Current updates in management of Clostridium difficile infection in cancer patients

Background: Clostridium difficile infection (CDI) is a significant health burden, now recognized as the leading cause of acquired diarrhea in patients receiving antibiotic therapy. Complications of infection with this pathogen include severe diarrhea, causing electrolyte imbalances, dehydration, hemodynamic instability, toxic megacolon, shock, and death. Hence it is extremely paramount to stay updated on management options for this infection, especially in cancer patients.

Review: This article presents an in-depth review of literature on the treatment modalities available for CDI in cancer patients. Relevant articles highlighting therapeutic and symptomatic management of CDI patients with underlying malignancy have been summarized.

Conclusions: Despite the current options available, more studies are needed to assess the newer therapeutic options that are being employed for populations other than cancer patients.     

Fidaxomicin versus oral vancomycin for severe Clostridium difficile infection: a retrospective cohort study

ObjectivesThis study was conducted to compare clinical outcomes of fidaxomicin versus oral vancomycin in the management of severe Clostridium difficile infection (CDI).MethodsThe investigation was a retrospective, multicentre, propensity score-matched analysis using a national clinical administrative database. Veterans treated for severe CDI from any Veterans Affairs Medical Center between 1 June 2011 and 30 June 2017 were included if they received fidaxomicin or an oral vancomycin regimen for treatment. The two groups were matched by the nearest-neighbour method from a propensity score derived from independent variables associated with the selection of a fidaxomicin course.ResultsPropensity score matching resulted in two well-matched cohorts consisting of 213 fidaxomicin and 639 oral vancomycin courses. No statistically-significant difference was found for the primary outcome of combined clinical failure or recurrence (68/213 (31.9%) versus 163/639 (25.5%), respectively, p 0.071). Additionally, no statistically significant differences were found for the secondary outcomes of 30-day (23/213 (10.8%) versus 75/639 (11.7%), respectively, p 0.71), 90-day (48/213 (22.5%) versus 140/639 (21.9%), respectively, p 0.85), and 180-day mortality (62/213 (29.1%) versus 186/639 (29.1%), respectively, p 1.0) between the two treatment groups.ConclusionsCourses of fidaxomicin or oral vancomycin for severe CDI resulted in similar treatment outcomes. Study findings are consistent with current treatment guideline recommendations for the use of either agent in the management of severe CDI.     

铋剂四联10天疗法联合酪酸梭菌、聚普瑞锌治疗幽门螺杆菌感染的疗效分析

目的 评价铋剂四联10 d疗法联合酪酸梭菌、聚普瑞锌治疗幽门螺杆菌（Hp）感染的疗效及安全性。方法 选取2018年7月—2021年6月于湘雅常德医院就诊使用铋剂四联10 d疗法联合酪酸梭菌、聚普瑞锌治疗Hp感染的209例患者作为研究对象。患者采用艾司奥美拉唑镁肠溶片（20 mg）+阿莫西林胶囊（1 g）+克拉霉素（0.5 mg）+胶体酒石酸铋胶囊（220 mg）均2次/d,酪酸梭菌活菌片（350 mg）3次/d,疗程10 d。后续追加艾司奥美拉唑肠溶片（20 mg,1次/d）+酪酸梭菌活菌片（350 mg,3次/d）+聚普瑞锌颗粒（75 mg,2次/d）,疗程14 d。结果 符合方案集分析（PP）和意向性分析（ITT）的Hp根除成功率分别为97.4%（189/194）和90.4%（189/209）,9例（4.4%）患者在治疗期间出现不良反应,但程度均较轻微,可自行缓解。结论 铋剂四联10 d疗法联合酪酸梭菌、聚普瑞锌作为Hp感染的治疗方案,根除率高,安全可行,在缩短抗生素疗程的同时不仅增加患者的依从性,也减少细菌产生耐药性。     

