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Background: This study was performed to determine the magnitude of Clostridioides difficile infection (CDI) in a tertiary care hospital in patients with antibiotic associated diarrhea (AAD) and to study the risk factors associated with this disease. Methods: A descriptive study was conducted in the department of Microbiology in a tertiary care hospital during December 2019 to May 2021. Stool samples were collected from patients with signs and symptoms of AAD who had been consuming antibiotic or anticancer drugs durng six weeks before the sampling. The samples were subjected to C. difficile glutamate dehydrogenase (GDH) enzyme and CD toxin A & B detection by Enzyme Linked Fluorescent Assay (ELFA). Patient’s demographic features and clinical details were noted and statistically correlated with the test results. Results: Among the total 70 samples tested 20 (28%) were positive for GDH alone and 12 (17%) were positive for both GDH and CD toxin A and B. Fluoroquinolones was a significant risk factor in the study. Sepsis and colitis was found to have significant association with C.difficile infection in our study. The crude mortality rate was 17%. Conclusion: Prompt and precise diagnosis and knowledge about the risk factors of CDI helps in effective management and prevention of CDI. [ABSTRACT FROM AUTHOR]

ABSTRACT Background: Clostridioides difficile infection (CDI) is a potentially severe disease that can present with refractoriness, recurrence, and evolution to death. In Brazil, the epidemiology of CDI seems to differ from that of the United States and most European countries, with only one ribotype (RT) 027-related case and a high prevalence of RT106. Objective: The aim of this study was to evaluate the outcomes of CDI and its possible association with ribotypes at a university hospital in Brazil. Methods: A total of 65 patients with CDI were included and stool samples were submitted to A/B toxin detection and toxigenic culture, and toxigenic isolates (n=44) were also PCR ribotyped. Results: Patients’ median age was 59 (20-87) years and there were 16 (24.6%) deaths. The median Charlson comorbidity index (CCI) was 4 (0-15) and 16.9% of the patients had CCI ≥8. The ATLAS score and non-improvement of diarrhea were related to higher mortality. A longer length of hospitalization was related to the enteral nutrition and use of multiple antibiotics. The period between CDI diagnosis and hospital discharge was longer in those who received new antibiotics after diagnosis, multiple antibiotics, and required intensive care treatment. Recurrence was associated with CCI >7. Twenty ribotypes were identified and RT106 was the most frequently detected strain (43.2%). No relationship was observed between the ribotypes and outcomes. CDI was present in patients with more comorbidities. Conclusion: Risk factors for higher mortality, longer hospital stay and recurrence were identified. A diversity of ribotypes was observed and C. difficile strains were not related to the outcomes.

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Background: This study was performed to determine the magnitude of Clostridioides difficile infection (CDI) in a tertiary care hospital in patients with antibiotic associated diarrhea (AAD) and to study the risk factors associated with this disease. Methods: A descriptive study was conducted in the department of Microbiology in a tertiary care hospital during December 2019 to May 2021. Stool samples were collected from patients with signs and symptoms of AAD who had been consuming antibiotic or anticancer drugs durng six weeks before the sampling. The samples were subjected to C. difficile glutamate dehydrogenase (GDH) enzyme and CD toxin A & B detection by Enzyme Linked Fluorescent Assay (ELFA). Patient’s demographic features and clinical details were noted and statistically correlated with the test results. Results: Among the total 70 samples tested 20 (28%) were positive for GDH alone and 12 (17%) were positive for both GDH and CD toxin A and B. Fluoroquinolones was a significant risk factor in the study. Sepsis and colitis was found to have significant association with C.difficile infection in our study. The crude mortality rate was 17%. Conclusion: Prompt and precise diagnosis and knowledge about the risk factors of CDI helps in effective management and prevention of CDI.

This article provides an overview of the field of probiotics and their potential benefits for human health. Probiotics are live microorganisms that can improve digestive disorders, infectious diarrhea, and antibiotic-associated diarrhea. They have also shown positive effects on immune function, brain function, weight loss, respiratory tract infections, and the prevention of allergic diseases. However, there are limitations and challenges in the prescription and consumption of probiotics, such as strain-specificity and lack of standard regulations. Further research and clinical trials are needed to establish optimal strains, dosages, and treatment durations, as well as to explore potential interactions with other medications or treatments. The article also includes a compilation of various research articles on probiotics, covering a wide range of topics related to their effects on human health. [Extracted from the article]

A recent article in the Journal of Infectious Diseases explores the potential use of loratadine, an over-the-counter antihistamine, as a treatment for Clostridioides difficile infection (CDI). The authors conducted preclinical studies using murine and hamster models, as well as human cell lines and colonic explants, to demonstrate the anti-inflammatory effects of loratadine in CDI. The findings suggest that loratadine may attenuate toxin B-mediated colonic inflammation, independent of histamine receptors but dependent on SRC and NFкB. However, the authors note that the optimal dosage of loratadine for CDI treatment is unclear, and further research is needed to assess its safety and efficacy in humans. [Extracted from the article]

