DOI: https://doi.org/10.22263/2312-4156.2022.4.20
L.M. Nemtsov, G.I. Yupatau
Therapy and prevention of diarrhea associated with Clostridium difficile infection during the COVID-19 pandemia
Vitebsk State Order of Peoples’ Friendship Medical University, Vitebsk, Republic of Belarus
Vestnik VGMU. 2022;21(4):20-28.
Abstract.
The review summarizes the materials of international clinical guidelines and the results of clinical trials on the use of antibiotics and biological therapy for the treatment and prophylaxis of diarrhea associated with Clostridium difficile infection in the conditions of the COVID-19 pandemia.
A requirement necessary for the successful treatment of the first episode of diarrhea associated with Clostridium difficile infection is the withdrawal of previously prescribed antibiotics and timely administration of the standard etiotropic therapy for 10 days (vancomycin, fidaxomicin, or metronidazole, depending on the severity of the case). In recurrent episodes of pseudomembranous colitis, the standard therapy (vancomycin, fidaxomicin) is provided in a tapered/pulsed regimen for up to 5-8 weeks with gradual reduction of the dose and frequency of administration.
Keywords: antibiotic-associated diarrhea, antibiotics, biological therapy, pseudomembranous colitis, Clostridium difficile, COVID-19.
References
1. Bagdasarian N, Rao К, Malani PN. Diagnosis and treatment of Clostridium difficile in adults: a systematic review. JAMA. 2015 Jan;313(4):398-408. doi: http://dx.doi.org/10.1001/jama.2014.17103
2. Lessa FC, Winston LG, McDonald LC. Burden of Clostridium difficile infection in the United States. N Engl J Med. 2015 Jun;372(24):2369-70. doi: http://dx.doi.org/10.1056/NEJMc1505190
3. Baccolini V, Migliara G, Isonne C, Dorelli B, Barone LC, Giannini D, et al. The impact of the COVID-19 pandemic on healthcare-associated infections in intensive care unit patients: a retrospective cohort study. Antimicrob Resist Infect Control. 2021 Jun;10(1):87. doi: http://dx.doi.org/10.1186/s13756-021-00959-y
4. Lewandowski K, Rosołowski M, Kaniewska M, Kucha P, Meler A, Wierzba W, et al. Clostridioides difficile infection in coronavirus disease 2019 (COVID-19): an underestimated problem? Pol Arch Intern Med. 2021 Feb;131(2):121-127. doi: http://dx.doi.org/10.20452/pamw.15715
5. Sandhu A, Tillotson G, Polistico J, Salimnia H, Cranis M, Moshos J, et al. Clostridioides difficile in COVID-19 Patients, Detroit, Michigan, USA, March-April 2020. Emerg Infect Dis. 2020 Sep;26(9):2272-2274. doi: http://dx.doi.org/10.3201/eid2609.202126
6. Linares-García L, Cárdenas-Barragán ME, Hernández-Ceballos W, Pérez-Solano CS, Morales-Guzmán AS, Miller DS, et al. Bacterial and Fungal Gut Dysbiosis and Clostridium difficile in COVID-19: A Review. J Clin Gastroenterol. 2022 Apr;56(4):285-298. doi: http://dx.doi.org/10.1097/MCG.0000000000001669
7. Ivashkin VT, Yushchuk ND, Maev IV, Lapina TL, Poluektova EA, Shifrin OS, i dr. Recommendations of the Russian Gastroenterological Association on the Diagnosis and Treatment of Clostridium difficile-associated Disease. Ros Zhurn Gastroenterologii Gepatologii Koloproktologii. 2016;26(5):56-65. (In Russ.)
8. Chernenkaia TV. Pseudomembranous colitis: diagnosis, treatment and prevention (literature review). Neotlozh Med Pomoshch' Zhurn im NV Sklifosovskogo. 2016;(1):33-9. (In Russ.)
