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Antibiotics
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Clostridium difficile Infection
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Clostridium difficile Infection

A special issue of Antibiotics (ISSN 2079-6382).

Deadline for manuscript submissions: closed (30 April 2015) | Viewed by 96802

Special Issue Editor

Dr. Yung-Fu Chang

E-Mail Website
Guest Editor
Department of Population Medicine and Diagnostic Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853-6401, USA
Interests: Molecular biology; vaccine development; bacterial pathogenesis; immunopathology; host defense mechanisms; functional genomics and proteomics; molecular diagnosis
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

This issue of Antibiotics is dedicated to the topic of Clostridium difficile infection (CDI), treatment and prevention. Various antimicrobial agents have been used to treat CDIs; however, questions remain as to why some patients are at risk of treatment failure and recurrent infections. For this special issue, we invite the submission of both primary research manuscripts and review articles on topics related to CDI treatment and prevention, including antibiotics, small molecules, antibody and probiotics, their contribution to host defense, mechanisms of action, as well as drug resistance, mechanism of recurrence and their contribute to microbial pathogenesis.  Submitted manuscripts will be peer-reviewed to ensure that the issue contains high quality contributions. Collectively, this issue will provide the readership with the most up-to-date information on Clostridium difficile infection (CDI) treatment and prevention.

Prof. Dr. Yung-Fu Chang
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Antibiotics is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

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Published Papers (9 papers)

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Research

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730 KiB  
Article
A Multi-Faceted Approach of One Teaching Hospital NHS Trust during the Clostridium difficile Epidemic—Antibiotic Management and Beyond
by Helena White, Martin Wiselka and David Bell
Antibiotics 2016, 5(1), 13; https://doi.org/10.3390/antibiotics5010013 - 26 Feb 2016
Cited by 2 | Viewed by 6906
Abstract
The incidence of Clostridium difficile infection (CDI) in the UK rose dramatically during the early years of this century, in part associated with the emergence of the hyper-virulent ribotype 027 strain. The University Hospitals of Leicester (UHL), a 2000-bed acute UK NHS Trust, [...] Read more.
The incidence of Clostridium difficile infection (CDI) in the UK rose dramatically during the early years of this century, in part associated with the emergence of the hyper-virulent ribotype 027 strain. The University Hospitals of Leicester (UHL), a 2000-bed acute UK NHS Trust, implemented a number of interventions, which led to an 80% reduction in new cases over a twelve month period. Changes were introduced as a result of collaboration between the Infection Prevention team, the departments of Microbiology and Infectious Diseases, and with the support of the Trust Executive. These strategies are described in detail and included; implementation of antimicrobial stewardship, specific hygiene and cleaning measures, the introduction of a care pathway form for all infected patients, the opening of an isolation ward for patients with CDI, strengthened organisation and clinical management, and rigorous attention to education within the Trust. The implementations described are of continued relevance in the face of new infection challenges, such as the increasing incidence of multi-drug resistant organisms. Full article
(This article belongs to the Special Issue Clostridium difficile Infection)
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Review

