Infecciones por Clostridioides difficile en pediatría. La visión del laboratorio a partir del diagnóstico microbiológico / Clostridioides difficile infections in pediatrics. The view of the laboratory based on microbiological diagnosis

La infección por Clostridioides difficile (ICD) es la principal responsable de diarreas nosocomiales en adultos. En los últimos años se registró un aumento en la incidencia de la ICD en la población adulta que, en cambio, no fue bien caracterizado en pediatría. El objetivo de este trabajo es analizar los datos resultantes del diagnóstico microbiológico de ICD en el Hospital de Pediatría "Prof. Dr. Juan P. Garrahan". Materiales y métodos: se realizó un estudio retrospectivo observacional descriptivo que abarcó desde el 01/01/2018 hasta el 31/12/2021. El diagnóstico se realizó mediante enzimoinmunoensayo para glutamato deshidrogenasa (GDH) y toxinas en materia fecal (MF). Cuando sólo se detectó GDH, se realizó un cultivo toxigénico (CT) de la MF para la detección de toxinas in vitro. Se registraron: edad, sexo y procedencia de los pacientes y recurrencias de las ICD. Se efectuaron estudios de sensibilidad de 387 cepas de C. difficile a metronidazol (MTZ) y vancomicina (VAN). Resultados: en 6632 muestras (1764 pacientes) se registraron 649 estudios positivos (9,8%) (139 pacientes), la mayoría correspondieron a pacientes internados en áreas no críticas. Edad promedio: 7 años (7 ± 4,7). Sexo: 55% masculino. Recurrencias: 62 (45%). Positivos detectados mediante CT: 43%. Sensibilidad antibiótica: 100% a MTZ y 99,7% a VAN. Conclusión: Nuestra población presenta un bajo porcentaje de positividad. Se destaca el rendimiento del CT que permitió el diagnóstico de más de un tercio de los casos. MTZ y VANCO tuvieron excelente actividad in vitro frente a C. difficile (AU)

Clostridioides difficile infection (CDI) is the main cause of nosocomial diarrhea in adults. In recent years there has been an increase in the incidence of CDI in the adult population; however, CDI has not been well characterized in pediatrics. The aim of this study was to analyze the data resulting from the microbiological diagnosis of CDI at Hospital de Pediatría Prof. Dr. Juan P. Garrahan. Materials and methods: a retrospective, observational and descriptive study was conducted from 01/01/2018 to 12/31/2021. Diagnosis was made using enzyme immunoassay for glutamate dehydrogenase (GDH) and toxins in stools. When only GDH was detected, toxigenic culture (TC) of stools was performed for in vitro toxin detection. The age, sex and origin of patients and CDI recurrences were recorded. Sensitivity studies of 387 strains of C. difficile to metronidazole (MTZ) and vancomycin (VAN) were performed. Results: In 6,632 samples (1,764 patients), 649 positive results (9.8%) were recorded (139 patients), most of which corresponded to patients hospitalized in noncritical areas. Mean age: 7 years (7 ± 4.7). Sex: 55% male. Recurrences: 62 (45%). TC-positive results: 43%. Antibiotic sensitivity: 100% to MTZ and 99.7% to VAN. Conclusion: A low percentage of positivity was found in our population. The performance of TC was outstanding, allowing for the diagnosis of more than one third of the cases. MTZ and VANCO had excellent in vitro activity against C. difficile (AU)

Diagnóstico microbiológico de infección por Clostridioides difficile en épocas de COVID-19 en un hospital pediátrico de alta complejidad / Microbiological diagnosis of Clostridioides difficile infection in times of COVID-19 in a high complexity pediatric hospital

Resumen La infección por Clostridioides difficile (ICD) puede variar desde diarrea hasta megacolon tóxico. Los objetivos del trabajo fueron mostrar la variación en el número de casos diagnosticados de ICD en este laboratorio entre 2020, cuando comenzó la pandemia de COVID-19 y 2019 y 2021 y detallar los casos precedidos por la infección de SARS-CoV-2. El presente es un estudio retrospectivo observacional en el que se registraron el número total de muestras procesadas con sospecha de ICD y el de positivas y los antecedentes clínicos de pacientes con ICD hasta dos meses después de su diagnóstico de COVID-19. Durante 2020 se procesaron menos muestras que en 2019 y 2021; sin embargo, el porcentaje de positividad fue de 13,1%, 7,2% y 7,8%, respectivamente. Esto pudo deberse a mejoras en el criterio clínico al momento de seleccionar las muestras con sospecha de ICD.

