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Introduction. Clostridium difficile infections (CDI) remain a global health concern. Currently, no unified approach to the diagnostics and determining severity of these infections despite their high urgency throughout the world was proposed. The aim of the study is to identify risk factors for CDI, investigate clinical and epidemiological features of the disease course and potential for using the ATLAS scale to assess its severity. Materials and methods. 36 CDI patients hospitalized at the Infectious Disease Clinic of Varna were analyzed during the period from January 2018 until June 2019. Clinical and epidemiologic study was conducted. The diagnosis was made by using a rapid immunochromatographic test; CDI patient stratification was performed by ATLAS scoring system. Results and discussion. Within the aforementioned period, 1100 patients were hospitalized at the Infectious Disease Clinic of Varna, and CDIs were reported in 3,3% of cases. The most affected were elderly individuals (the mean age was 69,816,4 years old) most of whom were females (92%) with only 6% of males. The following risk factors were investigated: comorbidities 32 patients (88,89%), recent hospitalization 19 patients (52,78%), antibiotic use 31 patients (86,11%). Twenty-four patients (66,67%, ATLAS score 4 points) had mild CDI, whereas moderate form of CDI was observed in 12 patients (33,33%). No severe CDI or death were observed. The characteristic clinical presentation included fever, diarrhea and abdominal cramping. The treatment was implemented according to the national and international recommendations by using oral Metronidazole for 11 patients (30,56%), Vancomycin for 12 patients (33,33%), or both for 13 patients (36,11%). Conclusion. Patients at risk with symptoms of enterocolitis and a history of antibiotic use or hospitalizations should be screened for the presence of toxin-forming strains of Clostridium difficile. According to the European Centre for Disease Prevention (ECDC) the diagnostic yield of CDI may be increased by using two-step protocol, whereas the ATLAS score system may be a useful tool for routine evaluation of patients with CDI.