To enhance immunomodulatory effects of lyophilized probiotics, we screened a new lyophilizing protective agent, that is Wolfiporia cocos polysaccharide (WP). This study demonstrated WP significantly increased the survival rate among seven polysaccharides, with the optimal dosage being 10 % (w / v). The ratio of bacterial suspension to lyophilizing protective agent was 1:2, in the condition, the probiotic survival rate of probiotics reached 83.06 %. Probiotic powder with WP (PWP) showed superior improvement in immune regulation and gut microbiota in antibiotic-associated diarrhea (AAD) mice compared to powder without WP. It notably increased IgM, IgG and IgA contents, and enhanced the activity of macrophage cells in the abdominal cavity. Furthermore, PWP exhibited the combined benefits of both the WP and PP in regulating the gut microbiota homeostasis, inhibiting the dysbiosis of the gut microbiota reflected in a significant increase in Proteobacteria, such as Sutterella , and decrease in Bacteroidetes, such as Muribaculaceae induced by AAD. Additionally, the correlation analysis indicated Sutterella had negative correlations with the immunomodulatory activities, meanwhile Muribaculace had positive correlations with the immunomodulatory activities. Overall, PWP could regulate the abundances of gut microbiota, thereby modulating immune activities and alleviating antibiotic-associated diarrhea, providing valuable insights for the development and application of WP in probiotics. [ABSTRACT FROM AUTHOR]

Probiotics are beneficial bacteria living in the microbiota ecosystem of the human body playing particular important roles in human health. The increasing rate of various diseases and the studies about the balance of gut microbiome made scientists trying to find novel therapies in this regard and hypothesize the relationships between the imbalance of gut microbiome and spread of various diseases especially in the immune system. Previous studies have indicated that when administrated in specific amounts, probiotics exert beneficial properties for human health such as antibacterial effects, cytotoxic effects, Hypocholesterolemic effects, immunomodulatory effects, wound healing effects etc. Probiotics also are known to produce nourishing healthy supplements for the human body such as vitamin K and B as well as healthy fatty acids. In this regard summarization of scientific evidence may help to familiarize the scientists with this novel area of research helping to find effective therapies for various disease. In this study, we used published literature in scientific databases such as Web of Science, Cochrane Library, Medline, PubMed, Science Direct, Scopus, as well as Google Scholar for data collection. So, the present review describes scientific-based evidence about probiotics and some of their beneficial effects to highlight the path for further researches about these beneficial bacteria.

Competing Interests: Potential conflicts of interest. Both authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr Ciaran Kelly has acted as a paid consultant to: Facile Therapeutics, Ferring Pharma, Finch, Fzata, Merck, Milkyway Life Sciences, Pfizer, Recursion, RVAC Medicines, Seres Therapeutics, Summit Therapeutics and has acted as a study investigator for: Milkyway Life Sciences and Merck.

Clostridium difficile infection (CDI) is a common and serious nosocomial infection worldwide. It is also problem in our hospital, a medical school in Khon Kaen University. Rationale use of antimicrobial in the treatment of CDI is still being questionable. This study aimed to explore the characteristic and evaluate the treatment of CDI in our setting. This retrospective cohort study was performed in 168 CDI patients admitted at Srinagarind Hospital between October 2013 and September 2016. Patient medical records were reviewed for demographics, comorbidities, antimicrobial exposures, treatments and clinical outcomes. Antimicrobial therapy for CDI was then evaluated in accordance with the current CDI guideline. Most CDI patients aged over 50 years (72.6%) and 42.8% aged over 65 years. Common comorbidities in the patients were cardiovascular disease (47.6%), diabetes mellitus (27.4%), chronic kidney disease (20.8%), malignancy (16.7%), cerebrovascular disease (11.3%), chronic hepatitis (3.6%) and chronic obstructive pulmonary disease (2.4%). Patients who had taken antimicrobial during hospitalization prior to CDI diagnosis constituted 83.9% of total study population. Metronidazole, vancomycin and both were initial therapy in 83.9, 4.8 and 11.3% of CDI, respectively. Appropriateness of CDI treatment in all terms was 44% and recovery rate was 62% of assessable cases. Nine patients (5.4%) died during hospitalization. In conclusion, most patients had CDI risk factors including elderly, comorbidity, antimicrobial exposure, and prolonged hospital stay. Inappropriate CDI treatment was found in asymptomatic carriers or inappropriate treatment duration. Initial therapy with metronidazole should change to oral vancomycin which was the first-line therapy in the current guidelines. [ABSTRACT FROM AUTHOR]