酪酸梭菌活菌散联合多潘立酮治疗小儿功能性消化不良的疗效及相关作用机制

目的 分析酪酸梭菌活菌散联合多潘立酮治疗小儿功能性消化不良（FD）的疗效及相关作用机制。方法 选取2019年3月—2020年7月就诊于合肥市第一人民医院的FD患儿144例。根据不同治疗方法将患儿分为对照组和观察组。两组患儿均给予调整饮食、建立良好排便习惯、预防及纠正水电解质与酸碱平衡等常规支持治疗,在此基础上,对照组接受多潘立酮治疗,观察组采取酪酸梭菌活菌散+多潘立酮治疗,均治疗1周。评估两组疗效、用药安全性,并观察治疗前后胃动力学、脑肠轴相关因子［5-羟色胺（5-HT）、神经肽S受体1（NPSR1）、P物质（SP）］、胃肠激素［生长抑素（SST）、胃动素（MTL）、促胃泌素（GAS）、瘦素（Leptin）］变化。结果 观察组总有效率较对照组高（P <0.05）。对照组治疗前后胃窦收缩幅度、胃窦收缩频率及胃窦运动指数差值较观察组高（P <0.05）。对照组治疗前后5-HT、SP差值较观察组低,NPSR1差值较观察组高（P <0.05）。对照组治疗前后MTL、GAS差值较观察组高,治疗前后SST、Leptin差值较观察组低（P <0.05）。两组患儿不良反应率比较,差异无统计学意义（P >0.05）。结论 酪酸梭菌活菌散联合多潘立酮治疗FD患儿的疗效确切,且未明显增加不良反应,其作用机制可能与改善胃动力学、调节脑肠轴因子及胃肠激素水平有关。     

Physician attitudes toward the use of fecal microbiota transplantation for the treatment of recurrent Clostridium difficile infection

BACKGROUND:

Fecal microbiota transplantation (FMT) is a safe and effective, yet infrequently used therapy for recurrent Clostridium difficile infection (CDI).

OBJECTIVE:

To characterize barriers to FMT adoption by surveying physicians about their experiences and attitudes toward the use of FMT.

METHODS:

An electronic survey was distributed to physicians to assess their experience with CDI and attitudes toward FMT.

RESULTS:

A total of 139 surveys were sent and 135 were completed, yielding a response rate of 97%. Twenty-five (20%) physicians had treated a patient with FMT, 10 (8%) offered to treat with FMT, nine (7%) referred a patient to receive FMT, and 83 (65%) had neither offered nor referred a patient for FMT. Physicians who had experience with FMT (performed, offered or referred) were more likely to be male, an infectious diseases specialist, >40 years of age, fellowship trained and practicing in an urban setting. The most common reasons for not offering or referring a patient for FMT were: not having ‘the right clinical situation’ (33%); the belief that patients would find it too unappealing (24%); and institutional or logistical barriers (23%). Only 8% of physicians predicted that the majority of patients would opt for FMT if given the option. Physicians predicted that patients would find all aspects of the FMT process more unappealing than they would as providers.

CONCLUSIONS:

Physicians have limited experience with FMT despite having treated patients with multiple recurrent CDIs. There is a clear discordance between physician beliefs about FMT and patient willingness to accept FMT as a treatment for recurrent CDI.     

酪酸梭菌活菌胶囊联合常规疗法治疗溃疡性结肠炎的临床观察

为观察酪酸梭菌活菌胶囊口服联合常规疗法治疗轻中度溃疡性结肠炎的临床疗效,将55例轻、中度溃疡性结肠炎患者随机分为两组,对照组25例给予常规疗法治疗,观察组30例在对照组治疗的基础上加服酪酸梭菌活菌胶囊,疗程为6周。疗程结束后,比较两组临床症状治疗效果、结肠镜复查结果的完全缓解率和总有效率。结果显示,观察组临床症状效果、结肠镜复查结果完全缓解率和总有效率均明显优于对照组（P〈0．05）。结果表明,酪酸梭菌活菌胶囊联合常规疗法对轻、中度溃疡性结肠炎的疗效优于常规疗法。     

Clostridium difficile infection as a cause of severe sepsis

Although colitis is often seen in critically ill patients who have received multiple broad-spectrum antibiotics, there are no reports describing severe sepsis as a result ofClostridium difficile infection. We describe three cases of severe sepsis with local intestinalClostridium difficile infection as the only identifiable etiology. The mechanism of severe sepsis may be a derangement of the gastrointestinal barrier function. This could result in absorption of microbes or endotoxin or activation of inflammatory cascades in the submucosa of the intestine or liver.