Nutritional support as a part of complex therapy for clostridial infection

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Abstract

In order to study modern principles of diagnosis, treatment and prevention of clostridial infection, an analysis of publications on the topic in the medical databases eLibrary, PubMed, Medline (2004–2023) was carried out. Based on the data obtained, a modern concept of etiology, pathogenesis, and methods of treating the disease using specialized principles of diet therapy and nutritional support is presented. It has been shown that today clostridial infection is one of the most dangerous nosocomial infections, the diagnosis of which is quite difficult. Timely testing and a clear diagnostic algorithm make it possible to identify the disease in the early stages of its development. Vancomycin and metronidazole remain the main therapeutic agents, but the effectiveness of the latter has been questioned by recent studies. It is clear that further clinical studies are needed to study the target population of bezlotoxumab and regulate the use of fecal microbiota transplantation, which appears to be promising. A specialized enteral mixture enriched with the natural anti-inflammatory growth factor TGF-β2 has a pathogenetic effect, accelerating the healing of the colon mucosa and improving nutritional status for a long time. Prevention of clostridial infection is largely ensured by hygiene measures, as well as the rational use of antibiotics.

About the authors

Anastasia S. Ivanova

State Scientific Centre of Coloproctology

Email: i.anastasia@hotmail.com
ORCID iD: 0000-0001-7321-4323
SPIN-code: 2179-2310
Russian Federation, Moscow

Olga A. Obukhova

N.N. Blokhin National Medical Research Center of Oncology

Author for correspondence.
Email: obukhova0404@yandex.ru
ORCID iD: 0000-0003-0197-7721
SPIN-code: 6876-7701

MD, Cand. Sci. (Medicine)

