Clostridioides (Clostridium) difficile: A silent nosocomial pathogen

Knowledge Assessment of Hospital Nursing Staff in Saudi Arabia Regarding Clostridioides difficile Infection: A Descriptive Cross-Sectional Study

Clostridioides difficile (C. difficile), a gram-positive, spore-forming bacillus, has emerged as a leading cause of healthcare-associated infections, significantly contributing to infectious diarrhea and increasing healthcare costs. This descriptive, cross-sectional study was conducted among Saudi Arabian nursing staff from July to December 2023 to assess their knowledge and practices related to the diagnosis and management of C. difficile infection (CDI). Data were collected using a modified questionnaire. Overall, 358 nurses were surveyed, and 66% reported knowledge of C. difficile procedures. However, only 30.4% of the respondents correctly classified C. difficile as an anaerobic bacillus, while 42.2% were aware of the organism's common occurrence in healthy adult volunteers. Additionally, 55.6% of respondents were aware of risk factors and 48.9% could name typical medicines that might cause illness. Only 24.0% acknowledged the cytotoxin test as the gold standard for detection, 26.8% identified hand washing with water and soap as an effective method to prevent the transmission of CDI, and 36.3% identified oral metronidazole as the first-line treatment for CDI. In summary, this study revealed a significant lack of awareness among nurses in Saudi Arabia regarding various aspects of CDI, emphasizing the need for improved education and training to address the knowledge gaps and quality of patient care.

Metronidazole and Vancomycin Have a Synergic Effect, with Plant Extracts as Helpful Tools to Combat Clostridioides difficile Infections

Background/Objectives: The prolonged use of antibiotics is closely related to increased infections caused by Clostridioides difficile (Cdiff). Plant-origin compounds have been expanding in recent years as the best opportunity to identify new synergic therapies to combat antibiotic-associated diseases. Mexico has incredible plant biodiversity; natural compounds with antibacterial properties are an alternative treatment. The main objective of this study was to analyze the effect of medicinal plants with an antibacterial action against toxigenic clinical Cdiff strains that have a synergic effect on the antibiotics commonly used to combat this disease. Methods: The plants were selected for plants that were previously used in research, and their extracts were tested against Cdiff strains. The antibacterial activity, synergy, and antagonism between the extracts and their synergic effect with antibiotics were evaluated. Results: Our results demonstrated that some extracts have effective antimicrobial activity and synergic effects with vancomycin and metronidazole. Conclusions: This study suggests that plant extracts and plant compounds derived from these extracts could be used as synergic-antibiotic therapy to combat Cdiff infections.

A molecular epidemiological and transmission analysis of Clostridioides difficile using draft whole-genome sequencing in a single hospital

BACKGROUND

The nosocomial transmission of toxin-producing Clostridioides difficile is a significant concern in infection control. C. difficile, which resides in human intestines, poses a risk of transmission, especially when patients are in close contact with medical staff.

METHODS

To investigate the nosocomial transmission of C. difficile in a single center, we analyzed the genetic relationships of the bacteria. This was done using draft whole-genome sequencing (WGS) and examining single nucleotide polymorphisms (SNPs) in core-genome, alongside data regarding the patient's hospital wards and room changes. Our retrospective analysis covered 38 strains, each isolated from a different patient, between April 2014 and January 2015.

RESULTS

We identified 38 strains that were divided into 11 sequence types (STs). ST81 was the most prevalent (n = 11), followed by ST183 (n = 10) and ST17 (n = 7). A cluster of strains that indicated suspected nosocomial transmission (SNT) was identified through SNP analysis. The draft WGS identified five clusters, with 16 of 38 strains belonging to these clusters. There were two clusters for ST81 (ST81-SNT-1 and ST81-SNT-2), two for ST183 (ST183-SNT-1 and ST183-SNT-2), and one for ST17 (ST17-SNT-1). ST183-SNT-1 was the largest SNT cluster, encompassing five patients who were associated with Wards A, B, and K. The most frequent room changer was a patient labeled Pt08, who changed rooms seven times in Ward B. Patients Pt36 and Pt10, who were also in Ward B, had multiple admissions and discharges during the study period.