Background and Purpose: Clostridioides difficile infection (CDI) is a leading cause of healthcare-associated infections worldwide, with hypervirulent strains linked to severe disease and higher mortality. This study aims to analyze the epidemiology of CDI at a tertiary-care hospital in Italy and compare clinical outcomes between patients infected with hypervirulent and non-hypervirulent strains.A retrospective comparative study was conducted on patients diagnosed with CDI at ASST Spedali Civili di Brescia, Italy, from January 2015 to June 2023. Hypervirulent strains were identified using the GeneXpert assay as positive for cytotoxin gene (tcdB), binary toxin genes (tcdA and tcdB) and a single nucleotide deletion at position 117 in the tcdC gene and compared to a randomized matched control group with non-hypervirulent CDI. Clinical data were collected and analyzed, with multivariate logistic regression employed to identify risk factors for hypervirulent CDI.Of 1,059 positive C. difficile specimens, a statistically significant trend between January 2015 to June 2023 was found in the increasing incidence of CDI cases per 1,000 hospital admissions and 10,000 bed-days. Notably, a remarkable increase of hypervirulent strains was recorded in 2021 and 2022 when compared to previous years. A total of 130 patients were analyzed: 62 (47.7%) with hypervirulent CDI and 68 (52.3%) controls. Hypervirulent CDI was associated with higher 30-day mortality (18% vs. 5.8%, p = 0.03). Multivariate analysis showed that hypervirulent CDI significantly increased 30-day mortality risk (OR = 9.915, CI = 2.37–61.05, p = 0.005) and that prior antibiotic therapy was a significant risk factor (OR = 5.49, CI = 1.19–39.96, p = 0.047).Our epidemiological data, while suggesting a potential resurgence in CDI transmission during COVID-19 pandemic, are derived from a single-center experience with limited generalizability to the broader population. Nonetheless, they highlight the need for strengthened antimicrobial stewardship and national surveillance systems to effectively monitor and manage these strains.Methods: Clostridioides difficile infection (CDI) is a leading cause of healthcare-associated infections worldwide, with hypervirulent strains linked to severe disease and higher mortality. This study aims to analyze the epidemiology of CDI at a tertiary-care hospital in Italy and compare clinical outcomes between patients infected with hypervirulent and non-hypervirulent strains.A retrospective comparative study was conducted on patients diagnosed with CDI at ASST Spedali Civili di Brescia, Italy, from January 2015 to June 2023. Hypervirulent strains were identified using the GeneXpert assay as positive for cytotoxin gene (tcdB), binary toxin genes (tcdA and tcdB) and a single nucleotide deletion at position 117 in the tcdC gene and compared to a randomized matched control group with non-hypervirulent CDI. Clinical data were collected and analyzed, with multivariate logistic regression employed to identify risk factors for hypervirulent CDI.Of 1,059 positive C. difficile specimens, a statistically significant trend between January 2015 to June 2023 was found in the increasing incidence of CDI cases per 1,000 hospital admissions and 10,000 bed-days. Notably, a remarkable increase of hypervirulent strains was recorded in 2021 and 2022 when compared to previous years. A total of 130 patients were analyzed: 62 (47.7%) with hypervirulent CDI and 68 (52.3%) controls. Hypervirulent CDI was associated with higher 30-day mortality (18% vs. 5.8%, p = 0.03). Multivariate analysis showed that hypervirulent CDI significantly increased 30-day mortality risk (OR = 9.915, CI = 2.37–61.05, p = 0.005) and that prior antibiotic therapy was a significant risk factor (OR = 5.49, CI = 1.19–39.96, p = 0.047).Our epidemiological data, while suggesting a potential resurgence in CDI transmission during COVID-19 pandemic, are derived from a single-center experience with limited generalizability to the broader population. Nonetheless, they highlight the need for strengthened antimicrobial stewardship and national surveillance systems to effectively monitor and manage these strains.Results: Clostridioides difficile infection (CDI) is a leading cause of healthcare-associated infections worldwide, with hypervirulent strains linked to severe disease and higher mortality. This study aims to analyze the epidemiology of CDI at a tertiary-care hospital in Italy and compare clinical outcomes between patients infected with hypervirulent and non-hypervirulent strains.A retrospective comparative study was conducted on patients diagnosed with CDI at ASST Spedali Civili di Brescia, Italy, from January 2015 to June 2023. Hypervirulent strains were identified using the GeneXpert assay as positive for cytotoxin gene (tcdB), binary toxin genes (tcdA and tcdB) and a single nucleotide deletion at position 117 in the tcdC gene and compared to a randomized matched control group with non-hypervirulent CDI. Clinical data were collected and analyzed, with multivariate logistic regression employed to identify risk factors for hypervirulent CDI.Of 1,059 positive C. difficile specimens, a statistically significant trend between January 2015 to June 2023 was found in the increasing incidence of CDI cases per 1,000 hospital admissions and 10,000 bed-days. Notably, a remarkable increase of hypervirulent strains was recorded in 2021 and 2022 when compared to previous years. A total of 130 patients were analyzed: 62 (47.7%) with hypervirulent CDI and 68 (52.3%) controls. Hypervirulent CDI was associated with higher 30-day mortality (18% vs. 5.8%, p = 0.03). Multivariate analysis showed that hypervirulent CDI significantly increased 30-day mortality risk (OR = 9.915, CI = 2.37–61.05, p = 0.005) and that prior antibiotic therapy was a significant risk factor (OR = 5.49, CI = 1.19–39.96, p = 0.047).Our epidemiological data, while suggesting a potential resurgence in CDI transmission during COVID-19 pandemic, are derived from a single-center experience with limited generalizability to the broader population. Nonetheless, they highlight the need for strengthened antimicrobial stewardship and national surveillance systems to effectively monitor and manage these strains.Discussion: Clostridioides difficile infection (CDI) is a leading cause of healthcare-associated infections worldwide, with hypervirulent strains linked to severe disease and higher mortality. This study aims to analyze the epidemiology of CDI at a tertiary-care hospital in Italy and compare clinical outcomes between patients infected with hypervirulent and non-hypervirulent strains.A retrospective comparative study was conducted on patients diagnosed with CDI at ASST Spedali Civili di Brescia, Italy, from January 2015 to June 2023. Hypervirulent strains were identified using the GeneXpert assay as positive for cytotoxin gene (tcdB), binary toxin genes (tcdA and tcdB) and a single nucleotide deletion at position 117 in the tcdC gene and compared to a randomized matched control group with non-hypervirulent CDI. Clinical data were collected and analyzed, with multivariate logistic regression employed to identify risk factors for hypervirulent CDI.Of 1,059 positive C. difficile specimens, a statistically significant trend between January 2015 to June 2023 was found in the increasing incidence of CDI cases per 1,000 hospital admissions and 10,000 bed-days. Notably, a remarkable increase of hypervirulent strains was recorded in 2021 and 2022 when compared to previous years. A total of 130 patients were analyzed: 62 (47.7%) with hypervirulent CDI and 68 (52.3%) controls. Hypervirulent CDI was associated with higher 30-day mortality (18% vs. 5.8%, p = 0.03). Multivariate analysis showed that hypervirulent CDI significantly increased 30-day mortality risk (OR = 9.915, CI = 2.37–61.05, p = 0.005) and that prior antibiotic therapy was a significant risk factor (OR = 5.49, CI = 1.19–39.96, p = 0.047).Our epidemiological data, while suggesting a potential resurgence in CDI transmission during COVID-19 pandemic, are derived from a single-center experience with limited generalizability to the broader population. Nonetheless, they highlight the need for strengthened antimicrobial stewardship and national surveillance systems to effectively monitor and manage these strains. [ABSTRACT FROM AUTHOR]

