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Navarro ML, Nieto M, Perez-Martínez A. The need for evolution in the management of febrile neutropenia in pediatric cancer: TRIIO KIDS update. Clin Transl Oncol 2023; 25:633-642. [PMID: 36244052 DOI: 10.1007/s12094-022-02971-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 09/28/2022] [Indexed: 10/17/2022]
Abstract
New treatments have increased the life expectancy of pediatric patients diagnosed with malignant hematological diseases, often at the cost of protracting their immunocompromised state in the form of prolonged neutropenia. This neutropenic state favors the development of bacterial and fungal infections. Moreover, recent years have seen a series of changes in the epidemiology of fungal and Clostridium infections. These changes necessitate adaptations to the management of pediatric patients with febrile neutropenia, who are at risk of further increases in already high rates of morbidity and mortality. This article discusses the current bases for the management of febrile neutropenia and associated emerging fungal infections, as well as the epidemiology, diagnosis, and treatment of Clostridioides difficile in pediatric patients diagnosed with malignant hematological diseases.
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Affiliation(s)
- Maria Luisa Navarro
- Department of Paediatric Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Montserrat Nieto
- Paediatric Intensive Care Unit, Hospital Infantil Niño Jesús, Madrid, Spain
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Jiang T, Hu X, Lin C, Xia Z, Yang W, Zhu Y, Xu H, Tang H, Shen J. Rapid visualization of Clostridioides difficile toxins A and B by multiplex RPA combined with CRISPR-Cas12a. Front Microbiol 2023; 14:1119395. [PMID: 36970685 PMCID: PMC10030577 DOI: 10.3389/fmicb.2023.1119395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 02/17/2023] [Indexed: 03/29/2023] Open
Abstract
Purpose Clostridioides difficile (C. difficile) infection is the most common cause of nosocomial infection, which is a severe challenge in modern medical care. Currently, many laboratory diagnostic methods for C. difficile are available, such as PCR, culture-based tests, and antigen-based tests. However, these methods are not suitable for rapid point-of-care testing (POCT). Therefore, it is of great significance to develop a rapid, sensitive, and cost-effective method to detect C. difficile toxin genes. Methods Recently, the development of clustered regularly interspaced short palindromic repeats (CRISPR) technology has emerged as a promising tool for rapid POCT. In this study, we developed a rapid and specific detection platform for dual C. difficile toxins by combining recombinase polymerase amplification (RPA) and CRISPR/Cas12a. Results The platform includes multiplex RPA-cas12a-fluorescence assay and multiplex RPA-cas12a-LFS (Lateral flow strip) assay, through which the detection limit for tcdA and tcdB was 10 copies/μL and 1 copy/μL, respectively. The results can be more clearly distinguished using a violet flashlight, which realized a portable visual readout. The platform can be tested within 50 min. Furthermore, our method did not cross-react with other pathogens that cause intestinal diarrhea. The results of 10 clinical samples using our method was 100% consistent with those from real-time PCR detection. Conclusion In conclusion, the CRISPR-based double toxin gene detection platform for C. difficile is an effective, specific, and sensitive detection method, which can be used as a powerful on-site detection tool for POCT in the future.
