events than linezolid (LZD). However, studies on the long-term efficacy and safety of TZD, particularly in patients with hematological malignancies (HMs), remain limited. This study aimed to evaluate the safety of l/span …

Larry Sutton, MD, PhD, discussed how oxygen affects C. difficile and provides anti-inflammatory effects in the gut, with potential applications for gastrointestinal diseases.

Abdulwhab Shremo Msdi, PharmD, offers insights on its complexities, why institutions have been slower to include this dosing technique, and why clinicians need to consider this approach.

Tackling Clostridioides difficile (CD): current evidences and future directions in the treatment of CD infections

We identified the characteristics that significantly differentiated the patients who died from those who survived. Mortality is significantly higher in the group of patients with CDI than that in the other hospitalised patients.

Our study suggests that early acetaminophen administration may offer renal protection by reducing the risk of AKI in critically ill patients with CDI. Prospective, multicenter randomized controlled studies are needed to verify this finding.

spaniClostridioides difficile/i infection (CDI) is one of the main causes of morbidity associated with antibiotic use, producing both healthcare-associated infections and community infections. This study aims to describe the epidemiological characteristics, the clinical outcomes, previous antibiotic/span …

A hospital pharmacy practice implemented to reduce medication costs may impact vancomycin prescribing at discharge and, in turn, may negatively impact readmission rates for patients with CDI treated with oral vancomycin.

Background Acetaminophen serves as a standard antipyretic and analgesic agent in the intensive care unit (ICU). However, the association between its administration and acute kidney injury (AKI) among critically ill patients remains controversial, particularly lacking research in patients with Clostridioides difficile infection (CDI). Our aim was to explore the potential relationship between early acetaminophen administration and AKI in critically ill patients with concurrent CDI. Methods Using data from the Medical Information Mart for Intensive Care (MIMIC) IV version 2.2 database, we performed a retrospective cohort study. AKI within 7 days of ICU admission was the main outcome that was measured. We utilized multivariable logistic regression models adjusted for potential confounders based on statistical significance and clinical relevance, to investigate the association between acetaminophen exposure and the risk of AKI in patients with CDI. Additionally, subgroup analyses and sensitivity analysis were conducted to assess the robustness of our primary findings. Results The average age of 984 participants was 66.8 ± 16.5 years, and 52.7% (519) were male. The overall proportion of patients who developed AKI was 75.4% (742/984). In patients without and with acetaminophen administration, AKI rates were 79.8% (380/476) and 71.3% (362/508), respectively. Compared to the non-acetaminophen administration group, the risk of AKI was lower in the acetaminophen administration group (absolute risk difference: -8.5%, 95%CI: -13.83%∼-3.17%, P 0.01).After adjusting for potential confounders, acetaminophen administration was associated with a 32% reduction in the risk of AKI (OR = 0.68, 95%CI:0.48∼0.96, P = 0.027). Conclusion Our study suggests that early acetaminophen administration may offer renal protection by reducing the risk of AKI in critically ill patients with CDI. Prospective, multicenter randomized controlled studies are needed to verify this finding.

Splenic abscesses are rare but serious infections often linked to immunosuppressive conditions. While Clostridioides difficile is well-known for causing colitis, its occurrence in locations outside the gastrointestinal tract, like the spleen, is exceedingly rare. This report highlights a unique case of a C. difficile splenic abscess in a patient with systemic sclerosis and multiple comorbidities.  A 73-year-old female with a history of systemic sclerosis, recent colectomy with end ileostomy for fulminant C. difficile colitis, and other significant comorbidities, presented with abdominal pain, nausea, and decreased ostomy output. A CT scan revealed an organized splenic infarction with surrounding fluid collection, as well as a right parastomal hernia. The initial management included intravenous (IV) piperacillin-tazobactam, oral vancomycin, and IV fluids. Surgical consultation determined that immediate intervention was unnecessary, and a follow-up was planned. An interventional radiologist performed aspiration of the fluid collection, which was positive for C. difficile. Infectious Disease specialists subsequently recommended a 3-week course of oral metronidazole, and the patient was discharged with symptom control on an oral pain regimen.  There are many diagnostic and therapeutic challenges posed by extraintestinal C. difficile infections. Splenic abscesses caused by C. difficile are rare, and their variable clinical presentations can lead to delays in diagnosis. Currently, no standardized guidelines exist for managing such infections, making individualized treatment essential. The successful management of our patient’s infection involved advanced imaging, percutaneous drainage, and tailored antibiotic therapy. Given the potential for antibiotic resistance and recurrence, prolonged follow-up and careful management are recommended.  Extraintestinal C. difficile infections, such as splenic abscesses, are rare and complex, highlighting the need for further research to develop standardized diagnostic and therapeutic protocols. This case contributes to the limited literature on this rare entity, underscoring the importance of a multidisciplinary approach in optimizing patient outcomes.

This systemwide initiative focusing on standardizing processes, feedback on performance, and accountability was associated with sustainable improvements in mortality and a reduction in infectious and safety events.

We identified the characteristics that significantly differentiated the patients who died from those who survived. Mortality is significantly higher in the group of patients with CDI than that in the other hospitalised patients.

Enteral administration of vancomycin is the standard treatment for Clostridioides difficile (Clostridium difficile) colitis and is presumed to have no systemic absorption. In critically ill pati...

While C difficile infection among individuals with cirrhosis is linked to factors such as increased in-hospital mortality and longer length of stay, it is not linked to 30-day mortality.

Paul Feuerstadt, MD, FACG, AGAF, discusses how the management of recurrent Clostridioides difficile infections is evolving toward more targeted approaches, including microbiome-based therapies like fecal microbiota transplantation, newer antibiotics such as fidaxomicin, and emerging preventive strategies focusing on microbiome restoration and preservation.

Clostridioides difficile is a leading cause of healthcare associated infection and an unacceptably high proportion of patients with C. difficile infection die despite conventional antibiotic treatment. Host-directed immunotherapy has been proposed as an ideal treatment modality for …

spaniClostridioides difficile/i is a leading cause of healthcare associated infection and an unacceptably high proportion of patients with iC. difficile/i infection die despite conventional antibiotic treatment. Host-directed immunotherapy has been proposed as an ideal treatment modality for /span …

Enhancing understanding and treatment of post-infectious IBS following Clostridioides difficile Infection

Clostridium difficile infection CDI is a significant global health concern primarily affecting older adults and those with weakened immune systems This bacterial infection often associated with prolonged use of antibiotics can cause severe gastrointestinal issues including diarrhea colitis and in ...

Jacinda Abdul-Mutakabbir, PharmD, MPH, AAHIVP, discusses a study she conducted that highlights how social determinants of health exacerbate severity and increase rates of mortality from Clostridioides difficile infections in vulnerable communities.

An HIV- positive patient with Kaposi's sarcoma and undergoing chemotherapy, had been on antibiotic therapy for around 14 days with ceftriaxone and imipenem. He was admitted with a 5-day evolution of watery diarrhea followed by rectorrhagia. His CD4 level was 226 cells/ mm3. Colonoscopy was done with …

(BPT) - Every year, nearly half a million people in the U.S. suffer from a serious and potentially deadly infection called Clostridioides difficile or C. diff.1,2 C. diff is a bacteria that can …