Abstract Clostridioides difficile infection (CDI) can cause anything from diarrhea to toxic megacolon. The objectives of this study were: to show the variation in the number of diagnosed cases of CDI in this center, comparing 2020, when the COVID-19 pandemic began, with 2019 and 2021 and to detail cases preceded by SARS-CoV-2 infection. This is an observational retrospective study in which the total number of samples processed with suspected CDI were recorded. The positive ones and the clinical history of patients with a diagnosis of CDI up to two months after their diagnosis of SARS-CoV-2 infection were recorded as well. During 2020 a smaller number of samples were processed. However, during this year the percentage of positivity was 13.1% vs. 7,2% and 7.8% during 2019 and 2021, respectively. It is believed that this may have been due to improvements in clinical suspicion and sample selection for CDI diagnosis.

Resumo A infecção por Clostridioides difficile (ICD) pode causar desde diarreia até megacólon tóxico. Os objetivos desta apresentação foram: mostrar a variação do número de casos diagnosticados de ICD neste laboratório, entre 2020 quando começou a pandemia de COVID-19 e 2019 e 2021 e, detalhar os casos precedidos pela infecção por SARS-CoV-2. Esse estudo foi retrospectivo observacional e foram registrados: o número total de amostras processadas com suspeita de ICD e de amostras positivas e os antecedentes clínicos daqueles pacientes com diagnóstico de ICD até dois meses após o diagnóstico de COVID 19. Durante 2020, foram processadas menos amostras do que em 2019 e 2021; no entanto, o percentual de positividade foi de 13,1%, 7,2% e 7,8%, respectivamente. Isso pode ter sido resultado de melhorias no critério clínico na hora de selecionar as amostras com suspeita de ICD.

Progress in probiotics for treating Clostridioides difficile infection / 中华微生物学和免疫学杂志

Clostridioides difficile infection (CDI) is an infectious disease with fever, abdominal pain and diarrhea as the main clinical manifestations. At present, CDI is mainly treated with antibiotics and faecal microbiota transplantation. As recurrent and refractory CDI continues to increase, it is important to seek a more effective alternative therapy. However, many of the studies on the prevention and control of CDI by probiotics are still in the early stage. This paper summarized the research on the types, mechanisms and technical means of probiotics in the treatment of CDI.

Assessing risk factors, mortality, and healthcare utilization associated with Clostridioides difficile infection in four Latin American countries

ABSTRACT Background: Clostridioides difficile infection (CDI) is the most common cause of healthcare-associated infections in Western countries. Risk factors, mortality, and healthcare utilization for CDI in Latin America are poorly understood. This study assessed risk factors and burden associated with nosocomial CDI in four Latin American countries. Methods: This retrospective, case-control study used databases and medical records from 8 hospitals in Argentina, Brazil, Chile, and Mexico to identify nosocomial CDI cases from 2014 − 2017. Cases were patients aged ≥18 years with diarrhea and a positive CDI test ≥72 h after hospital admission. Two controls (without diarrhea; length of hospital stay [LOS] ≥3 days; admitted ±14 days from case patient; shared same ward) were matched to each case. CDI-associated risk factors were assessed by univariate and multivariable analyses. CDI burden (LOS, in-hospital mortality) was compared between cases and controls. Results: The study included 481 cases and 962 controls. Mean age and sex were similar between cases and controls, but mean Charlson comorbidity index (4.3 vs 3.6; p< 0.001) and recent hospital admission (35.3% vs 18.8%; p< 0.001) were higher among cases. By multivariable analyses, CDI risk was associated with prior hospital admission within 3 months (odds ratio [OR], 2.08; 95% CI: 1.45, 2.97), recent antibiotic use (ie, carbapenem; OR, 2.85; 95% CI: 1.75, 4.64), acid suppressive therapy use (OR, 1.71; 95% CI: 1.14, 2.58), and medical conditions (ie, renal disease; OR, 1.48; 95% CI: 1.19, 1.85). In-hospital mortality rate (18.7% vs 6.9%; p< 0.001) and mean overall LOS (33.5 vs 18.8 days; p< 0.001) were higher and longer, respectively, in cases versus controls. Conclusion: Antibiotic exposure, preexisting medical conditions, and recent hospital admission were major risk factors for CDI in Argentina, Brazil, Chile, and Mexico. CDI was associated with increased in-hospital risk of death and longer LOS. These findings are consistent with published literature in Western countries.