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Affiliation(s)
- Tong Jiang
- The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
- Anhui Public Health Clinical Center, Hefei, Anhui, China
| | - Xinyi Hu
- The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
- Anhui Public Health Clinical Center, Hefei, Anhui, China
| | - Chunhui Lin
- The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
- Anhui Public Health Clinical Center, Hefei, Anhui, China
| | - Zhaoxin Xia
- The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
- Anhui Public Health Clinical Center, Hefei, Anhui, China
| | - Wensu Yang
- The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
- Anhui Public Health Clinical Center, Hefei, Anhui, China
| | - Yi Zhu
- The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
- Anhui Public Health Clinical Center, Hefei, Anhui, China
| | - Huaming Xu
- The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
- Anhui Public Health Clinical Center, Hefei, Anhui, China
| | - Hao Tang
- The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
- Anhui Public Health Clinical Center, Hefei, Anhui, China
| | - Jilu Shen
- The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
- Anhui Public Health Clinical Center, Hefei, Anhui, China
- *Correspondence: Jilu Shen,
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Jaqueti Aroca J, Molina Esteban LM, García-Arata I, García-Martínez J, Cano De Torres I, Prieto Menchero S. Significance of a polymerase chain reaction method in the detection of Clostridioides difficile. REVISTA ESPANOLA DE QUIMIOTERAPIA 2021; 34:141-144. [PMID: 33601876 PMCID: PMC8019460 DOI: 10.37201/req/010.2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Clostridioides difficile (CD) is the most common cause of nosocomial diarrhea. Detection of CD toxin in patients' faecal samples is the traditional rapid method for the diagnosis of CD infection. Various testing algorithms have been proposed: an initial screening test using a rapid test, and a confirmatory test (cytotoxicity neutralization assay, toxigenic culture, nucleic acid amplification test) for discordant results. The aim of this study was to evaluate the effectiveness of a two-step algorithm using an immunochromatographic test followed of a polymerase chain reaction (PCR). METHODS The specimens have been tested according to the following schedule: 1) Step one: All samples were tested for detection of glutamate dehydrogenase antigen (GDH) and toxin A/B using the C. diff QUIK CHEK Complete test. All GDH and toxins positive results were considered CD positives; 2) Step two: When the results were discrepant (only GDH+ or toxins+), the samples were confirmed using the PCR test BD MAX Cdiff. All PCR positive results were considered CD positives. RESULTS A total of 2,138 specimens were initially tested. 139 were positive for GDH and toxins. 160 discrepant results (148 GDH+ and 12 toxins+) were tested by PCR, 117 were positive (107/148 GDH+ and 10/12 toxins+). CONCLUSIONS The implementation of a PCR method showed an increase de 117 positive results (73.1% of discrepant). Considering the sensitivity of C.diff QUIK CHEK (instructions of manufacturer), the GDH discrepant results may be false negatives, y the samples PCR and toxins positives may be real positives results.
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Affiliation(s)
- J Jaqueti Aroca
- Jerónimo Jaqueti Aroca, Laboratorio Clínico, Hospital Universitario de Fuenlabrada, Camino del Molino, 2. 28942 Madrid, Spain.
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Mateu L, Fernández-Rivas G, Sopena N. Diagnosis and treatment of Clostridioides difficile infection. Med Clin (Barc) 2020; 155:30-35. [PMID: 32430207 DOI: 10.1016/j.medcli.2020.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 02/21/2020] [Accepted: 02/24/2020] [Indexed: 02/08/2023]
Abstract
Clostridioides difficile is the main cause of healthcare-associated diarrhoea in adults. The incidence of C.difficile infection (CDI) has increased in recent years. The risk of recurrence of CDI is 15%-25% in a first episode and this risk is increased in subsequent episodes. Toxigenic culture and cytotoxicity tests are the reference techniques for the microbiological diagnosis of CDI. These are laborious and slow techniques and therefore they have been replaced in clinical practice by the application of a multi-step algorithm that includes the detection of glutamate dehydrogenase (GDH), toxins and molecular techniques. The treatment of choice for CDI is Vancomycin. In recent years, new drugs and new treatment strategies have appeared that are especially useful in the treatment of relapses of CDI.
