The Strain and the Clinical Outcome of Clostridioides difficile Infection: A Meta-analysis.

Background: The association between bacterial strains and clinical outcomes in Clostridioides difficile infection (CDI) has yielded conflicting results across studies. We conducted a systematic review and meta-analyses to assess the impact of these strains. Methods: Five electronic databases were used to identify studies reporting CDI severity, complications, recurrence, or mortality according to strain type from inception to June 2022. Random effect meta-analyses were conducted to assess outcome proportions and risk ratios (RRs). Results: A total of 93 studies were included: 44 reported recurrences, 50 reported severity or complications, and 55 reported deaths. Pooled proportions of complications were statistically comparable between NAP1/BI/R027 and R001, R078, and R106. Pooled attributable mortality was 4.8% with a gradation in patients infected with R014/20 (1.7%), R001 (3.8%), R078 (5.3%), and R027 (10.2%). Higher 30-day all-cause mortality was observed in patients infected with R001, R002, R027, and R106 (range, 20%-25%).NAP1/BI/R027 was associated with several unfavorable outcomes: recurrence 30 days after the end of treatment (pooled RR, 1.98; 95% CI, 1.02-3.84); admission to intensive care, colectomy, or CDI-associated death (1.88; 1.09-3.25); and 30-day attributable mortality (1.96; 1.23-3.13). The association between harboring the binary toxin gene and 30-day all-cause mortality did not reach significance (RR, 1.6 [0.9-2.9]; 7 studies). Conclusions: Numerous studies were excluded due to discrepancies in the definition of the outcomes and the lack of reporting of important covariates. NAP1/BI/R027, the most frequently reported and assessed strain, was associated with unfavorable outcomes. However, there were not sufficient data to reach significant conclusions on other strains.

Isolated Fetal Sinus Bradycardia as a First Sign of Congenital Hypopituitarism.

We present a case of marked fetal sinus bradycardia as the sole presenting sign of congenital combined pituitary hormone deficiencies. Fetal sinus bradycardia < 120 beats/min was detected at 36 weeks of gestation during an otherwise uncomplicated pregnancy. Sinus bradycardia persisted after birth, and congenital hypothyroidism and growth hormone deficiencies were subsequently identified. Normal sinus rhythm was rapidly restored with hormone supplementation. Hypothyroidism and growth hormone deficiency should be considered in the differential diagnosis of unexplained perinatal sinus bradycardia because early diagnosis may help to avoid potential complications (ie, mental retardation, severe hypoglycemia, and growth anomaly).

Nous présentons un cas de bradycardie sinusale fœtale significative constituant l'unique signe de déficit hypophysaire combiné d'origine congénitale. Une bradycardie sinusale fœtale avec un rythme cardiaque inférieur à 120 battements par minute a été détectée au cours de la 36e semaine d'une grossesse par ailleurs sans complications. La bradycardie sinusale a persisté après la naissance. Une hypothyroïdie ainsi qu'un déficit en hormone de croissance d'origine congénitale ont été constatés ultérieurement. Une supplémentation hormonale a permis de normaliser rapidement le rythme sinusal. L'hypothyroïdie et le déficit en hormone de croissance doivent être pris en compte dans le diagnostic différentiel d'une bradycardie sinusale périnatale inexpliquée, car un diagnostic précoce peut aider à éviter des complications potentielles (retard mental, hypoglycémie sévère et anomalie de croissance).