Clostridioides difficile (C.diff) infection (CDI) causes significant morbidity and mortality among older adults. Vaccines to prevent CDI are in development; however, data on the target population's preferences are needed to inform vaccination recommendations in the United States (US). This study assessed US adults' willingness to receive a C.diff vaccine and examined how vaccine attributes influence their choices. A cross-sectional online survey with a discrete choice experiment (DCE) was conducted among US adults aged ≥50 years. DCE attributes included effectiveness, duration of protection, reduction in symptom severity, out-of-pocket (OOP) costs, number of doses, and side effects. The DCE included 11 choice tasks, each with two hypothetical vaccine profiles and an opt-out (i.e., no vaccine). Attribute-level preference weights were estimated using hierarchical Bayesian modeling. Attribute relative importance (RI) was compared between select subgroups. Of 1216 adults in the analyses, 29.9% reported they knew either 'a little' (20.7%) or 'a lot' (9.2%) about C.diff before the study. A C.diff vaccine was chosen 58.0% of the time (vs. opt-out) across choice tasks. It was estimated that up to 75.0% would choose a vaccine when OOP was $0. Those who were immunocompromised/high-risk for CDI (vs. not) more frequently chose a C.diff vaccine. Decreases in OOP costs (RI = 56.1), improvements in vaccine effectiveness (RI = 17.7), and reduction in symptom severity (RI = 10.3) were most important to vaccine choice. The rank ordering of attributes by importance was consistent across subgroups. OOP cost, improvements in vaccine effectiveness, and reduction in CDI severity were highly influential to vaccine selection. Most adults aged ≥50 years were receptive to a C.diff vaccine, especially with little-to-no OOP cost, suggesting that mandating insurance coverage of vaccination with no copayment may increase uptake. The limited awareness about C.diff among adults presents an opportunity for healthcare providers to educate their patients about CDI prevention. • C.diff infection causes significant morbidity and mortality among older adults. • Adults ≥50 years were receptive to vaccination despite low awareness of C.diff. • Cost, effectiveness, and reducing severity most impact hypothetical vaccine choice. • Adults who had a high-risk condition were less likely to opt out of vaccination. • Most adults were willing to accept a vaccine that had $0 out-of-pocket cost. [ABSTRACT FROM AUTHOR]