Clostridioides difficile (C. difficile) has been identified as the leading cause of antibiotic associated diarrhea (AAD). Co-carriage of an intact pathogenicity locus (PaLoc) with binary toxin genes in C. difficile strains seems to be linked with severe disease outcomes in the infected patients. Epidemiology of C. difficile infection (CDI) in hospital setting and knowledge about their genetic context help us to decrease the morbidity, mortality , and costs associated with Clostridioides difficile infection. In the present study was aimed to characterize genetic diversity of PaLoc among different C. difficile strains isolated from hospitalized patients and carriage of cytolethal distending toxin gene (cdt) in different hospitals. C. difficile strains were isolated from stool samples of inpatients referred to a reference laboratory from different hospitals and also outpatients with diarrhea, during 2008–2011. DNA was extracted from pure culture of the bacterium and PCR was performed for tcdA , tcdB , tcdE , tcdC , tcdD , and cdu2 genes. Carriage of two binary toxin genes cdtA , cdtB was also determined in these strains. To find clonal strains, similarity of genotypes and integrity of PaLoc among the isolates was compared in each hospital. The intact PaLoc was found most frequently among the isolates in the outpatients (19/51, 37.2%, Group I), while incomplete PaLoc found mostly in patients who were hospitalized in the infectious diseases and internal diagnosis wards. tcdA and tcdB genes were detected in different combinations among the studied strains. These strains showed tcdA + B + , tcdA + B −, and tcdA − B + genotypes in a frequency of 76.4% (39/51), 7.8% (4/51), and 17.6% (9/51), respectively. Analysis of gene composition of the PaLoc showed 19 distinct genotypes among the 51 strains. Accordingly, 38 strains were classified mainly into 6 regular groups, while the remaining strains showed heterogeneous patterns. tcdC − / tcdD − constituted the most common genotypic group among the strains with partial PaLoc (7/51, 13.7%). A hypertoxigenic genotype, tcdC −/ tcdA + / tcdB + , was detected in 2 strains (2/51, 3.9%). The intact genotype was also detected in a C. difficile isolate from outpatients. Cdt encoding genes toxins was observed in low numbers of the strains (7/52, 13.5%). All of cdtA + B + strains were belonged to PaLoc group 1 (intact genotype). Statistical analyses showed no correlation between particular genotypes and special wards of the hospitals (p value>0.05). Collectively, our results showed diversity of C. difficile strains in most wards of the studied hospitals. Diversity of PaLoc genotypes in the strains that isolated from the same wards proposed endogenous routes of the infection, as common cause of CDI in these patients. • Infection of C. difficile in hospital settings is mainly mediated by the strains representing intact PaLoc. • Endogenous route of CDI is assumed as common cause of infection due to diversity of PaLoc genotypes among the isolates. • Strategies should be designed for prevention of Infection with hypervirulent strains of C. difficile in hospitals. [ABSTRACT FROM AUTHOR]

The present study aimed to investigate whether probiotic recovery is affected when consumed together with antibiotics. Fecal samples were collected from an earlier antibiotic associated diarrhea, randomized, placebo-controlled study with a product consisting of a combination of Lactobacillus acidophilus NCFM, Lactobacillus paracasei Lpc-37, and Bifidobacterium lactis Bi-07, B. lactis Bl-04 at equal numbers and at a total dose of 1010 CFU. Fecal samples were collected during the screening visit (T0), i.e., at the time of antibiotic prescription, and then on the last day of the antibiotic treatment (T1) as well as seven days after the subject had stopped taking the antibiotic treatment (T2) and at two weeks after completing antibiotic treatment and one week after probiotic/placebo consumption stopped (T3). Samples were analyzed for the presence of the four administered strains. The study was registered at clinicaltrials.gov as NCT01596829. Detection levels of all four strains were significantly increased from T0 to T1 and returned to baseline level from T2 to T3. There were also significantly more subjects with detectable levels of L. paracasei Lpc-37, B. lactis Bi-07, and B. lactis Bl-04 at T1 and T2 compared to T0 and T3, and compared to placebo. Each of the four strains could be detected in the feces of patients apparently unaffected by the simultaneous consumption of antibiotics.

Background and Objectives: Clostridium difficile is responsible for 15-25% of nosocomial antibiotic associated diarrhea (AAD) cases and all cases of pseudomembranous colitis. C. difficile has two major virulence factors, toxin A (enterotoxin) and toxin B (cytotoxin). The aim of this study was to determine the frequency of C. difficile strains in patients with diarrhea in Babol' hospitals with toxigenic culture and PCR assay. Materials and Methods: One hundred stool specimens were taken from diarrheal patients in hospitals of the city of Babol. All patients had a history of antibiotic use. The samples were cultured on CCFA medium. In the next stage, toxigenic culture was performed for isolated C. difficile strains. Then, PCR assay was used to identify gdh, tcdA and tcdB genes among isolated C. difficile strains. Results: From the 100 stool samples, eight (8%) samples were positive in C. difficile culture. In toxigenic culture, two (2%) of these strains had cytopathic effects on Vero cells. All eight strains had the gdh gene. This gene is specific for C. difficile. Two strains that had cytopathic effects on toxigenic culture were positive for toxin genes. Conclusion: The frequency of toxigenic strains in different parts of the world is variable, and needs to be continually investigated. In the present study, the PCR method had a good correlation with toxigenic culture. Thus, it can replace the laborious and costly cell culture method.