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Affiliation(s)
- Lourdes Mateu
- Servicio de Enfermedades Infecciosas, Hospital Universitari Germans Trias i Pujol. Departamento de Medicina, Universitat Autònoma de Barcelona. Institut de Recerca Germans Trias i Pujol. CIBER de Enfermedades Respiratorias, Badalona, Barcelona, España.
| | - Gema Fernández-Rivas
- Servicio de Microbiología, Laboratorio Clínico de la Metropolitana Norte, Hospital Universitari Germans Trias i Pujol. Departamento de Genética y Microbiología, Universitat Autònoma de Barcelona. Institut de Recerca Germans Trias i Pujol, Badalona, Barcelona, España
| | - Nieves Sopena
- Servicio de Enfermedades Infecciosas, Hospital Universitari Germans Trias i Pujol. Departamento de Medicina, Universitat Autònoma de Barcelona. Institut de Recerca Germans Trias i Pujol. CIBER de Enfermedades Respiratorias, Badalona, Barcelona, España
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Albiach L, Camprubí D, Alvarez-Martínez MJ, Soriano A. Ribotype 027 Clostridioides difficile infection presented as a traveller's diarrhoea. Enferm Infecc Microbiol Clin 2019; 38:196-197. [PMID: 31607397 DOI: 10.1016/j.eimc.2019.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 07/18/2019] [Accepted: 07/18/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Laia Albiach
- Infectious Diseases Department, Hospital Clínic de Barcelona, Spain.
| | - Daniel Camprubí
- Tropical Medicine and International Health Department, Hospital Clínic de Barcelona, Spain; ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Miriam J Alvarez-Martínez
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain; Microbiology Department, Hospital Clínic de Barcelona, Spain
| | - Alex Soriano
- Infectious Diseases Department, Hospital Clínic de Barcelona, Spain
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Salavert M, Cobo J, Pascual Á, Aragón B, Maratia S, Jiang Y, Aceituno S, Grau S. Cost-Effectiveness Analysis of Bezlotoxumab Added to Standard of Care Versus Standard of Care Alone for the Prevention of Recurrent Clostridium difficile Infection in High-Risk Patients in Spain. Adv Ther 2018; 35:1920-1934. [PMID: 30328061 PMCID: PMC6223985 DOI: 10.1007/s12325-018-0813-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Indexed: 12/12/2022]
Abstract
Introduction Clostridium difficile infection (CDI) is the major cause of infectious nosocomial diarrhoea and is associated with considerable morbidity, mortality and economic impact. Bezlotoxumab administered in combination with standard of care (SoC) antibiotic therapy prevents recurrent CDI. This study assessed the cost-effectiveness of bezlotoxumab added to SoC, compared to SoC alone, to prevent the recurrence of CDI in high-risk patients from the Spanish National Health System perspective. Methods A Markov model was used to simulate the natural history of CDI over a lifetime horizon in five populations of patients at high risk of CDI recurrence according to MODIFY trials: (1) ≥ 65 years old; (2) severe CDI; (3) immunocompromised; (4) ≥ 1 CDI episode in the previous 6 months; and (5) ≥ 65 years old and with ≥ 1 CDI episode in the previous 6 months. The incremental cost-effectiveness ratio (ICER) expressed as cost per quality-adjusted life-year (QALY) gained was calculated. Deterministic (DSA) and probabilistic sensitivity analyses (PSA) were performed. Results In all patient populations (from 1 to 5), bezlotoxumab added to SoC reduced CDI recurrence compared to SoC alone by 26.4, 19.5, 21.2, 26.6 and 39.7%, respectively. The resulting ICERs for the respective subgroups were €12,724, €17,495, €9545, €7386, and €4378. The model parameters with highest impact on the ICER were recurrence rate (first), mortality, and utility values. The probability that bezlotoxumab was cost-effective at a willingness-to-pay threshold of €21,000/QALY was 85.5%, 54.1%, 86.0%, 94.5%, 99.6%, respectively. Conclusion The results suggest that bezlotoxumab added to SoC compared to SoC alone is a cost-effective treatment to prevent the recurrence of CDI in high-risk patients. The influence of changes in model parameters on DSA results was higher in patients ≥ 65 years old, with severe CDI and immunocompromised. Additionally, PSA estimated that the probability of cost-effectiveness exceeded 85% in most subgroups. Funding Merck Sharp & Dohme Corp. Electronic supplementary material The online version of this article (10.1007/s12325-018-0813-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Miguel Salavert
- Infectious Diseases Unit, Hospital Universitario La Fe, Valencia, Spain.