Russian Federation, Moscow

References

  1. Riley TV. Clostridium. In: Irving WL. Medical Microbiology: A Guide to Microbial Infections: Pathogenesis, Immunity, Laboratory Investigation and Control. Barer MR, Swann A, Perera N, editors. Elsevier; 2019.
  2. Bartlett JG, Onderdonk AB, Cisneros RL. Clindamycin-associated colitis in hamsters: protection with vancomycin. Gastroenterology. 1977;73(4 Pt 1):772–776.
  3. Czepiel J, Dróżdż M, Pituch H, et al. Clostridium difficile infection: review. Eur J Clin Microbiol Infect Dis. 2019;38:1211–1221. doi: 10.1007/s10096-019-03539-6
  4. Tedesco FJ, Barton RW, Alpers DH. Clindamycin-associated colitis. A prospective study. Ann Intern Med. 1974;81(4):429–433. doi: 10.7326/0003-4819-81-4-429
  5. Hookman P, Barkin JS. Clostridium difficile associated infection, diarrhea and colitis. World J Gastroenterol. 2009;15(13):1554–1580. doi: 10.3748/wjg.15.1554
  6. Avi P, Ben Izhar Sh, Orna N, et al. Clostridium difficile infection: associations with chemotherapy, radiation therapy, and targeting therapy treatments. Curr Med Chem. 2016;23(39):4442–4449. doi: 10.2174/0929867323666161028162018
  7. Drapkina OM, Lazebnik LB, Bakulin IG, et al. Clostridioides difficile infection: diagnosis, treatment, and prevention Clinical guidelines of the Russian Scientific Medical Society of Internal Medicine, the Gastroenterological Scientific Society of Russia, and the North- West Society of Gastroenterologists and Hepatologists. Experimental and Clinical Gastroenterology. 2023;(2):4–32. EDN: TKKDIC doi: 10.31146/1682-8658-ecg-210-2-4-32
  8. McDonald LC, Coignard B, Dubberke E, et al. Recommendations for surveillance of Clostridium difficile-associated disease. Infect Control Hosp Epidemiol. 2007;28(2):140–145. doi: 10.1086/511798
  9. Bouza E, Aguado JM, Alcalá L, et al. Recommendations for the diagnosis and treatment of Clostridioides difficile infection: An official clinical practice guideline of the Spanish Society of Chemotherapy (SEQ), Spanish Society of Internal Medicine (SEMI) and the working group of Postoperative Infection of the Spanish Society of Anesthesia and Reanimation (SEDAR). Rev Esp Quimioter. 2020;33(2):151–175. doi: 10.37201/req/2065.2020
  10. Shlyapnikov SA, Naser NR, Batyrshin IM, et al. The antibiotic-associated colitis is a new problem in surgery. Bulletin of Pirogov National Medical & Surgical Center. 2020;15(2):138–143. EDN: GDPLJK doi: 10.25881/BPNMSC.2020.62.96.024
  11. Debast SB, Bauer MP, Kuijper EJ, European Society of Clinical Microbiology and Infectious Diseases. European Society of Clinical Microbiology and Infectious Diseases: update of the treatment guidance document for Clostridium difficile infection. Clin Microbiol Infect. 2014;20 Suppl. 2:1–26. doi: 10.1111/1469-0691.12418
  12. Van Prehn J, Reigadas E, Vogelzang EH, et al. Guideline committee of the European Study Group on Clostridioides difficile. 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;27 Suppl. 2: S1–S21. doi: 10.1016/j.cmi.2021.09.038
  13. Burke KE, Lamont JT. Clostridium difficile infection: a worldwide disease. Gut and Liver. 2014;8(1):1–6. doi: 10.5009/gnl.2014.8.1.1
  14. Abt MC, McKenney PT, Pamer EG. Clostridium difficile colitis: pathogenesis and host defence. Nature Reviews Microbiology. 2016;14(10):609–620. doi: 10.1038/nrmicro.2016.108
  15. Elliott B, Androga GO, Knight DR, Riley TV. Clostridium difficile infection: evolution, phylogeny and molecular epidemiology. Infection, Genetics and Evolution. 2017;49:1–11. doi: 10.1016/j.meegid.2016.12.018
  16. Shen A. Clostridium difficile toxins: mediators of inflammation. J Innate Immun. 2012;4(2):149–158. doi: 10.1159/000332946
  17. Hookman P, Barkin JS. Clostridium difficile associated infection, diarrhea and colitis. World J Gastroenterol. 2009;15(13):1554–1580. doi: 10.3748/wjg.15.1554
  18. Cohen SH, Gerding DN, Johnson S, et al. Clinical practice guidelines for Clostridium difficile infection in adults: 2010 update by the Society for Healthcare Epidemiology of America (SHEA) and the Infectious Diseases Society of America (IDSA). Infect Control Hosp Epidemiol. 2010;31(5):431–455. doi: 10.1086/651706
  19. Ooijevaar RE, van Beurden YH, Terveer EM, et al. Update of treatment algorithms for Clostridium difficile infection. Clin Microbiol Infect. 2018;24(5):452–462. doi: 10.1016/j.cmi.2017.12.022
  20. Johnson S, Lavergne V, Skinner AM, 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;73(5):1029–1044. doi: 10.1093/cid/ciab549
  21. Guery B, Galperine T, Barbut F. Clostridioides difficile: diagnosis and treatments. BMJ. 2019;366. doi: 10.1136/bmj.l4609