Clostridioides difficile is the main cause of antibiotic-associated diarrhea in humans and is a major enteropathogen in several animal species. In newborn piglets, colonic lesions caused by C. difficile A and B toxins (TcdA and TcdB, respectively) cause diarrhea and significant production losses. The present study aimed to develop two recombinant vaccines from immunogenic C-terminal fragments of TcdA and TcdB and evaluate the immune response in rabbits and in breeding sows. Two vaccines were produced: bivalent (rAB), consisting of recombinant fragments of TcdA and TcdB, and chimeric (rQAB), corresponding to the synthesis of the same fragments in a single protein. Groups of rabbits were inoculated with 10 or 50 μg of proteins adjuvanted with aluminum or 0.85 % sterile saline in a final volume of 1 mL/dose. Anti -TcdA and anti -TcdB IgG antibodies were detected in rabbits and sows immunized with both rAB and rQAB vaccines by ELISA. The vaccinated sows were inoculated intramuscularly with 20 μg/dose using a prime-boost approach. Different antibody titers (p ≤ 0.05) were observed among the vaccinated groups of sows (rAB and rQAB) and control. Additionally, newborn piglets from vaccinated sows were also positive for anti -TcdA and anti -TcdB IgGs, in contrast to control piglets (p ≤ 0.05). Immunization of sows with the rQAB vaccine conferred higher anti -TcdA and anti -TcdB responses in piglets, suggesting the superiority of this compound over rAB. The synthesized recombinant proteins were capable of inducing antibody titers against C. difficile toxins A and B in sows, and were passively transferred to piglets through colostrum. • Synthesized fragments of A/B toxins were used in the development of two vaccines. • The immunogenicity of both vaccines was validated through testing on rabbits. • Sows administered a chimera vaccine showed high titers of IgG against A/B toxins. • Antibodies against A/B toxins were actively transferred to piglets via colostrum. [ABSTRACT FROM AUTHOR]

Elimination of fluoride pollution in water is the key to improving the water quality. However, the traditional defluorination methods all have defects such as unsatisfactory results and complicated operation. In this study, we proposed an electrosorption method and prepared a Ti/N metal organic framework derived porous carbon electrode for efficient CDI defluorination. The experimental results showed that the prepared titanium-based porous carbon composites possessed better electrochemical activity and more efficient electrosorption capacity compared with the original materials. The electrosorption capacity of TiNC at 1.2 V was 33.99 mg F- g−1 in an initial solution of 50 mg F- L−1 within 2 h. We further analyzed the electrosorption behavior using adsorption kinetics and isotherm models, from which we can see that chemisorption played an important role in adsorption process. Finally, we elaborated fluoride electrosorption mechanism from the perspectives such as ligand exchange and electrostatic attraction. This study provides a new strategy for the defluorination technology. [Display omitted] • First application of Ti/N-doped porous carbon for capacitive deionization defluorination. • Excellent fluoride ion electrosorption removal efficiency at 1.2 V and an initial F- concentration of 50 mg L−1. • Electrosorption materials with excellent selectivity for fluoride ions have been developed. [ABSTRACT FROM AUTHOR]

The study aimed to determine the influence of a pulsed electric field (PEF) treatment on vacuum drying (VD) of apples and their selected quality parameters. The apples were treated with a PEF at 1 kV.cm-1 (with a variable amount of the specific energy input: 1, 3.5, and 6 kJ.kg-1) before VD at 4 kPa (with a variable drying temperature: 40 °C, 55 °C, and 70 °C). The drying time, microstructure, retention of total phenolics (TPC) as well as the antioxidant activity of the obtained dried materials were studied. As a result of opening the cell structure of the apple tissues, the PEF significantly (P < 0.05) reduced the drying time - depending on the used process parameters - by 6-22%. Moreover, an increase in the drying temperature also shortened the drying time. The electroporation led to obtaining porous materials after drying, and with the higher amount of specific energy during the PEF pre-treatment that was applied, a higher porosity was observed in the dried apples. After the PEF-assisted VD, a significant (P < 0.05) decrease in the TPC (by 12-40%) and antioxidant activity (by 23-81%) were observed.

Abstract Background In the pediatric population, severe Clostridioides difficile infection (CDI) sometimes occurs, but most cases are asymptomatic. The asymptomatic carriage rate in pediatric populations is reportedly higher than in the adult population. It is difficult to diagnose CDI, even if C. difficile is detected in children with diarrhea. This study aimed to evaluate the positivity rate of toxigenic C. difficile in the pediatric population with diarrhea. Methods We collected and retrospectively analyzed gastrointestinal pathogen multiplex PCR results of 960 patients to estimate the positivity rate of toxigenic C. difficile in pediatric populations aged between 0 and 18 years. Results The overall rate of C. difficile toxin B positivity was 10.1% in the stool samples. The positivity rate peaked in 1-year-old infants (29/153, 19.0%) and continually decreased thereafter. The positivity rate we observed was lower than the rates described in the literature. Remarkably, no C. difficile was detected in neonates. Antibiotic usage was inversely related to the positivity rate, especially in infants < 2 years of age. The odds ratio of antibiotics was 0.44 (95% confidence interval (CI) 0.28–0.68; P < 0.001). The presence of concomitant gastrointestinal pathogens was not associated with toxigenic C. difficile positivity. Conclusions Even though toxigenic C. difficile infection is neither an important nor a common cause of pediatric diarrhea, children can spread it to adults at risk of developing CDI. The pediatric population can act as hidden reservoirs for pathogenic strains in the community.