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665 KiB  
Review
A Review of Management of Clostridium difficile Infection: Primary and Recurrence
by Yasmeen Vincent, Arif Manji, Kathleen Gregory-Miller and Christine Lee
Antibiotics 2015, 4(4), 411-423; https://doi.org/10.3390/antibiotics4040411 - 24 Sep 2015
Cited by 9 | Viewed by 6626
Abstract
Clostridium difficile infection (CDI) is a potentially fatal illness, especially in the elderly and hospitalized individuals. The recurrence and rates of CDI are increasing. In addition, some cases of CDI are refractory to the currently available antibiotics. The search for improved modalities for [...] Read more.
Clostridium difficile infection (CDI) is a potentially fatal illness, especially in the elderly and hospitalized individuals. The recurrence and rates of CDI are increasing. In addition, some cases of CDI are refractory to the currently available antibiotics. The search for improved modalities for the management of primary and recurrent CDI is underway. This review discusses the current antibiotics, fecal microbiota transplantation (FMT) and other options such as immunotherapy and administration of non-toxigenic Clostridium difficile (CD) for the management of both primary and recurrent CDI. Full article
(This article belongs to the Special Issue Clostridium difficile Infection)
649 KiB  
Review
Colonization Resistance of the Gut Microbiota against Clostridium difficile
by Ana Elena Pérez-Cobas, Andrés Moya, María José Gosalbes and Amparo Latorre
Antibiotics 2015, 4(3), 337-357; https://doi.org/10.3390/antibiotics4030337 - 7 Aug 2015
Cited by 63 | Viewed by 10204
Abstract
Antibiotics strongly disrupt the human gut microbiota, which in consequence loses its colonization resistance capacity, allowing infection by opportunistic pathogens such as Clostridium difficile. This bacterium is the main cause of antibiotic-associated diarrhea and a current problem in developed countries, since its [...] Read more.
Antibiotics strongly disrupt the human gut microbiota, which in consequence loses its colonization resistance capacity, allowing infection by opportunistic pathogens such as Clostridium difficile. This bacterium is the main cause of antibiotic-associated diarrhea and a current problem in developed countries, since its incidence and severity have increased during the last years. Furthermore, the emergence of antibiotic resistance strains has reduced the efficiency of the standard treatment with antibiotics, leading to a higher rate of relapses. Here, we review recent efforts focused on the impact of antibiotics in the gut microbiome and their relationship with C. difficile colonization, as well as, in the identification of bacteria and mechanisms involved in the protection against C. difficile infection. Since a healthy gut microbiota is able to avoid pathogen colonization, restoration of the gut microbiota seems to be the most promising approach to face C. difficile infection, especially for recurrent cases. Therefore, it would be possible to design probiotics for patients undergoing antimicrobial therapies in order to prevent or fight the expansion of the pathogen in the gut ecosystem. Full article
(This article belongs to the Special Issue Clostridium difficile Infection)
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780 KiB  
Review
Antimicrobial Resistance and Reduced Susceptibility in Clostridium difficile: Potential Consequences for Induction, Treatment, and Recurrence of C. difficile Infection
by Simon D. Baines and Mark H. Wilcox
Antibiotics 2015, 4(3), 267-298; https://doi.org/10.3390/antibiotics4030267 - 10 Jul 2015
Cited by 59 | Viewed by 17193
Abstract
Clostridium difficile infection (CDI) remains a substantial burden on healthcare systems and is likely to remain so given our reliance on antimicrobial therapies to treat bacterial infections, especially in an aging population in whom multiple co-morbidities are common. Antimicrobial agents are a key [...] Read more.
Clostridium difficile infection (CDI) remains a substantial burden on healthcare systems and is likely to remain so given our reliance on antimicrobial therapies to treat bacterial infections, especially in an aging population in whom multiple co-morbidities are common. Antimicrobial agents are a key component in the aetiology of CDI, both in the establishment of the infection and also in its treatment. The purpose of this review is to summarise the role of antimicrobial agents in primary and recurrent CDI; assessing why certain antimicrobial classes may predispose to the induction of CDI according to a balance between antimicrobial activity against the gut microflora and C. difficile. Considering these aspects of CDI is important in both the prevention of the infection and in the development of new antimicrobial treatments. Full article