Background and Objectives: Clostridium difficile is responsible for 15-25% of nosocomial antibiotic associated diarrhea (AAD) cases and all cases of pseudomembranous colitis. C. difficile has two major virulence factors, toxin A (enterotoxin) and toxin B (cytotoxin). The aim of this study was to determine the frequency of C. difficile strains in patients with diarrhea in Babol' hospitals with toxigenic culture and PCR assay. Materials and Methods: One hundred stool specimens were taken from diarrheal patients in hospitals of the city of Babol. All patients had a history of antibiotic use. The samples were cultured on CCFA medium. In the next stage, toxigenic culture was performed for isolated C. difficile strains. Then, PCR assay was used to identify gdh, tcdA and tcdB genes among isolated C. difficile strains. Results: From the 100 stool samples, eight (8%) samples were positive in C. difficile culture. In toxigenic culture, two (2%) of these strains had cytopathic effects on Vero cells. All eight strains had the gdh gene. This gene is specific for C. difficile. Two strains that had cytopathic effects on toxigenic culture were positive for toxin genes. Conclusion: The frequency of toxigenic strains in different parts of the world is variable, and needs to be continually investigated. In the present study, the PCR method had a good correlation with toxigenic culture. Thus, it can replace the laborious and costly cell culture method. [ABSTRACT FROM AUTHOR]

Objectives: Over the past two decades has been a dramatic worldwide increase in both incidence and severity of Clostridium Difficile infection (CDI). Several studies showed worse clinical outcomes in Inflammatory Bowel Disease (IBD) patients with CDI, including longer hospital stay, higher colectomy and mortality rates than in those without CDI. The aim of our study was to evaluate the prevalence of Clostridium difficile infection in IBD patients and to evaluate the particularities of diagnosis and treatment. Methodology: We performed a retrospective study that included 15 patients from a group of 220 IBD patients admitted in the Gastroenterology Department of the Clinical Emergency Hospital Bucharest between 2013- 2016 having also Clostridium Difficile infection. Results: The patients mean age was 44.1 years. The prevalence of CDI in patients with inflammatory bowel disease was 6.81%. Patients with ulcerative colitis were more susceptible to CDI (86.6%), than those with Crohn's disease (13.3%). We studied also the response to treatment. Metronidazole alone was effective in 33.3% of cases. Vancomycin combined with Metronidazole was effective in 60% of cases. Refractory CDI unresponsive to 48 hours of conventional therapy appeared in 6.6% of cases. The eradication was achieved only with Tigecycline and fecal microbiota transplant. Imunosupressive therapy was continued in all cases, concomitant with Metronidazole/Vancomicin. Conclusions: Patients with ulcerative colitis are at higher risk for CDI and have a poor prognosis than those with Crohn's disease. Average age of CDI in IBD patients significantly is lower than in general population. In IBD patients, presenting with diarrhea or a change in bowel habits, practitioners need to test for C. difficile and differentiate CDI symptoms from a disease flare. Special care to rule out C. difficile should be pursued prior to escalating or starting new immunosuppressive agents. Fecal microbiota transplant, probiotics, and newer antibiotics are good alternatives for refractory disease. [ABSTRACT FROM AUTHOR]

Clostridium difficile is the main infectious cause of antibiotic associated diarrhea (AAD). The objective of this study was to determine the frequency of C. difficile AAD in hospitalized patients. We searched MEDLINE (Pubmed), Embase, Web of Science and Cochrane library for subject headings and text words related to C. difficile AAD. Studies that investigated the prevalence or frequency of C. difficile AAD in health care settings were considered eligible. Using a random-effects model, data obtained from the identified studies were combined. Of the 2464 citations identified, twenty studies (5496 patients) met the inclusion criteria of the present study. Pooling all studies, the frequency of C. difficile among AAD patients was 20.0% (95% CI 13.0–28.0). The most frequently used antibiotics in health care settings were the following: Clindamycin, fluoroquinolones and cephalosporins. The current systematic review demonstrated the significant presence of C. difficile among patients with AAD. The limited and rational use of broad spectrum antibiotics and implementation of standard infection control measures are recommended to reduce the risk of C. difficile associated infections in hospitalized patients. [ABSTRACT FROM AUTHOR]

