Improving care for patients with Clostridioides difficile infection: A clinical practice and healthcare systems perspective.

Introduction: Arriving at a C. difficile infection (CDI) diagnosis, treating patients and dealing with recurrences is not straightforward, but a comprehensive and well-rounded understanding of what is needed to improve patient care is lacking. This manuscript addresses the paucity of multidisciplinary perspectives that consider clinical practice related and healthcare system-related challenges to optimizing care delivery. Methods: We draw on narrative review, consultations with clinical experts and patient representatives, and a survey of 95 clinical and microbiology experts from the UK, France, Italy, Australia and Canada, adding novel multi-method evidence to the knowledge base. Results and discussion: We examine the patient pathway and variations in clinical practice and identify, synthesize insights on and discuss associated challenges. Examples of key challenges include the need to conduct multiple tests for a conclusive diagnosis, treatment side-effects, the cost of some antibiotics and barriers to access of fecal microbiota transplantation, difficulties in distinguishing recurrence from new infection, workforce capacity constraints to effective monitoring of patients on treatment and of recurrence, and ascertaining whether a patient has been cured. We also identify key opportunities and priorities for improving patient care that target both clinical practice and the wider healthcare system. While there is some variety across surveyed countries' healthcare systems, there is also strong agreement on some priorities. Key improvement actions seen as priorities by at least half of survey respondents in at least three of the five surveyed countries include: developing innovative products for both preventing (Canada, Australia, UK, Italy, and France) and treating (Canada, Australia, and Italy) recurrences; facilitating more multidisciplinary patient care (UK, Australia, and France); updating diagnosis and treatment guidelines (Australia, Canada, and UK); and educating and supporting professionals in primary care (Italy, UK, Canada, and Australia) and those in secondary care who are not CDI experts (Italy, Australia, and France) on identifying symptoms and managing patients. Finally, we discuss key evidence gaps for a future research agenda.

The Problem of the Antibacterial Drugs Using in the COVID-19 Infection’s Era

Introduction. The COVID-19 infection has made its own adjustments not only to public life, but also had a significant impact on the healthcare system. The rapid spread of this infection around the globe caused an explosive rise in the incidence with the development of pneumonia. In this connection, one of the first drugs in therapy was antibacterial. The widespread use of antibacterial drugs in the first year of the pandemic led to an increase in the resistance of microorganisms and an increase in the number of cases of C. difficile infection. Purpose. To assess the state of resistance of clinically significant microorganisms in patients with COVID-19. Materials and methods. The study included clinically significant isolates of microorganisms isolated from the biological material of infectious patients. Who were hospitalized at the City Clinical Infectious Diseases Hospital in 2019–2021. We studied 159 isolates of microorganisms isolated from blood samples, CSF, and 198 C. difficile isolates isolated from patients treated at the City Clinical Infectious Diseases Hospital. Results. The ratio of microorganisms from sterile material has changed. In 2019, more than half of all isolated microorganisms were S. aureus, in 2020 A. baumannii became dominant, and in 2021 – S. aureus and K. pneumoniae. An increase in antibiotic resistance of K. pneumoniae, S. aureus, P. aeruginosa was noted. The resistance of A. baumannii has changed. The number of cases of C. difficile infection has increased. Conclusion. The widespread use of antibacterial drugs also affected the sensitivity of microorganisms inoculated from patients of the infectious disease hospital in Minsk. Thus, the antibiotic resistance of both the gram negative flora and the gram positive flora increased;increased number of cases of C. difficile infection. © 2022, Professionalnye Izdaniya. All rights reserved.

Maintaining standard volumes, efficacy and safety, of fecal microbiota transplantation for C. difficile infection during the COVID-19 pandemic: A prospective cohort study.

BACKGROUND: Fecal microbiota transplantation (FMT) can be a life-saving treatment against recurrent Clostridioides difficile infection (CDI). It is therefore necessary to maintain this procedure available for these patients during the COVID-19 pandemic while keeping high efficacy and safety standards. AIMS: To report outcomes of a FMT service that has adapted its operational workflow during COVID-19 pandemic to continue offering FMT to patients with CDI. METHODS: All patients with CDI referred to our center for FMT during pandemic were prospectively included. Each step of the FMT working protocol was adapted with specific security measures to prevent the transmission of SARS-CoV-2. RESULTS: Of 26 patients evaluated for FMT, 21 were treated for recurrent or refractory CDI. Eighteen patients completed the 8-week follow-up, and no one recurred after FMT. Follow-up is ongoing in 3 patients, although in all of them diarrhea disappeared after the first procedure. No serious adverse events were reported. Two patients had also COVID-19-related pneumonia, and were cured both from CDI and COVID-19. CONCLUSION: This is the first report to show that it is possible to maintain standard volumes, efficacy and safety of FMT for recurrent CDI during the COVID-19 pandemic, by adopting specific changes in the operational workflow.