(This article belongs to the Special Issue Clostridium difficile Infection)
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604 KiB  
Review
Fecal Microbiota Transplantation: Expanding Horizons for Clostridium difficile Infections and Beyond
by Thomas J. Borody, Debra Peattie and Scott W. Mitchell
Antibiotics 2015, 4(3), 254-266; https://doi.org/10.3390/antibiotics4030254 - 6 Jul 2015
Cited by 11 | Viewed by 8957
Abstract
Fecal Microbiota Transplantation (FMT) methodology has been progressively refined over the past several years. The procedure has an extensive track record of success curing Clostridium difficile infection (CDI) with remarkably few adverse effects. It achieves similar levels of success whether the CDI occurs [...] Read more.
Fecal Microbiota Transplantation (FMT) methodology has been progressively refined over the past several years. The procedure has an extensive track record of success curing Clostridium difficile infection (CDI) with remarkably few adverse effects. It achieves similar levels of success whether the CDI occurs in the young or elderly, previously normal or profoundly ill patients, or those with CDI in Inflammatory Bowel Disease (IBD). While using FMT to treat CDI, however, we learned that using the procedure in other gastrointestinal (GI) diseases, such as IBD without CDI, generally fails to effect cure. To improve results in treating other non-CDI diseases, innovatively designed Randomized Controlled Trials (RCTs) will be required to address questions about mechanisms operating within particular diseases. Availability of orally deliverable FMT products, such as capsules containing lyophilised fecal microbiota, will simplify CDI treatment and open the door to convenient, prolonged FMT delivery to the GI tract and will likely deliver improved results in both CDI and non-CDI diseases. Full article
(This article belongs to the Special Issue Clostridium difficile Infection)
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800 KiB  
Review
Antimicrobial Use, Human Gut Microbiota and Clostridium difficile Colonization and Infection
by Caroline Vincent and Amee R. Manges
Antibiotics 2015, 4(3), 230-253; https://doi.org/10.3390/antibiotics4030230 - 3 Jul 2015
Cited by 53 | Viewed by 10326
Abstract
Clostridium difficile infection (CDI) is the most important cause of nosocomial diarrhea. Broad-spectrum antimicrobials have profound detrimental effects on the structure and diversity of the indigenous intestinal microbiota. These alterations often impair colonization resistance, allowing the establishment and proliferation of C. difficile in [...] Read more.
Clostridium difficile infection (CDI) is the most important cause of nosocomial diarrhea. Broad-spectrum antimicrobials have profound detrimental effects on the structure and diversity of the indigenous intestinal microbiota. These alterations often impair colonization resistance, allowing the establishment and proliferation of C. difficile in the gut. Studies involving animal models have begun to decipher the precise mechanisms by which the intestinal microbiota mediates colonization resistance against C. difficile and numerous investigations have described gut microbiota alterations associated with C. difficile colonization or infection in human subjects. Fecal microbiota transplantation (FMT) is a highly effective approach for the treatment of recurrent CDI that allows the restoration of a healthy intestinal ecosystem via infusion of fecal material from a healthy donor. The recovery of the intestinal microbiota after FMT has been examined in a few reports and work is being done to develop custom bacterial community preparations that could be used as a replacement for fecal material. Full article
(This article belongs to the Special Issue Clostridium difficile Infection)
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828 KiB  
Review
Doxycycline and Tigecycline: Two Friendly Drugs with a Low Association with Clostridium Difficile Infection
by Yuan-Pin Hung, Jen-Chieh Lee, Hsiao-Ju Lin, Hsiao-Chieh Liu, Yi-Hui Wu, Pei-Jane Tsai and Wen-Chien Ko
Antibiotics 2015, 4(2), 216-229; https://doi.org/10.3390/antibiotics4020216 - 19 Jun 2015
Cited by 15 | Viewed by 9659
Abstract
Clostridium difficile infection (CDI) is known to be associated with prior exposure to many classes of antibiotics. Standard therapy for CDI (i.e., metronidazole and vancomycin) is associated with high recurrence rates. Although tetracycline derivatives such as tetracycline, doxycycline or tigecycline are [...] Read more.