陈东风，陆军军医大学大坪医院消化内科及消化内镜中心主任，教授，主任 医师，博士研究生，博士生导师。近5年来在核心期刊上以第一作者及通信作者发表论文120 余篇，其中SCI论文17篇。共获得国家自然科学基金及国家科技部国家支撑计划等课题共10 项。现任中华医学会消化病分会常委、全军消化内科专委会副主任委员、中华医学会消化病 分会消化整合医学学组副组长、中华医学会肝病分会酒精肝与脂肪肝学组委员、中国医师协 会消化病分会委员、重庆市医学会消化疾病专委会前任主任委员，获全军育才“银奖”，第三军 医大学“教学明星”。对消化系统疑难疾病诊断和治疗有较深造诣，特别对消化内镜、消化血 管介入、肿瘤生物治疗等有丰富的临床经验。在国内首批开展干细胞移植治疗终末期肝病、 粪菌移植治疗重症炎症性肠病及细胞生物免疫治疗恶性肿瘤。 研究领域主要为消化系统肿瘤、慢性肝病的基础研究与临床诊治、干细胞的分化调控及 炎症性肠病等4个方向。任《中华肝脏病杂志》《中华消化杂志》《中华胰腺病杂志》《临床肝胆病杂志》《胃肠病及肝脏病杂 志》《实用肝脏病杂志》《第三军医大学学报》等10本学术期刊编委，主编《诊断学》《野战内科急救学》《消化系统疑难病例 诊治思维》3部专著。多次主办全国消化病学及肝脏病学学术大会，培养硕、博士研究生46名。 [ABSTRACT FROM AUTHOR]

Antibiotic associated diarrhea (AAD) is a common complication in childhood in the outpatient and inpatient settings. This review provides up to date information on the use of probiotics in the prevention and treatment of AAD, including that from Clostridium Difficile, in children. The most recently systematic reviews and subsequently published randomized controlleds trials are considered. Different single and multistrain probiotics are described; a specific recommendation for the use of Lactobacillus Rhamnosus GG (LGG) and Saccharomyces boulardii (Sb) emerges. New information on LGG survival under amoxicillin/clavulanate therapy in children is also provided. This information is relevant in view of the frequent use of this molecule in children, its association with AAD, and LGG’s sensitivity to penicillin that might make this probiotic ineffective. In spite of a demonstrated positive effect of specific strains of probiotics on AAD, safety issues still remain among which the risk of associated severe infections and of antibiotic resistant gene exchange. [ABSTRACT FROM AUTHOR]

In recent decade the prevalence of antibiotic associated diarrhea was increased because of more antibiotic usage. Colstridum difficile is a microorganism which can cause mild to severe colitis. But the only cause of colitis related to Antibiotics is not colstridum difficle. In this case report we explain a child whit antibiotic associated colitis due to klebsiella oxtyoca.

Gut microflora contribute greatly to immune and nutritive functions and act as a physical barrier against pathogenic organisms across the gut mucosa. Critical illness disrupts the balance between host and gut microflora, facilitating colonization, overgrowth, and translocation of pathogens and microbial products across intestinal mucosal barrier and causing systemic inflammatory response syndrome and sepsis. Commonly used probiotics, which have been developed from organisms that form gut microbiota, singly or in combination, can restore gut microflora and offer the benefits similar to those offered by normal gut flora, namely immune enhancement, improved barrier function of the gastrointestinal tract (GIT), and prevention of bacterial translocation. Enteral supplementation of probiotic strains containing either Lactobacillus alone or in combination with Bifidobacterium reduced the incidence and severity of necrotizing enterocolitis and all-cause mortality in preterm infants. Orally administered Lactobacillus casei subspecies rhamnosus, Lactobacillus reuteri, and Lactobacillus rhamnosus were effective in the prevention of late-onset sepsis and GIT colonization by Candida in preterm very low birth weight infants. In critically ill children, probiotics are effective in the prevention and treatment of antibiotic-associated diarrhea. Oral administration of a mix of probiotics for 1 week to children on broad-spectrum antibiotics in a pediatric intensive care unit decreased GIT colonization by Candida, led to a 50% reduction in candiduria, and showed a trend toward decreased incidence of candidemia. However, routine use of probiotics cannot be supported on the basis of current scientific evidence. Safety of probiotics is also a concern; rarely, probiotics may cause bacteremia, fungemia, and sepsis in immunocompromised critically ill children. More studies are needed to answer questions on the effectiveness of a mix versus single-strain probiotics, optimum dosage regimens and duration of treatment, cost effectiveness, and risk-benefit potential for the prevention and treatment of various critical illnesses.

Introduction:Clostridium difficileinfection (CDI) is the most common nosocomial infection in the U.S. 25% of CDI patients go on to develop recurrent CDI (rCDI) following current standard of care (SOC) therapy, leading to morbidity, mortality and economic loss. The first passive immunotherapy drug targetingC.difficiletoxin B (bezlotoxumab) has been approved recently by the FDA and EMA for prevention of rCDI. Areas covered: A body of key studies was selected and reviewed by the authors. The unmet needs in CDI care were ascertained with emphasis in rCDI, including the epidemiology, pathophysiology and current management. The current knowledge about the immune response toC. difficiletoxins and how this knowledge led to the development and the clinical use of bezlotoxumab is described. Current and potential future competitors to the drug were examined. Expert commentary: A single 10 mg/kg intravenous infusion of bezlotoxumab has been shown to decrease rCDI by ~40% (absolute reduction ~10%) in patients being treated for primary CDI or rCDI with SOC antibiotics. TargetingC.difficiletoxins by passive immunotherapy is a novel mechanism for prevention ofC.difficileinfection. Bezlotoxumab will be a valuable adjunctive therapy to reduce the burden of CDI. [ABSTRACT FROM PUBLISHER]

