C Diff Treatment
Antibiotic Therapies for Clostridioides difficile Infection in Children
While rates of Clostridioides difficile infection (CDI) are increasing among children in the United States, studies assessing CDI treatment in children are severely lacking. Thus, treatment guidelines have historically relied on evidence from limited observational data in children and randomized con …
My Body Was Failing. I Started to Prepare for Death.
Courtesy Henry Holt & Co.In May 2015, I started to prepare for death. My life insurance to my niece, Zoe. My dog to Mom. My clothes to my big sister, Kaetlyn, for first dibs, then donated. My furniture and books to my boyfriend, Jimmy. Would it be uncouth to write my own obituary? I read about what would happen to my body if I died in the hospital: I’d be transferred to the morgue while my family decided what to do with my refrigerated corpse. Could my organs be donated, or were they too damaged from sickness and medication? Should I bequeath my pathetic body to science? I liked the idea of being buried in that body farm in Texas, where students could study my decomposition.I’d been fighting an arduous Crohn’s disease flare up combined with a recurrent bacterial infection of Clostridium dificile, or C. diff, since February, and had been an in-patient at Brooklyn Methodist Hospital since March. Crohn’s, an incurable form of inflammatory bowel disease (IBD) that I was diagnosed with in 2012, tricks my immune system into thinking my digestive system is an invader and needs to be violently dispelled from my body. It causes, among other symptoms, inflammation and ulceration from mouth to anus, diarrhea, vomiting, bleeding, fissures, fistulas, intestinal blockages, perforations, scar tissue, malnutrition, anemia, and joint pain.I Said ‘Yes’ to the Dress—and Faced My Past C. diff is a spore-forming bacteria that’s extremely contagious and hard to treat (dificile quite literally means difficult). Common in hospitals, nursing homes, and other health-care centers where antibiotic use is high and compromised immune systems are common, C. diff releases toxins that attack the lining of the large intestine. It causes aggressive, foul-smelling diarrhea, an increased white blood cell count, dehydration, fever, and abdominal bloating. If it isn’t treated properly, C. diff can kill you. It infects about 500,000 people every year in the United States and kills 30,000—a historically high number, thanks in part to increasing antibiotic resistance. In an IBD gut, riddled with inflammation, ulceration, and scar tissue (perfect places for the bacteria to hide and multiply), the chance of death increases dramatically.As weeks at Methodist passed, I became too weak to walk. My nurses encouraged me to at least shuffle around the room, but I kept falling down. They wrote “FALL RISK” on my dry-erase board. The chance of blood clots goes up when you’re bedridden, so I got anticoagulant shots and was hooked up to a compression device that wrapped around my skinny legs, squeezing them over and over again like two giant blood pressure cuffs. Nutrition and fluids came intravenously. Potassium and other electrolytes burned like salt in a wound as they traveled up my forearms. Nurses put wide pads, identical to the ones you use to train a puppy, under my butt when I stopped being able to make it to the bathroom. Sometimes, I’d drift off and wake up in my own mess, quick to apologize to the nurses who cleaned me up. “Honey, it’s my job,” they’d say with a reassuring smile and a pat on the hand. On their next round, they’d bring me ginger candies and giant cups of fresh crushed ice, trying to make me feel better for being a twenty-six-year-old woman who shit the bed.I’d had C. diff once before, during the spring of 2013. After failing round after round of antibiotics, doctors at Weill Cornell in Manhattan performed a fecal microbiota transplant (FMT), where the healthy stool from a donor (Zoe, nine years old at the time) was mixed with saline and transplanted via colonoscopy into my diseased large intestine. The flora from the healthy stool populated my gut with diverse bacteria, overtook the nasty C. diff bacteria, and rebalanced my microbiota. Forty-eight hours after the FMT, I felt markedly better and continued to improve over the coming months.But things were different in 2015 than they were in 2013 when I had C. diff the first time. The FDA was regulating fecal transplants more carefully, and