Background: Clostridium difficile infection (CDI) is a leading cause of healthcare-associated diarrhea worldwide. In this study, risk factors associated with the development of severe-complicated and recurrent outcomes in CDI patients in different age groups, including the non-elderly, were assessed in a third-level hospital. Methods: CDI cases were detected by clinical data and polymerase-chain-reaction (PCR). Clinical, demographic, epidemiological, and microbiological risk factors for CDI were evaluated. Results: During the study period, 248 out of 805 patients with nosocomial diarrhea were diagnosed with CDI and the majority were severe-complicated cases (87.90%). Female gender (OR 3.19, 95% CI 1.19–8.55, p = 0.02) and lymphoma (OR 3.95, 95% CI 1.03–15.13, p = 0.04) were risk factors for severe-complicated CDI. Mature adulthood (51–60 years) (OR 5.80, 95% CI 1.56–21.62, p = 0.01), previous rifampicin use (OR 7.44, 95% CI 2.10–26.44, p = 0.00), and neoplasm (solid malignant neoplasm or hematological malignancies) (OR 4.12, 95% CI 1.01–16.83, p = 0.04) were risk factors for recurrent infection. Autoimmune disorders (OR 6.62, CI 95% 1.26–34.73, p = 0.02), leukemia (OR 4.97, 95% CI 1.05–23.58, p = 0.04), lymphoma (OR 3.79, 95% CI 1.03–12.07, p = 0.04) and previous colistin treatment (OR 4.97, 95% CI 1.05–23.58, p = 0.04) were risk factors for 30-day mortality. Conclusion: Newly identified risk factors for recurrent CDI were rifampicin treatment and age between 51 and 60 years; colistin treatment was identified as a risk factor for 30-day mortality. Previously identified risk factors for severe-complicated CDI were confirmed, but with a major impact on non-elderly patients.

There is increased interest in many different processes based upon interactions between a charged solid surface and a liquid electrolyte. Energy storage in capacitive porous materials, ionic membranes, capacitive deionization (CDI) for water desalination, capacitive energy generation, removal of heavy ions from wastewater streams, and geophysical applications are some examples of these processes. Process development is driven by the production of porous materials with increasing surface area. Understanding of the physical phenomena occurring at the charged solid-electrolyte interface will significantly improve the design and development of more effective applied processes. The goal of this work is to critically review the current knowledge in the field. The focus is on concepts behind different models. We start by briefly presenting the classical electrical double layer (EDL) models in flat surfaces. Then, we discuss models for porous materials containing macro-, meso-, and micro-pores. Some of the current models for systems comprising two different pore sizes are also included. Finally, we discuss the concepts behind the most common models used for ionic transport and Faradaic processes in porous media. The latter models are used for simulation of electrosorption processes in porous media.

Every year, enteric infections and associated diarrhea kill millions of people. The situation is compounded by increases in the number of enteric pathogens that are acquiring resistance to antibiotics, as well as (hitherto) a relative paucity of information on host molecular targets that may contribute to diarrhea. Many forms of diarrheal disease depend on the dysregulation of intestinal ion transporters, and an associated imbalance between secretory and absorptive functions of the intestinal epithelium. A number of major transporters have been implicated in the pathogenesis of diarrheal diseases and thus an understanding of their expression, localization, and regulation after infection with various bacteria, viruses, and protozoa likely will prove critical in designing new therapies. This article surveys our understanding of transporters that are modulated by specific pathogens and the mechanism(s) involved, thereby illuminating targets that might be exploited for new therapeutic approaches.

