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Toxin Enzyme #Immunoassays Detect #Clostridioides difficile Infection with Greater Severity and Higher Recurrence Rates

https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciz009/5274659

Few data suggest Clostridioides difficile infections (CDI) detected by toxin enzyme immunoassays (EIA) are more severe and have worse outcomes than those detected by nucleic acid amplification tests (NAAT) only. We compared toxin-positive and NAAT-positive only CDI across geographically-diverse sites

Of 4878 cases, 2160 (44.3%) were toxin-positive and 2718 (55.7%) were NAAT-positive only. More toxin-positive than NAAT-positive only cases were aged ≥65 years (48.2% vs 38.0%; P<0.0001), had ≥3 unformed stool for ≥1 day (43.9% vs 36.6%; P<0.0001), and had white blood cells ≥15,000/µl (31.4% versus 21.4%; P<0.0001). In multivariable analysis, toxin-positivity was associated with recurrence (adjusted odds ratio [aOR]: 1.89, 95% CI: 1.61-2.23), but not with CDI-related complications (aOR: 0.91, 95% CI: 0.67-1.23) or 30-day mortality (aOR: 0.95; 95% CI: 0.73-1.24).

Conclusions
Toxin-positive CDI is more severe, but there were no differences in adjusted CDI-related complication and mortality rates between toxin-positive and NAAT-positive only CDI that were detected by an algorithm that utilized an initial GDH screening test.

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Activity of Hospital #Disinfectants against Vegetative Cells and Spores of #Clostridioides difficile Embedded in Biofilms

Clostridioides difficile spores can survive in the environment either in mono- or mixed-species biofilms. However, no previous studies have investigated chemical disinfection of C. difficile spores embedded in biofilms..

C. difficile vegetative cells and spores were recovered from biofilms regardless the type of biofilm growth or biofilm growth time. No disinfectant was able to completely eliminate C. difficile from the biofilms. Overall, Clorox, OPA, and Virex were most effective at killing C. difficile spores regardless of biofilm age, ribotype, or wash conditions (p= 0.001, each).

Clorox and OPA were also effective at killing total vegetative cell growth (P=0.001, each) but Virex was found to be ineffective against vegetative cell growth in biofilms (p=0.77). Clorox and Virex were most effective in reducing biomass followed by Nixall, OPA and Vital oxide.

Conclusion. No disinfectant was able to completely eliminate C. difficile embedded within biofilms although differences among disinfectants were noted. Future research will be required to determine methods to eradicate this persister reservoir.

https://aac.asm.org/content/early/2019/10/08/AAC.01031-19

Fecal #microbiota transplantation for recurrent #Clostridioides difficile infection associates with functional alterations in circulating microRNAs

https://2medical.news/2021/05/06/fecal-microbiota-transplantation-for-recurrent-clostridioides-difficile-infection-associates-with-functional-alterations-in-circulating-micrornas/

Serum #procalcitonin levels associate with #Clostridioides difficile infection in patients with #inflammatory bowel disease

https://2medical.news/2021/11/01/serum-procalcitonin-levels-associate-with-clostridioides-difficile-infection-in-patients-with-inflammatory-bowel-disease/