many doctors who’d performed them previously halted the procedure or stopped altogether. Under 2015’s FDA guidelines, most FMTs could be performed only in a clinical trial setting. My gastroenterologist called several doctors who all said the same thing: “We aren’t doing transplants right now.” No one wanted to step on the FDA’s toes. Professionally, I understood the fear of going up against a powerful government agency. But I was dying. I was twenty-six years old and I was dying, and no one wanted to ruffle feathers to help me not die. That was the deepest loneliness I’ve ever known.By May, I weighed 90 pounds. My skin appeared alien gray and hung from my bones like a saggy, deflated balloon. I relied on someone else for everything: sitting up, putting rubber-bottomed socks on, going to the bathroom, washing up in my room’s tiny shower. My body didn’t feel like my own. IVs got harder and harder to insert due to all the blown veins. Bruises covered my arms in spindly purple and green fireworks next to sore, scabby rashes from all the weeks of medical tape. My veins became so difficult to find that they had to use a machine called a Vein Viewer on my arms, legs, and neck to locate deeper locations less likely to blow up. I left IVs in longer than I should have for fear of not finding another useable spot. My blood pressure was 70/50 on a good day, and some days it wouldn’t register at all. The hospital’s endocrinologist suspected my adrenal glands were failing; they weren’t, I was just sick in lots of other ways. “Were there times you thought I might die?” I asked Mom. “Absolutely,” she said.I knew that I couldn’t stay hooked up to IV antibiotics forever but that stopping would free the infection to run rampant. Antibiotics were like a finger in the dam—they tamped things down but weren’t a long-term solution. Plus, the IBD flare, which carved my lower colon and rectum with ulceration, couldn’t be treated safely until the C. diff infection was gone—treatment for IBD required suppressing my immune system, the opposite of what I needed to fight C. diff. Getting better required a fecal transplant first and foremost, but I still couldn’t access one.The only thing that kept me from leaping from a window was the fuzzy euphoria of IV painkillers. Dilaudid, or hydromorphone, is an opioid analgesic that’s used for severe pain, like chronic and cancer-related pain. It’s chemically similar to morphine but much stronger, earning it the nickname “hospital heroin.” During the first few weeks I was admitted, a nurse injected me with 3 milligrams of Dilaudid every four hours (a delivery called IV push); later, the pain management team switched to a pump for more even and controllable relief. Every thirty minutes I pressed a button to dispense the medication into my forearm. Click.Upon injection, it created a heavy, exploding sensation from the center of my chest outward, like strong hands shoving me backward against the bed. Prickly warmth wove its way through my limbs and up my neck and scalp, followed by a sleepy brain fog that made everything pleasant and dreamlike. Though it didn’t always control the pain (gastrointestinal pain is notoriously difficult to manage), it made me care less about it. Time passed faster and my anxiety dissipated. I was floating somewhere outside the hospital room in a pink, opiate cloud, and that was juuuuuust fine. If I slipped into death, at least I wouldn’t mind.Dilaudid has a long list of potential side effects, including sleep disturbances and hallucinations. Though the medication made me tired, I never really slept. Opiates disrupt the deeper levels of sleep, including REM, so I wasn’t getting any restorative rest. I was somewhere between awake and asleep for weeks at a time. I blame this for Dad, who’d been dead for almost seven years by then, showing up in my hospital room.Dad died on December 9, 2008. He was fifty-six years old. The coroner thought he’d been dead a few days longer, but that’s the day the cops found him. He died on the toilet. For a long time, if I told people he was dead at all, I said he died on the bathroom floor. Like that was somehow more dignified. We cremated him. There was no memorial. The month after he died, I wrote this in my journal:Dear Dad,You died December 9th, 2008. Kaetlyn called the police after we couldn’t get a hold of you. I knew you were gone when she called me back and all she said was, “Are you home?” I knew then. I was on the sidewalk