ABSTRACT: Objectives: This study was designed to investigate the molecular epidemiology of Clostridioides difficile isolates in South Korea and to evaluate risk factors for rifaximin-non-susceptible C. difficile infection (CDI). Methods: A total of 413 patients with CDI from two sentinel hospitals in South Korea were enrolled in this study. Putative clinical risk factors for CDI were identified using digital medical records of the patients. Pathogen profiles, including antimicrobial susceptibility, toxin production and ribotype, were evaluated for each of the causative C. difficile isolates. Results: Of the 413 C. difficile isolates, 81 (19.6%) were shown to be rifaximin-non-susceptible, with the most common ribotypes being 018 (56.8%; 46/81), 017 (16.0%; 13/81) and 027 (6.2%; 5/81). Rifaximin-non-susceptible C. difficile isolates exhibited higher non-susceptibility rates to most of the other drugs tested in this study compared with rifaximin-susceptible isolates. Previous history of pulmonary tuberculosis and prior rifaximin treatment were shown to be associated with the occurrence of rifaximin-non-susceptible CDI compared with susceptible CDI. Conclusion: Non-susceptibility rates to rifaximin for the C. difficile isolates identified in this study were reasonably high with most of the resistant strains belonging to either ribotype 018 or 017. Widespread dissemination of these clones may be the result of antimicrobial selection pressure introduced by the widespread use of rifaximin. These results suggest that a sustainable surveillance programme for CDI and C. difficile resistance is needed in order to better control CDIs and to improve therapeutic efficacy.

In this work, the electrodes of a microbial desalination cell (MDC) are investigated as the positive and negative electrodes of an internal supercapacitor. The resulting system has been named a supercapacitive microbial desalination cell (SC-MDC). The electrodes are self-polarized by the red-ox reactions and therefore the anode acts as a negative electrode and the cathode as a positive electrode of the internal supercapacitor. In order to overcome cathodic losses, an additional capacitive electrode (AdE) was added and short-circuited with the SC-MDC cathode (SC-MDC-AdE). A total of 7600 discharge/self-recharge cycles (equivalent to 44 h of operation) of SC-MDC-AdE with a desalination chamber filled with an aqueous solution of 30 g L-1 NaCl are reported. The same reactor system was operated with real seawater collected from Pacific Ocean for 88 h (15,100 cycles). Maximum power generated was 1.63 ± 0.04 W m-2 for SC-MDC and 3.01 ± 0.01 W m-2 for SC-MDC-AdE. Solution conductivity in the desalination reactor decreased by ∼50% after 23 h and by more than 60% after 44 h. There was no observable change in the pH during cell operation. Power/current pulses were generated without an external power supply.

The zirconium-based metal–organic framework (MOF) (UiO-66)/bamboo carbon (BC) composite with chitosan was prepared using hydrothermal and impregnation methods and used for capacitive desalination (CDI) and disinfection of water. The results showed that these composites had fast ion exchange and charge transfer properties. During the CDI process, these composites' electrodes exhibited good cycle stability, electrosorption capacity (4.25 mg/g) and excellent bactericidal effect. These carbon-based composites electrodes' bactericidal rate for Escherichia coli could reach 99.99% within 20 minutes; therefore, they had good performance and were a good choice for high-performance deionization applications. [ABSTRACT FROM AUTHOR]

The present work is dedicated to the preparation and characterization of carbon-based electrodes for the removal of phosphates and nitrate ions from wastewater by CDI method. Carbons obtained from the pyrolysis were used to prepare electrodes and these electrodes were characterized using a number of experimental techniques. Based on the experimental results, the electrodes showed a strong affinity towards the nitrates than phosphates. This was evident from the kinetic constants and significantly higher capacity of electrosorption. At 1mM solutions, representative of a typical wastewater, nitrate exhibited about 3.5 times higher concentration than phosphates on a molar basis. The electrodes were reasonably stable under low concentrations of nitrates. At higher concentrations, the electrodes were not completely regenerable when the desorption step was carried out at 0V. These results are covered in this manuscript. [ABSTRACT FROM AUTHOR]

Turkish-speaking dyzygotic twins (n = 21) and singletons (n = 23) were tested through a standard articulation test to observe whether their consonant articulations were related to their vocabulary sizes, recorded through CDI forms, at age 3;0. Twins were observed to lag behind their singleton peers and performed below the norm level in their production. Vocabulary size failed to predict twins' articulation scores although it predicted the scores of the singleton group. The results suggested that articulation was not related to vocabulary size in twins. Exposure to sibling language was discussed as an alternative risk factor. [ABSTRACT FROM AUTHOR]