Currently, Clostridium difficile is the main reason of a nosocomial diarrhea, caused by uncontrolled antibacterial treatment. This problem is not paid, enough attention in our country. We analyzed. 536 cases of antibiotic associated infections using new immunochromotographical assay for express detection of Clostridium difficile. Since 2008 to 2011 evaluated rate of the positive tests was 28,7 % among the hospital patients. The first line therapy of this infection is vancomycine and metronidazole. We also observed increased incidence of mycosis, which accompanying the antibiotic associated diarrheas. During the same period the rate of Candida spp. infection was 50,8 % among the same patients. We used fluconazole and. amphotericine for the mycosis treatment. We also recommended to manage disbiosis during one year after discontinue of the treatment, and. we supposed reasonable to be managed by infectionist for this group of patients.

Objectives: Over the past two decades has been a dramatic worldwide increase in both incidence and severity of Clostridium Diffi cile infection (CDI). Several studies showed worse clinical outcomes in Inflammatory Bowel Disease (IBD) patients with CDI, including longer hospital stay, higher colectomy and mortality rates than in those without CDI. The aim of our study was to evaluate the prevalence of Clostridium diffi cile infection in IBD patients and to evaluate the particularities of diagnosis and treatment. Methodology: We performed a retrospective study that included 15 patients from a group of 220 IBD patients admitted in the Gastroenterology Department of the Clinical Emergency Hospital Bucharest between 2013- 2016 having also Clostridium Diffi cile infection. Results: The patients mean age was 44.1 years. The prevalence of CDI in patients with inflammatory bowel disease was 6.81%. Patients with ulcerative colitis were more susceptible to CDI (86.6%), than those with Crohn's disease (13.3%). We studied also the response to treatment. Metronidazole alone was effective in 33.3% of cases. Vancomycin combined with Metronidazole was effective in 60% of cases. Refractory CDI unresponsive to 48 hours of conventional therapy appeared in 6.6% of cases. The eradication was achieved only with Tigecycline and fecal microbiota transplant. Imunosupressive therapy was continued in all cases, concomitant with Metronidazole/Vancomicin. Conclusions: Patients with ulcerative colitis are at higher risk for CDI and have a poor prognosis than those with Crohn's disease. Average age of CDI in IBD patients signifi cantly is lower than in general population. In IBD patients, presenting with diarrhea or a change in bowel habits, practitioners need to test for C. diffi cile and differentiate CDI symptoms from a disease flare. Special care to rule out C. diffi cile should be pursued prior to escalating or starting new immunosuppressive agents. Fecal microbiota transplant, probiotics, and newer antibiotics are good alternatives for refractory disease. [ABSTRACT FROM AUTHOR]

Antibiotics are prescribed frequently for common childhood infections and Antibiotic-Associated Diarrhea (AAD) appear often in this children. AAD is unexplained diarrhea occurring between 2 hours to 2 months after starting antibiotics, where diarrhea is defined as more than 2 unformed stools for ≥2 days. Children younger than 6 years and type of antibiotics are the two risk factors identified for AAD. The antibiotics with which AAD was associated were: amoxycillin-clavulanate, cephalosporins, macrolides, trimethoprim-sulphamethoxazole and penicillin G and V. The most commonly mechanism for AAD is intestinal overgrowth with pathogenic microorganisms, especially Clostridium difficile, following alterations to the normal intestinal flora induced by antibiotics. Symptoms may range from a mild form of liquid diarrhea to a severe form of pseudomembranous colitis with abdominal pain, local, and systemic inflammation and a typical history of diarrhea that is chronologically related with antibiotic administration. Most of the AAD would respond to only discontinuation or change of the antibiotic, but in Clostridium difficile infection oral metronidazole or oral vancomycin are drugs of choice. Probiotics are increasingly used for prevention and treatment of diarrhea associated antibiotics in children. [ABSTRACT FROM AUTHOR]

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Introduction Antibiotic associated diarrhea (AAD) is common and frequently more severe in hospitalised elderly adults. It can lead to increased use of healthcare resources. We estimated the cost-effectiveness of a fermented milk with probiotic in preventing AAD and in particular Clostridium difficile associated diarrhea. Methods Clinical effectiveness data and cost information were incorporated in a model to estimate the cost impact of administering a fermented milk containing the probiotic Lactobacillus paracasei ssp paracasei CNCM I-1518 in a hospital setting. Preventing AAD by the consumption of the probiotic was compared to no preventive strategy. Results The probiotic intervention to prevent AAD generated estimated mean cost savings of £339 per hospitalised patient over the age of 65 years and treated with antibiotics, compared to no preventive probiotic. Estimated cost savings were sensitive to variation in the incidence of AAD, and to the proportion of patients who develop non-severe/severe AAD. However, probiotics remained cost saving in all sensitivity analyses. Conclusion Use of the fermented dairy drink containing the probiotic L.paracasei CNCM I-1518 to prevent AAD in older hospitalised patients treated with antibiotics could lead to substantial cost savings.