  22. Johnson S, Louie TJ, Gerding DN, et al. Vancomycin, metronidazole, or tolevamer for Clostridium difficile infection: results from two multinational, randomized, controlled trials. Clin Infect Dis. 2014;59:345–354. doi: 10.1093/cid/ciu313
  23. Nelson RL, Suda KJ, Evans CT. Antibiotic treatment for Clostridium difficile-associated diarrhoea in adults. Cochrane Database Syst Rev. 2017;3(3):CD004610. doi: 10.1002/14651858.CD004610.pub5
  24. Stevens VW, Nelson RE, Schwab-Daugherty EM, et al. Comparative effectiveness of vancomycin and metronidazole for the prevention of recurrence and death in patients with Clostridium difficile infection. JAMA Intern Med. 2017;177:546–553. doi: 10.1001/jamainternmed.2016.9045
  25. Chen J, Li Y, Wang S, et al. Targeting Clostridioides difficile: New uses for old drugs. Drug Discov Today. 2022;27(7):1862–1873. doi: 10.1016/j.drudis.2022.03.021
  26. Singh T, Bedi P, Bumrah K, et al. Fecal Microbiota Transplantation and Medical Therapy for Clostridium difficile Infection: Meta-analysis of Randomized Controlled Trials. J Clin Gastroenterol. 2022;56(10):881–888. doi: 10.1097/MCG.0000000000001610
  27. Hota SS, Sales V, Tomlinson G, et al. Oral vancomycin followed by fecal transplantation versus tapering oral vancomycin treatment for recurrent Clostridium difficile infection: an open-label, randomized controlled trial. Clin Infect Dis. 2017;64:265–271. doi: 10.1093/cid/ciw731
  28. Shedoeva LR, Chashkova EYu, Rubtsov AS. Successful Experience of Fecal Transplantation in a Patient with Severe Pseudomembranous Colitis. Acta biomedica scientifica. 2020; 5(6):248–253. EDN: HRYDCQ doi: 10.29413/ABS.2020-5.6.32
  29. Bischoff SC, Bager P, Escher J, et al. ESPEN guideline on clinical nutrition in inflammatory bowel disease. Cl Nutr. 2023;42(3):352–379. doi: 10.1016/j.clnu.2022.12.004
  30. Kashiya ShR, Kurmukov IA, Obukhova OA, et al. Application of antioxidants in complex intensive therapy of infectious complications of anti-tumor treatment. Clinical Oncohematology. Basic Research and Clinical Practice. 2012;5(1):54–60. EDN: SYADGD
  31. Obukhova OA, Kurmukov IA, Kashiya ShR. Diagnosis and treatment of iron-deficiency anemia in oncology. Gynecologic Oncology. 2014;(2):67–76. EDN: TAIZPH
  32. Khoroshilov IE, Ivanov SV. Enteral nutrition using «Modulen IBD» as a method of pathogenetic therapy of inflammatory bowel diseases. Effektivnaya farmakoterapiya. 2011;(5):18–22. (In Russ). EDN: SJWIKR
  33. Fell JME. Control of systemic and local inflammation with transforming growth factor beta containing formulas. J Parenter Enteral Nutr. 2005;29(4S):S126–S133. doi: 10.1177/01486071050290S4S126
  34. Bannerjee K, Camacho-Hübner C, Babinska K, et al. Anti-inflammatory and growth-stimulating effects precede nutritional restitution during enteral feeding in Crohn disease. J Pediatr Gastroenterol Nutr. 2004;38:270–275. doi: 10.1097/00005176-200403000-00007
  35. Hartman C, Berkowitz D, Weiss B, et al. Nutritional supplementation with polymeric diet enriched with transforming growth factor-beta 2 for children with Crohn’s disease. Isr Med Assoc J. 2008;10:503–507.
  36. Mikhailova TL, Romanov RI, Kostenko NV, et al. Experience with enteral nutrition in the treatment of patients with Crohn’s disease of the colon and ulcerative colitis. Koloproktologiya. 2006;(1(15)):19–23. (In Russ). EDN: MNIZKV
  37. Karakan T, Ibis M, Arhan M, Unal S. PP110-MON: Exclusive enteral nutrition with TGF-beta supplements improve clinical parameters and increase nutritional status of adult patients with inflammatory bowel disease. Clin Nutr. 2014;33 Suppl. 1:S170–S171. doi: 10.1016/S0261-5614(14)50445-1
  38. Agin M, Yucel A, Gumus M, Yuksekkaya HA, Tumgor G. The Effect of Enteral Nutrition Support Rich in TGF-β in the Treatment of Inflammatory Bowel Disease in Childhood. Medicina (Kaunas). 2019;55(10):620. doi: 10.3390/medicina55100620
  39. Morello E, Brambilla G, Bernardi S, et al. Nutritional intervention with TGF-beta enriched food for special medical purposes (TGF-FSMP) is associated with a reduction of malnutrition, acute GVHD, pneumonia and may improve overall survival in patients undergoing allogeneic hematopoietic stem transplantation. Transpl Immunol. 2023;81:101954. doi: 10.1016/j.trim.2023.101954

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2. Fig. 1. Endoscopic picture of pseudomembranes on the surface of the mucous membrane of the large intestine (open source).

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