| | - Javier Cobo
- Infectious Diseases Department, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Álvaro Pascual
- Clinical Microbiology and Infectious Diseases Unit, Hospital Universitario Virgen Macarena, Instituto de Biomedicina de Sevilla (IBIS), Universidad de Sevilla, Seville, Spain
| | | | | | - Yiling Jiang
- Merck Sharp & Dohme Ltd, Hoddesdon, Hertfordshire, UK
| | | | - Santiago Grau
- Pharmacy Department, Hospital del Mar, Universidad Autónoma de Barcelona, Barcelona, Spain
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Present and past perspectives on Clostridium difficile infection. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2018. [DOI: 10.1016/j.rgmxen.2017.07.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Characteristics of Clostridium difficile infection in a high complexity hospital and report of the circulation of the NAP1/027 hypervirulent strain in Colombia. BIOMEDICA 2017; 37:466-472. [DOI: 10.7705/biomedica.v37i4.3244] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Revised: 10/27/2016] [Indexed: 11/21/2022]
Abstract
Introducción. Clostridium difficile es el principal responsable de la diarrea asociada al uso de antibióticos. En Colombia y en Latinoamérica, el conocimiento sobre el comportamiento epidemiológico de la infección por C. difficile todavía es limitado.Objetivo. Describir las características de una serie de pacientes con infección por C. difficile.Materiales y métodos. Se hizo un estudio descriptivo de una serie de casos de pacientes con infección por C. difficile atendidos en la Fundación Clínica Shaio, entre enero de 2012 y noviembre de 2015.Resultados. Se estudiaron 36 pacientes con una edad promedio de 65 años. Se determinaron los siguientes factores relacionados con la infección por C. difficile: uso previo de antimicrobianos (94,4 %), hospitalización en los últimos tres meses (66,7 %) y uso de inhibidores de la bomba de protones (50 %). Las comorbilidades más comunes fueron la enfermedad renal crónica (41,7 %) y la diabetes mellitus (30,6 %). Los síntomas más frecuentes fueron más de tres deposiciones diarreicas (97,1 %) y dolor abdominal (42,9 %). En cuanto a la gravedad de los casos, 44,4 % se clasificó como leve a moderado, 38,9 % como grave, y 11,1 % como complicado o grave. El método de diagnóstico más utilizado (63,8% de los pacientes) fue la identificación de la toxina mediante reacción en cadena de la polimerasa (PCR). La mortalidad global durante la hospitalización fue de 8 %. Se identificaron cuatro cepas del serotipo NAP1/027 y nueve muestras fueron positivas para la toxina binaria.Conclusión. La infección por C. difficile debe sospecharse en pacientes con deposiciones diarreicas y factores asociados tradicionalmente a esta enfermedad. Se reportó la circulación de cepas hipervirulentas del serotipo NAP1/027 en Colombia, lo cual debe enfrentarse con la vigilancia epidemiológica y el diagnóstico temprano
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Choice of treatment in Clostridium difficile-associated diarrhoea: Clinical practice guidelines or risk classifications. Enferm Infecc Microbiol Clin 2017; 35:613-616. [PMID: 29179981 DOI: 10.1016/j.eimc.2017.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 11/07/2017] [Indexed: 12/17/2022]
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Álvarez-Hernández DA, González-Chávez AM, González-Hermosillo-Cornejo D, Franyuti-Kelly GA, Díaz-Girón-Gidi A, Vázquez-López R. Present and past perspectives on Clostridium difficile infection. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2017; 83:41-50. [PMID: 28684034 DOI: 10.1016/j.rgmx.2017.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 03/14/2017] [Accepted: 03/29/2017] [Indexed: 01/05/2023]
Abstract
Clostridium difficile is a Gram-positive bacillus that has become one of the main hospital-acquired human gastrointestinal infections in recent years. Its incidence is on the rise, involving more virulent strains, affecting new and previously uncontemplated groups of patients, and producing changes in clinical presentation and treatment response that influence disease outcome. Early diagnosis and disease stratification based on the severity of C.difficile infection are essential for therapeutic management and the implementation of containment measures. However, the speed at which new strains with greater pathogenicity are developing is surpassing that of the development of new drugs, making it necessary to validate other therapeutic options. The present article is a review of the epidemiologic, pathophysiologic, diagnostic, and therapeutic aspects of C.difficile infection, from its first isolation to the present date, that aims to contribute to the preparation of general physicians and specialists, so that patients with this infection receive opportune and quality medical attention.