Objective: To explore the clinical efficacy of feeding joint subtilis bacillus probiotic through nose in the treatment of coma patients with antibiotic associated diarrhoea. Mehods: A total of 76 coma patients with antibiotic associated diarrhoea, who were diagnosed in Zhongshan Affiliated Hospital of Dalian University from January 2011 to January 2014, were chosen as subjects and randomly divided into control group (n=38) and experimental group (n=38). The control group was treated with basic therapy and montmorillonite powder astringent fed through nose, while the experimental group was added joint subtilis bacillus probiotic(Mei Chang An) fed through nose on the basis of control group's therapy. The improvement of symptoms and the laboratory examination indexes of the stool in the two groups before and after treatment were compared; the adverse reactions of the two groups were recorded. Results: 33 patients in the experimental group and 31 patients in the control group completed the trial except 4 cases of death and 8 cases of stopping feeding through nose due to the recovery of consciousness during the treatment process. The treatment effective rate of experimental group was significantly higher than that of control group (P<0.05). The white blood cell turning negative rate ( 81.8%) in the experimental group was significantly higher than that (30%) in the control group 6d after treatment (P<0.05). The correct rate of intestinal bacteria in the experimental group 6d after treatment and after treatment were 84.2% and 94.7% respectively, which were significantly higher than those(41.2%and 64.7%) in the control group, the differences were statistically significant(P<0.05). The incidence of adverse reactions in the control group was significantly higher than that in the experimental group (P<0.05). Conclusions: Feeding Joint subtilis bacillus probiotic through nose can significantly improve the symptoms of coma patients with antibiotic associated diarrhea, quickly correct the intestinal bacteria group, alleviate intestinal inflammation, with high safety, which is worthy of clinical promotion. [ABSTRACT FROM AUTHOR]

Clostridium difficile infection (CDI) is the leading cause of death due to gastrointestinal infections in the US and is the most common cause of nosocomial diarrhea. The emergence of a hypervirulent strain in the early 2000s has been associated with a dramatic increase in the number and severity of cases in the US, Canada, and several other countries. Most cases are related to antibiotic use, but sporadic cases occur in otherwise healthy individuals with no risk factors. Morbidity and mortality are highest in the elderly. Diagnosis is confirmed by detection of C. difficile toxin in the stools. Treatment should be stratified by severity of disease, with metronidazole use for mild disease cases and vancomycin for severe disease. Recurrent CDI occurs in 10-20 % of cases. A first recurrence can be treated with a ten-day regimen of metronidazole or vancomycin; a second recurrence is best treated by a pulsed regimen of vancomycin. In patients with multiple (three or more) recurrences, fecal microbiota transplant has a high rate of success. The most important methods of prevention are wise antibiotic policies, hand hygiene, isolation, and barrier methods in hospital and long-term care facilities (LCTF) settings. [ABSTRACT FROM AUTHOR]

Highlights: [•] The tested probiotics have a dose-response effect on antibiotic associated diarrhoea (AAD). [•] The tested probiotics reduce incidence and duration of AAD in a dose dependent manner. [•] The tested probiotics reduce severity of AAD related symptoms in a dose dependent manner. [ABSTRACT FROM AUTHOR]

Overuse of broad-spectrum antibiotics in community medicine has resulted in a significant increase in the incidence of antibiotic associated diarrhea in outpatients. This paper describes the cases of long diagnostic road from the onset of symptoms of diarrhea to accurate diagnosis and cure. The biggest problem was to convince the primary care physicians that the etiology of Clostridium difficile diarrhea occurs not only in hospitalized patients. New indications and guidelines should be determined for the proper diagnosis of diarrhea in outpatients, including diagnostics of C. difficile. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To probe into the pathogenesis and treatment regimen of antibiotic associated diarrhea (AAD), so as to provide reference for the clinical treatment and experience for the clinical pharmacists. METHODS: To introduce the treatment process of one significant case with AAD participated by the clinical pharmacists through summarizing and analyzing the essential clinical data and distinctive features of condition changes. RESULTS: After the adjustment of medication regimen, the patient's abdominal pain relieved, body temperature dropped and white cell counts recovered after only 24 hours. After treatment of 5 d, the routine blood leukocyte count was 11.87 ×109/L, ratio of neutrophile granulocyte was 73.91%. CONCLUSIONS: The clinic should identify AAD as early as possible and adjust treatment regimen timely, which can improve the quality of medical care; and the clinical emergency could turn the corner rapidly. It is suggested that the clinic should attach more importance to the anti-infective therapy. [ABSTRACT FROM AUTHOR]

