ObjectiveTo systematically review the association between use of proton pumps inhibitors (PPIs) and clostridium difficile infection (CDI), so as to provide evidence for doctors' prescription. MethodsWe electronically searched databases including PubMed, The Cochrane Library (Issue 8, 2015), Web of Science, Ovid, CBM, CNKI, VIP, WanFang Data to collect case-control studies and cohort studies about the association between use of PPIs and CDI from January 1990 to October 2015. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then meta-analysis was performed using RevMan 5.3 software. ResultsA total of 47 articles involving 50 studies with 309620 cases were included. According to whether infected by clostridium difficile or not, these cases were divided into the case group (n=15913) and the control group (n=293707). The result of meta-analysis showed that the CDI rate of the PPIs therapy group was higher than that of the control group (OR=1.99, 95%CI 1.72 to 2.31, P<0.01, I2=87%) but a significant heterogeneity was found among studies. So subgroup analyses were performed according to the type of study design, type of patients, sample size and NOS scores of included studies. The results showed that, within different subgroups, the CDI rate of the PPIs therapy group was higher than that of the control group with significance, but the heterogeneity among studies was still existed. ConclusionCurrent evidence shows the use of PPI is associate with a 2-fold increase of the risk of CDI. Due to limited quality of the included studies, the above conclusion needs to be verified by more high quality studies.
Objective To explore the application of two methods of direct fecal detection ofClostridium difficilein patients with recurrent inflammatory bowel disease (IBD), including nucleic acid amplification test (NAAT) and enzyme immunoassay (EIA), in order to provide support for hospitals to prevent and control clostridium difficile infection (CDI). Methods Fresh feces of 48 patients with recurrent IBD treated between November 2014 and April 2015 were collected within 48 hours after admission. Anaerobic culture and identification, NAAT and EIA were used to test the same samples. Statistical analysis was performed using Kappa test. Results Among the 48 fecal samples,Clostridium difficilewas negative in 37 and positive in 11 including 2 (4.2%) with toxigenicClostridium difficile characterized as toxin type A+B+. Compared with anaerobic culture and identification, NAAT had a perfect correlation (Kappa=1.00,P<0.05), and EIA had an almost perfect correlation (Kappa=0.89,P<0.05). But EIA toxin test had missed detection of toxigenic samples. Conclusions For patients with recurrent IBD combined with CDI, both NAAT and EIA test may be applied to detctClostridium difficile in feces directly, while NAAT may show a better performance. Samples from highly suspected patients with negative toxin result tested by EIA should be confirmed by other methods such as NAAT.
Objective To overview the systematic review(SR) of efficacy and safety of fecal microbiota transplantation (FMT) in clostridium difficile infection (CDI). Methods PubMed, The Cochrane Library, EMbase, CNKI, VIP, WanFang Data databases and related website (http://scholar.google.com/) were electronically searched to collect SR and meta-analysis on FMT of CDI. The quality of collected documents and evidences were evaluated by OQAQ (Overview Quality Assessment Questionnaire) and GRADE (Grading of Recommendations Assessment, Development and Evaluation), respectively. Results Eleven SRs were included, in which 4 were completed by meta-analysis. The results of OQAQ showed that the score of one review was 2, the others SR received scores from 5 to 9. There were 9 SRs had reported the CDI clinical resolution rate (CRR), of which one SR showed CRR was 36.2%, and the others showed CRR were about 90%. Compared to upper gastrointestinal FMT, all studies showed lower gastrointestinal FMT (colonoscopy, enemas, etc.) had a higher CRR. The outcomes of selection and random fecal donor had no significant differences, and authors suggested that there should be made a standardization of donor screening table for safe fecal. Present evidence showed FMT were safety, and the majority of adverse events of FMT appeared to be mild, self-limiting and gastrointestinal in nature. The GRADE quality level of SR indicated from very low to moderate. Conclusion FMT, as a treatment for CDI, shows significant efficacy and safety, but need more high-level evidences because of its clinical translation difficulties. The study also give a reference to develop standardized clinical pathways of FMT to policy researchers.
Objective To investigate the infection rates of toxin-producing Clostridium difficile and Candida albicans in patients with antibiotic-associated diarrhea (AAD) in West China Hospital of Sichuan University, analyze their clinical characteristics and make a survey of the therapy. Methods Fecal specimens of AAD patients were collected in West China Hospital of Sichuan University from September 2014 to January 2015. Toxin-producing Clostridium difficile and Candida albicans were identified by polymerase chain reaction and then clinical data of cases was collected and analyzed. Results Twenty-eight patients with Clostridium difficile infection were detected from the 126 AAD patients, 20 patients (15.9%) in whom were infected with toxin-producing Clostridium difficile. Type A+B+, type A-B+, and type A+B- accounted for 35.7% (10/28), 35.7% (10/28) and 28.6% (8/28), respectively. Fifty-four patients (42.9%) with yeast infection were detected. The predominant isolate was Candida albicans, accounting for 20.6% (26/126), and the others were Candida glabrata (n=11), Candida tropical (n=10), Candida parapsilosis (n=3), Saccharomyces cerevisiae (n=2), Pichia pastoris (n=1), and Kodamaea ohmeri (n=1). Toxin-producing Clostridium difficile strains and Candida albicans strains were both isolated from 3 patients (2.4%). The main antibiotics used in AAD ppatients were penicillins, carbapenems, third generation cephalosporins, and fluoroquinolones. AAD patients were all with underlying diseases at different degrees. The main treatments were probiotics and montmorillonite powder. Conclusion The relatively high infection rates and complicated factors of AAD indicate that much more attention needs to be paid to the diagnosis and therapy of AAD by the clinical doctors.