9. Nemtcov LM. Pseudomembranous colitis as a multidisciplinary problem. Vestn VGMU. 2014;13(3):6-19. (In Russ.)
10. Surawicz CM, Brandt LJ, Binion DG, Ananthakrishnan AN, Curry SR, Gilligan PH, et al. Guidelinesfordiagnosis, treatment, andpreventionofClostridiumdifficileinfections. Am J Gastroenterol. 2013 Apr;108(4):478-99. doi: http://dx.doi.org/10.1038/ajg.2013.4
11. Shliapnikov SA, Naser NR, Batyrshin IM, Borodina MA2, Sklizkov DS, Ostroumova IuS, i dr. Antibiotic-associated colitis - an emerging problem in surgery. Vestn NMKhTs im NI Pirogova. 2020;15(2):138-43. (In Russ.)
12. Sheptulin AA. Diarrhea in patients with COVID-19 infection. Ros Zhurn Gastroenterologii Gepatologii Koloproktologii. 2020;30(6):51-6. (In Russ.) doi: http://dx.doi.org/10.22416/1382-4376-2020-30-6-51-56
13. Maslennikov R, Ivashkin V, Ufimtseva Anna, Poluektova E, Ulyanin A. Clostridioides difficile co-infection in patients with COVID-19. Future Microbiol. 2022 Jun;17:653-663. doi: http://dx.doi.org/10.2217/fmb-2021-0145
14. Spigaglia P. Clostridioides difficile infection (CDI) during the COVID-19 pandemic. Anaerobe. 2022 Apr;74:102518. doi: http://dx.doi.org/10.1016/j.anaerobe.2022.102518
15. Bentivegna E, Alessio G, Spuntarelli V, Luciani M, Santino I, Simmaco M, et al. Impact of COVID-19 prevention measures on risk of health care-associated Clostridium difficile infection. Am J Infect Control. 2021 May;49(5):640-642. doi: http://dx.doi.org/10.1016/j.ajic.2020.09.010
16. Bobo LD, Dubberke ER, Kollef M. Clostridium difficile in the ICU: the struggle continues. Chest. 2011 Dec;140(6):1643-1653. doi: http://dx.doi.org/10.1378/chest.11-0556
17. McCollum DL, Rodriguez MJ. Detection, Treatment, and Prevention of Clostridium difficile Infection. Clin Gastroenterol Hepatol. 2012 Jun;10(6):581-92. doi: http://dx.doi.org/10.1016/j.cgh.2012.03.008
18. Khanna S, Pardi DS, Aronson SL, Kammer PP, Orenstein R, Sauver JLS, et al. The epidemiology of community-acquired Clostridium difficile infection: a population-based study. Am J Gastroenterol. 2012 Jan;107(1):89-95. doi: http://dx.doi.org/10.1038/ajg.2011.398
19. Skazyvaeva EV, Skalinskaia MI, Bakulin IG, Zhuravleva MS, Demianova EV, Sitkin SI. Updated clinical guidelines for Clostridium difficile infection by the Infectious Diseases Society of America (IDSA) and the Society of Healthcare Epidemiologists of America (SHEA): a brief review of key points, critiques, and possible perspectives. Eksperim Klin Gastroenterologiya. 2019;165(5):3-14. (In Russ.) doi: http://dx.doi.org/10.31146/1682-8658-ecg-165-5-3-14
20. Johnson S, Lavergne V, Skinner AM, Gonzales-Luna AJ, Garey KW, Kelly CP, et al. Clinical Practice Guideline by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA): 2021 Focused Update Guidelines on Management of Clostridioides difficile Infection in Adults. Clin Infect Dis. 2021 Sep;73(5):e1029-e1044. doi: http://dx.doi.org/10.1093/cid/ciab549
21. Wee LEI, Conceicao EP, Tan JY, Magesparan KD, Amin IBM, Ismail BBS, et al. Unintended consequences of infection prevention and control measures during COVID-19 pandemic. Am J Infect Control. 2021 Apr;49(4):469-477. doi: http://dx.doi.org/10.1016/j.ajic.2020.10.019