Context: Keeping in view the recent flooding of the Indian market with antibiotic and probiotic combinations, we decided to look at the prevalence of antibiotic associated diarrhea (AAD) and Clostridium difficile infection (CDI) in children and reviewed evidence available for use of probiotics in the prevention of AAD. Evidence acquisition: We did a PubMed, Medline and Cochrane library search for literature available in last 25 years. Results: Prevalence of antibiotic associated diarrhea (AAD) is around 11%. Children younger than 2 years and type of antibiotics are the two risk factors identified for AAD. For the pediatric population, CDI reportedly decreased in a tertiary care hospital in India, though number of suspected samples tested increased. The incidence of community acquired CDI is increasing in the pediatric population also. Detection of toxin A and B by enzyme linked immunosorbent assay (ELISA) and detection of toxin B by tissue culture form the mainstay in the diagnosis of C. difficile. Most of the AAD would respond to only discontinuation or change of the antibiotic. Oral metronidazole or oral vancomycin are drugs of choice for CDI. Probiotics reduce the risk of AAD in children and for every 7-10 patients one less would develop AAD. Conclusion: Prevalence of AAD is low and majority will respond to discontinuation of antibiotic. CDI is uncommon in children. Probiotics will prevent AAD in only 1 in 7 children on antibiotics. We need cost effectiveness studies to decide the issue of needing a probiotic antibiotic combination to prevent AAD. [ABSTRACT FROM AUTHOR]

Abstract: Background: Recent data suggest that Clostridium difficile-associated diarrhea is becoming more severe and difficult to treat. Antibody responses to C. difficile toxin A are protective against symptomatic disease and recurrence. We examined the safety and pharmacokinetics (pk) of a novel neutralizing human monoclonal antibody against C. difficile toxin A (CDA1) in healthy adults. Methods: Five cohorts with 6 subjects each received a single intravenous infusion of CDA1 at escalating doses of 0.3, 1, 5, 10, and 20mg/kg. Safety evaluations took place on days 1, 2, 3, 7, 14, 28, and 56 post-infusion. Samples for pk analysis were obtained before and after infusion, and at each safety evaluation. Serum CDA1 antibody concentrations and human anti-human antibody (HAHA) titers were measured with enzyme-linked immunosorbent assays. A noncompartmental model was used for pk analysis. Results: Thirty subjects were enrolled. The median age was 27.5 yrs. There were no serious adverse events (AE) related to CDA1. Twenty-one of the 48 reported non-serious adverse events were possibly related to CDA1, and included transient blood pressure changes requiring no treatment, nasal congestion, headache, abdominal cramps, nausea, and self-limited diarrhea. Serum CDA1 concentrations increased with escalating doses: mean C max ranged from 6.82μg/ml for the 0.3mg/kg cohort to 511μg/ml for the 20mg/kg cohort. The geometric mean values of the half-life of CDA1 ranged between 25.3 and 31.8 days, and the volume of distribution approximated serum. No subject formed detectable HAHA titers. Conclusion: Administration of CDA1 as a single intravenous infusion was safe and well tolerated. C max increased proportionally with increasing doses. A randomized study of CDA1 in patients with C. difficile associated diarrhea is underway. [Copyright &y& Elsevier]

Copyright of Der Gastroenterologe is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revue Francaise des Laboratoires is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of EMC-Chirurgie is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Helicobacter pylori (Hp) eradication therapy alters gut microbiota, provoking gastrointestinal (GI) symptoms that could be improved by probiotics. The study aim was to assess the effect in Hp patients of a Test fermented milk containing yogurt and Lacticaseibacillus (L. paracasei CNCM I-1518 and I-3689, L. rhamnosus CNCM I-3690) strains on antibiotic associated diarrhea (AAD) (primary aim), GI-symptoms, gut microbiota, and metabolites. A randomised, double-blind, controlled trial was performed on 136 adults under 14-day Hp treatment, receiving the Test or Control product for 28 days. AAD and GI-symptoms were reported and feces analysed for relative and quantitative gut microbiome composition, short chain fatty acids (SCFA), and calprotectin concentrations, and viability of ingested strains. No effect of Test product was observed on AAD or GI-symptoms. Hp treatment induced a significant alteration in bacterial and fungal composition, a decrease of bacterial count and alpha-diversity, an increase of Candida and calprotectin, and a decrease of SCFA concentrations. Following Hp treatment, in the Test as compared to Control group, intra-subject beta-diversity distance from baseline was lower (padj = 0.02), some Enterobacteriaceae, including Escherichia-Shigella (padj = 0.0082) and Klebsiella (padj = 0.013), were less abundant, and concentrations of major SCFA (p = 0.035) and valerate (p = 0.045) were higher. Viable Lacticaseibacillus strains were detected during product consumption in feces. Results suggest that, in patients under Hp treatment, the consumption of a multi-strain fermented milk can induce a modest but significant faster recovery of the microbiota composition (beta-diversity) and of SCFA production and limit the increase of potentially pathogenic bacteria. [ABSTRACT FROM AUTHOR]

In recent decade the prevalence of antibiotic associated diarrhea was increased because of more antibiotic usage. Colstridum difficile is a microorganism which can cause mild to severe colitis. But the only cause of colitis related to Antibiotics is not colstridum difficle. In this case report we explain a child whit antibiotic associated colitis due to klebsiella oxtyoca. [ABSTRACT FROM AUTHOR]