Browsing by Subject "Clostridioides difficile infection"

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    Incidence and Risk Factors of Recurrent Clostridioides difficile Infection in Patients With Cirrhosis
    (Wolters Kluwer, 2020-07-13) Phatharacharukul, Parkpoom; Purpura, Russell D.; Gandhi, Devika; Xu, Huiping; Bickett-Burkhart, Katie; Chalasani, Naga; Fischer, Monika; Orman, Eric S.; Biostatistics, School of Public Health
    INTRODUCTION: Clostridioides difficile infection (CDI) is common in patients with cirrhosis and is associated with poor outcomes. CDI risk factors in this population have been well characterized; however, risk factors of recurrent CDI (R-CDI) after treatment have not been explored. We sought to estimate the incidence of R-CDI and its associated risk factors in patients with cirrhosis. METHODS: We performed a cohort study of patients with cirrhosis hospitalized with CDI between 2012 and 2016. We collected patient characteristics, including detailed information on the CDI, features of the underlying liver disease, and outcomes including R-CDI, hospital readmission, and mortality. R-CDI was defined as CDI occurring 2–8 weeks after the initial episode. Cox proportional hazards model was used to identify variables independently associated with the outcomes. RESULTS: A total of 257 hospitalized patients with cirrhosis and CDI were included. CDI was community associated in 22.6%. The incidence of R-CDI was 11.9%. R-CDI was not significantly associated with medications at hospital admission or discharge. Independent risk factors of R-CDI included increased Charlson Comorbidity Index (hazard ratio [HR] 1.30; 95% confidence interval [CI]: 1.09–1.55) and use of lactulose (HR 2.58; 95% CI: 1.09–6.09). The 30-day readmission rate was 37%, and readmission was associated with increased Charlson Comorbidity Index (HR 1.12; 95% CI: 1.03–1.23) and Model for End-Stage Liver Disease score (HR 1.04; 95% CI: 1.01–1.07). The 90-day mortality was 22.8%. DISCUSSION: In patients with cirrhosis, R-CDI is associated with comorbidity burden and lactulose use. Attention to these factors might aid clinicians in efforts to prevent R-CDI and improve outcomes in this population.
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    Inflammatory Bowel Disease Outcomes Following Fecal Microbiota Transplantation for Recurrent C. difficile Infection
    (Oxford University Press, 2021-08-19) Allegretti, Jessica R.; Kelly, Colleen R.; Grinspan, Ari; Mullish, Benjamin H.; Hurtado, Jonathan; Carrellas, Madeline; Marcus, Jenna; Marchesi, Julian R.; McDonald, Julie A.K.; Gerardin, Ylaine; Silverstein, Michael; Pechlivanis, Alexandros; Barker, Grace F.; Blanco, Jesus Miguens; Alexander, James L.; Gallagher, Kate I.; Pettee, Will; Phelps, Emmalee; Nemes, Sara; Sagi, Sashidhar V.; Bohm, Matthew; Kassam, Zain; Fischer, Monika; Medicine, School of Medicine
    Background: Recurrent Clostridioides difficile infection (CDI) in patients with inflammatory bowel disease (IBD) is a clinical challenge. Fecal microbiota transplantation (FMT) has emerged as a recurrent CDI therapy. Anecdotal concerns exist regarding worsening of IBD activity; however, prospective data among IBD patients are limited. Methods: Secondary analysis from an open-label, prospective, multicenter cohort study among IBD patients with 2 or more CDI episodes was performed. Participants underwent a single FMT by colonoscopy (250 mL, healthy universal donor). Secondary IBD-related outcomes included rate of de novo IBD flares, worsening IBD, and IBD improvement-all based on Mayo or Harvey-Bradshaw index (HBI) scores. Stool samples were collected for microbiome and targeted metabolomic profiling. Results: Fifty patients enrolled in the study, among which 15 had Crohn's disease (mean HBI, 5.8 ± 3.4) and 35 had ulcerative colitis (mean partial Mayo score, 4.2 ± 2.1). Overall, 49 patients received treatment. Among the Crohn's disease cohort, 73.3% (11 of 15) had IBD improvement, and 4 (26.6%) had no disease activity change. Among the ulcerative colitis cohort, 62% (22 of 34) had IBD improvement, 29.4% (11 of 34) had no change, and 4% (1 of 34) experienced a de novo flare. Alpha diversity significantly increased post-FMT, and ulcerative colitis patients became more similar to the donor than Crohn's disease patients (P = 0.04). Conclusion: This prospective trial assessing FMT in IBD-CDI patients suggests IBD outcomes are better than reported in retrospective studies.
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    Outcomes of Fecal Microbiota Transplantation in Patients With Inflammatory Bowel Diseases and Recurrent Clostridioides difficile Infection
    (Elsevier, 2020) Allegretti, Jessica R.; Kelly, Colleen R.; Grinspan, Ari; Mullish, Benjamin H.; Kassam, Zain; Fischer, Monika; Medicine, School of Medicine
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    Reorganisation of faecal microbiota transplant services during the COVID-19 pandemic
    (BMJ Publishing Group, 2020-07-03) Ianiro, Gianluca; Mullish, Benjamin H.; Kelly, Colleen R.; Kassam, Zain; Kuijper, Ed J.; Ng, Siew C.; Iqbal, Tariq H.; Allegretti, Jessica R.; Bibbò, Stefano; Sokol, Harry; Zhang, Faming; Fischer, Monika; Costello, Samuel Paul; Keller, Josbert J.; Masucci, Luca; Prehn, Joffrey van; Quaranta, Gianluca; Quraishi, Mohammed Nabil; Segal, Jonathan; Kao, Dina; Satokari, Reetta; Sanguinetti, Maurizio; Tilg, Herbert; Gasbarrini, Antonio; Cammarota, Giovanni; Medicine, School of Medicine
    The COVID-19 pandemic has led to an exponential increase in SARS-CoV-2 infections and associated deaths, and represents a significant challenge to healthcare professionals and facilities. Individual countries have taken several prevention and containment actions to control the spread of infection, including measures to guarantee safety of both healthcare professionals and patients who are at increased risk of infection from COVID-19. Faecal microbiota transplantation (FMT) has a well-established role in the treatment of Clostridioides difficile infection. In the time of the pandemic, FMT centres and stool banks are required to adopt a workflow that continues to ensure reliable patient access to FMT while maintaining safety and quality of procedures. In this position paper, based on the best available evidence, worldwide FMT experts provide guidance on issues relating to the impact of COVID-19 on FMT, including patient selection, donor recruitment and selection, stool manufacturing, FMT procedures, patient follow-up and research activities.