Clostridium difficile infection (CDI) is known to be associated with prior exposure to many classes of antibiotics. Standard therapy for CDI (i.e., metronidazole and vancomycin) is associated with high recurrence rates. Although tetracycline derivatives such as tetracycline, doxycycline or tigecycline are not the standard therapeutic choices for CDI, they may serve as an alternative or a component of combination therapy. Previous tetracycline or doxycycline usage had been shown to have less association with CDI development. Tigecycline, a broad-spectrum glycylcycline with potency against many gram-positive or gram-negative pathogens, had been successfully used to treat severe or refractory CDI. The in vitro susceptibility of C. difficile clinical isolates to tigecycline in many studies showed low minimal inhibitory concentrations. Tigecycline can suppress in vitro toxin production in both historical and hypervirulent C. difficile strains and reduce spore production in a dose-dependent manner. Tetracycline compounds such as doxycycline, minocycline, and tigecycline possess anti-inflammatory properties that are independent of their antibiotic activity and may contribute to their therapeutic effect for CDI. Although clinical data are limited, doxycycline is less likely to induce CDI, and tigecycline can be considered one of the therapeutic choices for severe or refractory CDI. Full article
(This article belongs to the Special Issue Clostridium difficile Infection)
487 KiB  
Review
The Antimicrobial Stewardship Approach to Combating Clostridium Difficile
by Eric Wenzler, Surafel G. Mulugeta and Larry H. Danziger
Antibiotics 2015, 4(2), 198-215; https://doi.org/10.3390/antibiotics4020198 - 17 Jun 2015
Cited by 15 | Viewed by 8605
Abstract
Clostridium difficile remains a major public health threat and continues to contribute to excess morbidity, mortality and healthcare costs. Antimicrobial stewardship programs have demonstrated success in combating C. difficile, primarily through antibiotic restrictive strategies. As the incidence and prevalence of C. difficile [...] Read more.
Clostridium difficile remains a major public health threat and continues to contribute to excess morbidity, mortality and healthcare costs. Antimicrobial stewardship programs have demonstrated success in combating C. difficile, primarily through antibiotic restrictive strategies. As the incidence and prevalence of C. difficile associate disease continues to increase both in the hospital and community setting, additional stewardship approaches are needed. This manuscript reviews stewardship interventions that have been successful against C. difficile associated disease and proposes future tactics that antimicrobial stewardship programs may employ to develop a more global approach to combat this difficult pathogen. Full article
(This article belongs to the Special Issue Clostridium difficile Infection)
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780 KiB  
Review
Probiotics for the Primary and Secondary Prevention of C. difficile Infections: A Meta-analysis and Systematic Review
by Lynne V. McFarland
Antibiotics 2015, 4(2), 160-178; https://doi.org/10.3390/antibiotics4020160 - 13 Apr 2015
Cited by 83 | Viewed by 17072
Abstract
Clostridium difficile infections are a global clinical concern and are one of the leading causes of nosocomial outbreaks. Preventing these infections has benefited from multidisciplinary infection control strategies and new antibiotics, but the problem persists. Probiotics are effective in preventing antibiotic-associated diarrhea and [...] Read more.
Clostridium difficile infections are a global clinical concern and are one of the leading causes of nosocomial outbreaks. Preventing these infections has benefited from multidisciplinary infection control strategies and new antibiotics, but the problem persists. Probiotics are effective in preventing antibiotic-associated diarrhea and may also be a beneficial strategy for C. difficile infections, but randomized controlled trials are scarce. This meta-analysis pools 21 randomized, controlled trials for primary prevention of C. difficile infections (CDI) and four trials for secondary prevention of C. difficile recurrences and assesses the efficacy of specific probiotic strains. Four probiotics significantly improved primary CDI prevention: (Saccharomyces boulardii, Lactobacillus casei DN114001, a mixture of L. acidophilus and Bifidobacterium bifidum, and a mixture of L. acidophilus, L. casei and L. rhamnosus). None of the tested probiotics significantly improved secondary prevention of CDI. More confirmatory randomized trials are needed to establish if probiotics are useful for preventing C. difficile infections. v Full article
(This article belongs to the Special Issue Clostridium difficile Infection)
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