Estudo epidemiológico e caracterização de coorte de pacientes com infecção por Clostridioides difficile internados no Hospital das Clínicas da UFMG / Epidemiological study and characterization of a cohort of patients with Clostridioides difficile infection hospitalized at the Hospital das Clínicas of UFMG

Introdução: a infecção por Clostridioides difficile (ICD) é a principal causa bacteriana de diarreia infecciosa associada aos cuidados de saúde e é responsável por significativa morbimortalidade, assim como por custos elevados relacionados ao tratamento em todo o mundo. Na Europa e nos Estados Unidos a densidade de incidência varia entre 2,9 e 8,3 casos/10.000 pacientes-dia. Não existem dados precisos sobre a taxa de incidência na América Latina. Objetivos: obter a medida da densidade de incidência da ICD associada aos cuidados de saúde em hospital de alta complexidade e descrever o perfil desta coorte de pacientes. Métodos: foi realizada busca ativa diária de casos de diarreia durante o período de 3 meses, entre abril e julho de 2021. Os casos suspeitos foram submetidos ao teste rápido para pesquisa da glutamato desidrogenase (GDH) e das toxinas A e B de C. difficile. Nas amostras positivas apenas para o GDH, a confirmação diagnóstica foi feita por meio da cultura toxigênica. Resultados: foram identificados 104 pacientes com diarreia e o C. difficile toxigênico foi responsável por 21 casos. A densidade de incidência foi de 9,2 casos para cada 10.000 pacientes-dia. A mediana de idade dos pacientes com ICD foi de 63 (19-80) anos, 57,1% eram do sexo masculino e a média do Índice de Comorbidades de Charlson foi de 4,10 (±2,49). Dezessete pacientes (81%) fizeram uso de antibiótico (ATB) nos 3 meses que precederam a infecção e a média do número de ATB foi de 3,29 (±2,72). A ICD foi considerada grave em 11 pacientes (52,4%). Vancomicina foi opção inicial de tratamento em 14 pacientes (66,7%), e 11 pacientes (52,4%) apresentaram resposta até o quinto dia. Dois pacientes estavam no segundo episódio de ICD e um paciente apresentou recorrência após período de recrutamento. Ocorreram três óbitos, provavelmente não relacionados à ICD. Conclusão: a medida da densidade de incidência foi alta e aponta para a necessidade de medidas que visem melhor controle da infecção. A amostra de pacientes foi caracterizada como complexa, com múltiplas comorbidades, uso recente de vários ATB e mortalidade alta.

Introduction: Clostridioides difficile (ICD) infection is the leading bacterial cause of healthcare-associated infectious diarrhea and it is responsible for significant morbidity and mortality rates, as well as treatment-related costs worldwide. In Europe and the United States, the incidence density varies between 2.9 and 8.3 cases/10,000 patient-days. There is no precise data about the incidence rate in Latin America. Objectives: get the measure of the incidence density of healthcare-related ICD in a high-complexity hospital and to define the profile of this cohort of patients. Methods: daily active search for diarrhea cases was carried out during a 3-month period, between April and July 2021. Suspected cases were submitted to a rapid test for glutamate dehydrogenase (GDH) and C. difficile toxins A and B. In samples positive only for GDH, diagnostic confirmation was made through toxigenic culture. Results: 104 patients with diarrhea were identified and toxigenic C. difficile was responsible for 21 cases. The incidence density was 9.2 cases for every 10,000 patient-days. The median age of patients with ICD was 63 (19-80) years, 57.1% were male and the mean Charlson Comorbidity Index was 4.10 (±2.49). Seventeen patients (81%) used antibiotics (ATB) in the 3 months preceding the infection and the mean number of ATB was 3.29 (±2.72). ICD was considered severe in 11 patients (52.4%). Vancomycin was the initial treatment option in 14 patients (66.7%) and 11 patients (52,4%) responded by the fifth day. Two patients were in the second episode of ICD and one patient had recurrence after the recruitment period. There were three deaths, probably unrelated to CDI. Conclusion: The measure of incidence density was high and points to the need for measures aimed at better infection control. The sample of patients was characterized as complex, with multiple comorbidities, recent use of multiple ATB and high mortality.