in the cold when she told me. Her phone rang and it said your name, but when she answered it was not you. It was the coroner.You were gone.The world changed in that moment.The next day, Mom picked me up and took me home. The world looked different. It kept going on without me. And you.Kaetlyn and I went to the funeral home where your body was. They told us cremation was a good idea, which means you looked awful. We had to tell them the obituary version of your life.I think that is all I can handle for now.You broke my heart.I love you. Please come back to me.Please.In his apartment, there was a meditation mat on the floor and a wooden Buddha statue on the windowsill; an unbuckled wristwatch lay beside the mat. Harold Budd and Brian Eno’s The Pearl, the same album he played me as a colicky baby, was in the CD player beside his bed. Google searches on his computer included stuff like “LIVER FAILURE BLOATING,” “LIVER REGENERATION POSSIBLE,” and “WHAT HAPPENS TO BODY DURING CREMATION?” He didn’t want to die. In an email several months before his death, he wrote to me: “I will, in all likelihood, live to be 90. When I’m very old, I’d like you and your sister to put me in a rowboat at sunset and push me out to sea.”Kaetlyn and I found other evidence that he’d been sick: used tissues strewn about, a heating pad on the sofa, vomit and feces dried to the carpet as though he couldn’t make it to the bathroom in time. No one tells you that when you’re poor, you have to cl
VIDEO: Preventing and treating C. diff icile infection
WASHINGTON; In this video, infectious disease pharmacist Kerry LaPlante, PharmD, FCCP, FIDSA, discusses a presentation she gave at the World Anti-Microbial Resistance Congress on Clostridioides difficile infection. LaPlante, who is department chair and a professor of pharmacy at the University of Rhode Island College of Pharmacy, talked about the importance of infection control and being a
Effective definition of low humoral response to Clostridioides difficile infection
Antibodies IgG CD anti-toxin B detection at a dilution of 1:400, using a B ELISA technique, effectively identified patients at increased risk of recurrence. This information could help assist in the management of patients.
Management and characteristics of patients suffering from Clostridiodes difficile infection in primary care
GPs provide relevant ambulatory care for mild primary episodes of CDI using oral metronidazole. Persistent diarrhoea despite an appropriate anti-Clostridiodes regimen should be interpreted as an early predictor of relapse.
Microbiome Therapeutic Demonstrates Reduction of C. Difficile Recurrence - Pharmacy Times
SER-109, an investigational, oral, biologically-sourced microbiome therapeutic designed to reduce recurrence of C. difficile infection (CDI), demonstrated a 31.1% absolute reduction in the rate of CDI recurrence over 12 weeks compared to placebo
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Sahil Khanna, MBBS, MS, FACG on Twitter
Following up on my talk yesterday at #ACG2021, correction to where @AmCollegeGastro recommends metronidazole for low risk patients with #Cdiff. I made an #error confusing @AmCollegeGastro and @IDSAInfo guidelines. @DrPaulGastro @DrStollman @ckellymd @DrJessicaA pic.twitter.com/Ls3R1PGW7U— Sahil Khanna, MBBS, MS, FACG (@Khanna_S) October 28, 2021
European Society of Clinical Microbiology and Infectious Diseases: 2021 update on the treatment guidance document for Clostridioides difficile infection in adults
Important changes compared with previous guideline include but are not limited to: (1) metronidazole is no longer recommended for treatment of CDI when fidaxomicin or vancomycin are available, (2) fidaxomicin is the preferred agent for treatment of initial CDI and the first recurrence of CDI when av …
Potential Cost Savings Associated with Targeted Substitution of Current Guideline-Concordant Inpatient Agents with Omadacycline for the Treatment of Adult Hospitalized Patients with Community-Acquired Bacterial Pneumonia at High Risk for Clostridioides difficile Infections: Results of Healthcare-Decision Analytic Model from the United States Hospital Perspective
The findings of this simulated model suggest that prioritizing the use of omadacycline over current CABP treatments in hospitalized CABP with a DRS ≥ 6 may potentially reduce attributable HCA-CDI costs. The findings are not unique to omadacycline and could be applied to any antibiotic that confers a …