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Affiliation(s)
- D A Álvarez-Hernández
- Coordinación de Servicios Médicos, Cruz Roja Mexicana I.A.P., Delegación Huixquilucan, Huixquilucan, Estado de México, México.
| | - A M González-Chávez
- Departamento de Cirugía General, Hospital Español de México, Ciudad de México, México
| | | | - G A Franyuti-Kelly
- Facultad de Ciencias de la Salud, Universidad Anáhuac México Norte, Naucalpan de Juárez, Estado de México, México
| | - A Díaz-Girón-Gidi
- Departamento de Cirugía General, Fundación Clínica Médica Sur, Ciudad de México, México
| | - R Vázquez-López
- Departamento de Microbiología y Parasitología, Facultad de Ciencias de la Salud, Universidad Anáhuac México Norte, Naucalpan de Juárez, Estado de México, México
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García-Lozano T, Aznar-Oroval E, Martín-Utrilla S. Recurrencias en infecciones por Clostridium difficile en pacientes con cáncer. Med Clin (Barc) 2016; 147:417-418. [DOI: 10.1016/j.medcli.2016.04.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 04/18/2016] [Accepted: 04/28/2016] [Indexed: 02/04/2023]
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Fernández-Bañares F, Accarino A, Balboa A, Domènech E, Esteve M, Garcia-Planella E, Guardiola J, Molero X, Rodríguez-Luna A, Ruiz-Cerulla A, Santos J, Vaquero E. Diarrea crónica: definición, clasificación y diagnóstico. GASTROENTEROLOGIA Y HEPATOLOGIA 2016; 39:535-59. [DOI: 10.1016/j.gastrohep.2015.09.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 09/21/2015] [Accepted: 09/30/2015] [Indexed: 12/16/2022]
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Clostridium difficile, ¿están todos los que son? ACTA ACUST UNITED AC 2015; 30:79-85. [DOI: 10.1016/j.cali.2015.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Revised: 01/19/2015] [Accepted: 01/20/2015] [Indexed: 12/26/2022]
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[Clostridium difficile infection due to ribotype 027: description of an imported case in Spain]. Enferm Infecc Microbiol Clin 2013; 32:542-3. [PMID: 24332712 DOI: 10.1016/j.eimc.2013.10.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Accepted: 10/14/2013] [Indexed: 11/22/2022]
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Sánchez-Muñoz LA, de Santos-Castro PÁ, Rodríguez-Martín C, Vásquez-Posso B. Infecciones producidas por Clostridium difficile. Observaciones. Enferm Infecc Microbiol Clin 2013; 31:557. [DOI: 10.1016/j.eimc.2013.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2013] [Accepted: 04/05/2013] [Indexed: 11/15/2022]
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Réplica a «Infecciones producidas por Clostridium difficile. Observaciones». Enferm Infecc Microbiol Clin 2013; 31:558. [DOI: 10.1016/j.eimc.2013.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 04/25/2013] [Indexed: 11/22/2022]
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