CONCLUSIONS

Additional culture tests and SNP analysis of C. difficile using draft WGS revealed silent transmission within the wards, particularly in cases involving frequent room changes and repeated admissions and discharges. Monitoring C. difficile transmission using WGS-based analysis could serve as a valuable marker in infection control management.

Therapeutics involved in managing initial and recurrent Clostridium difficile infection: An updated literature review

Clostridium difficile infection (CDI) has been increasing due to the effect of recurrent hospitalizations. The use of antibiotics has been shown to alter the gut microbiome and lead to CDIs. The treatment is limited to three major antibiotics; however, the incidence of recurrent CDIs has been increasing and drug resistance is a major concern. This aspect is a growing concern in modern medicine especially in the elderly population, critical care patients, and immunocompromised individuals who are at high risk of developing CDIs. Clostridium difficile can lead to various complications including septic shock and fulminant colitis that could prove to be lethal in these patients. Newer modalities of treatment have been developed including bezlotoxumab, a monoclonal antibody and fecal microbiota transplant. There have been studies showing asymptomatic carriers and drug resistance posing a major threat to the healthcare system. Newer treatment options are being studied to treat and prevent CDIs. This review will provide an insight into the current treatment modalities, prevention and newer modalities of treatment and challenges faced in the treatment of CDIs.

Comparison of fidaxomicin, thuricin CD, vancomycin and nisin highlights the narrow spectrum nature of thuricin CD

Vancomycin and metronidazole are commonly used treatments for Clostridioides difficile infection (CDI). However, these antibiotics have been associated with high levels of relapse in patients. Fidaxomicin is a new treatment for CDI that is described as a narrow spectrum antibiotic that is minimally active on the commensal bacteria of the gut microbiome. The aim of this study was to compare the effect of fidaxomicin on the human gut microbiome with a number of narrow (thuricin CD) and broad spectrum (vancomycin and nisin) antimicrobials. The spectrum of activity of each antimicrobial was tested against 47 bacterial strains by well-diffusion assay. Minimum inhibitory concentrations (MICs) were calculated against a select number of these strains. Further, a pooled fecal slurry of 6 donors was prepared and incubated for 24 h with 100 µM of each antimicrobial in a mini-fermentation system together with a no-treatment control. Fidaxomicin, vancomycin, and nisin were active against most gram positive bacteria tested in vitro, although fidaxomicin and vancomycin produced larger zones of inhibition compared to nisin. In contrast, the antimicrobial activity of thuricin CD was specific to C. difficile and some Bacillus spp. The MICs showed similar results. Thuricin CD exhibited low MICs (<3.1 µg/mL) for C. difficile and Bacillus firmus, whereas fidaxomicin, vancomycin, and nisin demonstrated lower MICs for all other strains tested when compared to thuricin CD. The narrow spectrum of thuricin CD was also observed in the gut model system. We conclude that the spectrum of activity of fidaxomicin is comparable to that of the broad-spectrum antibiotic vancomycin in vitro and the broad spectrum bacteriocin nisin in a complex community.

A Rare Case of Polymerase Chain Reaction-Negative Severe Clostridioides difficile Infection

Accurately diagnosing Clostridioides difficile infection (CDI) is crucial for effective patient management. A misdiagnosis poses risks to patients, leads to treatment delays, and contributes to infection transmission in healthcare settings. While using polymerase chain reaction (PCR) to amplify the toxin B gene is a sensitive method for detecting toxigenic C. difficile, there is still a risk of false-negative results. These inaccuracies could have significant consequences for diagnosing and treating CDI, emphasizing the need for careful consideration and other diagnostic approaches. This case report highlights a patient with severe CDI who had negative PCR and toxin and a biopsy showing pseudomembranous colitis on further testing due to persistence and worsening of symptoms. In the diagnosis of C. difficile infection, healthcare providers should consider clinical symptoms, although diarrhea, which is a major sign of CDI, can be due to other causes. Even in the presence of negative PCR results, if a patient displays symptoms consistent with C. difficile-associated disease, healthcare providers may still contemplate treatment.