22. Luo Y, Grinspan LT, Fu Y, Adams-Sommer V, Wille DK, Patel G, et al. Hospital-onset Clostridioides difficile infections during the COVID-19 pandemic. Infect Control Hosp Epidemiol. 2021 Sep;42(9):1165-1166. doi: http://dx.doi.org/10.1017/ice.2020.1223
23. Hawes AM, Desai A, Patel PK. Did Clostridioides difficile testing and infection rates change during the COVID-19 pandemic? Anaerobe. 2021 Aug;70:102384. doi: http://dx.doi.org/10.1016/j.anaerobe.2021.102384
24. McMullen KM, Smith BA, Rebmann T. Impact of SARS-CoV-2 on hospital acquired infection rates in the United States: Predictions and early results. Am J Infect Control. 2020 Nov;48(11):1409-1411. doi: http://dx.doi.org/10.1016/j.ajic.2020.06.209
25. Weiner-Lastinger LM, Pattabiraman V, Konnor RY, Patel PR, Wong E, Xu SY, et al. The impact of coronavirus disease 2019 (COVID-19) on healthcare-associated infections in 2020: A summary of data reported to the National Healthcare Safety Network. Infect Control Hosp Epidemiol. 2022 Jan;43(1):12-25. doi: http://dx.doi.org/10.1017/ice.2021.362
26. Wilcox MH, prepared. Updated guidance on the management and treatment of Clostridium difficile infection. London: Public Health England; 2013. 29 p.
27. Kukla M, Adrych K, Dobrowolska A, Mach T, Reguła J, Rydzewska G. Guidelines for Clostridium difficile infection in adults. Prz Gastroenterol. 2020;15(1):1-21. doi: http://dx.doi.org/10.5114/pg.2020.93629
28. van Prehn J, Reigadas E, Vogelzang EH, Bouza E, Hristea A, Guery B, et al. European Society of Clinical Microbiology and Infectious Diseases: 2021 update on the treatment guidance document for Clostridioides difficile infection in adults. Clin Microbiol Infect. 2021 Dec;27 Suppl 2:S1-S21. doi: http://dx.doi.org/10.1016/j.cmi.2021.09.038
29. Clostridioides difficile infection: antimicrobial prescribing: NICE guideline. London: Public Health England; 2021. 40 p. Available from: https://www.nice.org.uk/guidance/ng199/resources/clostridioides-difficile-infection-antimicrobial-prescribing-pdf-66142090546117. [Accessed 20th Jule 2022].
30. Cimolai N. Does oral vancomycin use necessitate therapeutic drug monitoring? Infection. 2020 Apr;48(2):173-182. doi: http://dx.doi.org/10.1007/s15010-019-01374-7
31. Louie TJ, Miller MA, Mullane KM, Weiss K, Lentnek A, Golan Y, et al. Fidaxomicin versus vancomycin for Clostridium difficile infection. N Engl J Med. 2011 Feb;364(5):422-31. doi: http://dx.doi.org/10.1056/NEJMoa0910812
32. Nelson RL, Suda KJ, Evans CT. Antibiotic treatment for Clostridium difficile-associated diarrhoea in adults. Cochrane Database Syst Rev. 2017 Mar;3(3):CD004610. doi: http://dx.doi.org/10.1002/14651858.CD004610.pub5
33. McDonald LC, Gerding DN, Johnson S, Bakken JS, Carroll KC, Coffin SE, et al. Clinical Practice Guidelines for Clostridium difficile Infection in Adults and Children: 2017 Update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA). Clin Infect Dis. 2018 Mar;66(7):e1-e48. doi: http://dx.doi.org/10.1093/cid/cix1085
34. Perras C, Tsakonas E, Ndegwa S, Conly J, Valiquette L, Farrah K. Vancomycin or Metronidazole for Treatment of Clostridium difficile Infection: Clinical and Economic Analyses. Ottawa: Canadian Agency for Drugs and Technologies in Health (Technology report); 2011. N 136. 144 p. Available from: https://www.ncbi.nlm.nih.gov/books/NBK174415/pdf/Bookshelf_NBK174415.pdf . [Accessed 20th Jule 2022].
35. Garey KW, Ghantoji SS, Shah DN, Habib M, Arora V, Jiang Z-D, et al. A randomized, double-blind, placebo-controlled pilot study to assess the ability of rifaximin to prevent recurrent diarrhoea in patients with Clostridium difficile infection. J Antimicrob Chemother. 2011 Dec;66(12):2850-5. doi: http://dx.doi.org/10.1093/jac/dkr377
36. Splinter LE, Kerstenetzky L, Jorgenson MR, Descourouez JL, Leverson GE, Saddler CM, et al. Vancomycin Prophylaxis for Prevention of Clostridium difficile Infection Recurrence in Renal Transplant Patients. Ann Pharmacother. 2018 Feb;52(2):113-119. doi: http://dx.doi.org/10.1177/1060028017727756
37. Caroff DA, Menchaca JT, Zhang Z, Rhee C, Calderwood MS, Kubiak DW, et al. Oral vancomycin prophylaxis during systemic antibiotic exposure to prevent Clostridiodes difficile infection relapses. Infect Control Hosp Epidemiol. 2019 Jun;40(6):662-667. doi: http://dx.doi.org/10.1017/ice.2019.88
38. Mullane KM, Winston DJ, Nooka A, Morris MI, Stiff P, Dugan MJ, et al. A randomized, placebo-controlled trial of fidaxomicin for prophylaxis of Clostridium difficile-associated diarrhea in adults undergoing hemato-poietic stem cell transplantation. Clin Infect Dis. 2019 Jan;68(2):196-203. doi: http://dx.doi.org/10.1093/cid/ciy484
39. Debast SB, Bauer MP, Kuijper EJ. European Society of Clinical Microbiology and Infectious Diseases: update of the treatment guidance document for Clostridium difficile infection. Clin Microbiol Infect. 2014 Mar;20 Suppl 2:1-26. doi: http://dx.doi.org/10.1111/1469-0691.12418
40. Goldenberg JZ, Ma SSY, Saxton JD, Martzen MR, Vandvik PO, Thorlund K, et al. Probiotics for the prevention of Clostridium difficile-associated diarrhea in adults and children. Cochrane Database Syst Rev. 2013 May;(5):CD006095. doi: http://dx.doi.org/10.1002/14651858.CD006095.pub3
41. Shen NT, Maw A, Tmanova LL, Pino A, Ancy K, Crawford CV, et al. Timely Use of Probiotics in Hospitalized Adults Prevents Clostridium difficile Infection: A Systematic Review With Meta-Regression Analysis. Gastroenterology. 2017 Jun;152(8):1889-1900.e9. doi: http://dx.doi.org/10.1053/j.gastro.2017.02.003
42. Goldenberg JZ, Yap C, Lytvyn L, Lo CK-F, Beardsley J, Mertz D, et al. Probiotics for the prevention of Clostridium difficile‐associated diarrhea in adults and children. Cochrane Database Syst Rev. 2017 Dec;12(12):CD006095. doi: http://dx.doi.org/10.1002/14651858.CD006095.pub4
43. Ivashkin V, Fomin V, Moiseev S, Brovko M, Maslennikov R, Ulyanin A, et al. Efficacy of a Probiotic Consisting of Lacticaseibacillus rhamnosus PDV 1705, Bifidobacterium bifidum PDV 0903, Bifidobacterium longum subsp. infantis PDV 1911, and Bifidobacterium longum subsp. longum PDV 2301 in the Treatment of Hospitalized Patients with COVID-19: a Randomized Controlled Trial. Probiotics Antimicrob Proteins. 2021 Oct;1-9. doi: http://dx.doi.org/10.1007/s12602-021-09858-5
Information about authors:
L.M. Nemtsov – Doctor of Medical Sciences, professor of the Chair of Internal Diseases Propedeutics, Vitebsk State Order of Peoples’ Friendship Medical University, https://orcid.org/0000-0003-0889-5825
E-mail: Этот адрес электронной почты защищён от спам-ботов. У вас должен быть включен JavaScript для просмотра. – Leonid M. Nemtsov;
H.I. Yupatau – Doctor of Medical Sciences, professor, head of the Chair of Internal Diseases Propedeutics, Vitebsk State Order of Peoples’ Friendship Medical University.