The most effective treatment for recurrent Clostridioides difficile infection (CDI) is faecal microbiota transplantation (FMT); however, the optimal route of administration is thus far unknown. This retrospective cohort study of 343 patients sought to evaluate the efficacy of treatment with FMT capsules, FMT enema, and rectal bacteriotherapy (RBT) during a five-year period. The primary endpoint was clinical resolution from CDI after eight weeks, and secondary endpoints were time to recurrence and death during the follow-up period. The proportion of patients with clinical resolution was 79.9% in the FMT capsule group, 53.3% in the FMT enema group, and 61.8% in the RBT group, corresponding to an adjusted odds ratio of 3.79 (CI: 1.82 to 8.26) in the FMT capsule group compared with FMT enema, and 2.92 (CI: 1.49 to 6.03) compared with RBT. The hazards ratio for recurrence within the first 12 months of follow-up was 0.24 (CI: 0.06 to 0.89) in the FMT capsule group compared with FMT enema, and 0.26 (CI: 0.08 to 0.91) compared with RBT. There was no difference in mortality. In conclusion, FMT capsules were more effective than both FMT enema and RBT as treatment of recurrent CDI and reduced the risk of further recurrences. [ABSTRACT FROM AUTHOR]

Background: Immunocompromised patients are particularly vulnerable to Clostridioides difficile infection (CDI), hospitalizations and recurrences. Studies have shown that fecal microbiota transplant (FMT) is safe and effective in immunocompromised patients. Aims: To examine the outcomes of FMT for CDI in a diverse cohort of immunocompromised patients stratified by medication class. Methods: We performed a retrospective, long-term follow-up study of FMT in immunocompromised patients, including those undergoing chemotherapy, with inflammatory bowel disease (IBD) on immunomodulators, prior solid organ transplant on immunosuppressants, on chronic steroids 20 mg/day or higher for a minimum of three months, or HIV positive. Primary outcomes included adjusted primary cure rate within 8 weeks, as well as rates of non-response, recurrences, relapses and adverse events. Secondary outcomes included adjusted overall cure rate. Primary cure rate was defined as patients not requiring repeat CDI treatment within 8 weeks after index FMT, and overall cure rate was defined as resolution of CDI symptoms after index FMT or second FMT. Results: Our cohort included 77 immunosuppressed patients (53.2% female, median age 39.1 years, range 7–95 years). The majority of our cohort were IBD patients on biologics (62.3%). Adjusting for colectomies and deaths, our primary and overall cure rates were 85.1% and 86.5%, respectively. Twelve patients received FMT for severe or fulminant CDI with a 3-month survival rate of 91.7%. 11.7% of patients experienced serious adverse events following FMT. Conclusions: Our study supports the efficacy and safety of FMT in immunocompromised patients, though future research is needed to further ascertain the potential effects of immunosuppression on FMT outcomes. [ABSTRACT FROM AUTHOR]

The neuronal L-type voltage-gated Ca2+ channel (CaV1.2) interacts with Ca2+ binding protein 1 (CaBP1), that promotes Ca2+-induced channel activity. The binding of CaBP1 to the IQ-motif in CaV1.2 (residues 1644–1665) blocks the binding of calmodulin and prevents Ca2+-dependent inactivation of CaV1.2. This Ca2+-induced binding of CaBP1 to CaV1.2 is important for modulating neuronal synaptic plasticity, which may serve a role in learning and memory. Here we report NMR assignments of the C-terminal domain of CaBP1 (residues 99–167, called CaBP1C) that contains two Ca2+ bound at the third and fourth EF-hands (EF3 and EF4) and is bound to the CaV1.2 IQ-motif from CaV1.2 (BMRB accession no. 51518). [ABSTRACT FROM AUTHOR]

In recently updated international guidelines, fidaxomicin is preferentially recommended as first-line treatment over vancomycin both for the first episode of CDI and for rCDI, based on the results of different randomized controlled trials (RCTs). Although noninferiority was the rule in phase-3 RCTs with regard to the primary endpoint of clinical cure, for shaping these recommendations, particular attention was devoted to the improved global cure and reduced risk of recurrent CDI (rCDI) observed with fidaxomicin compared to vancomycin in RCTs. Overall, while the major driver of choice should remain the global benefit for the patient, consideration of available resources should be necessarily weighed in the balance, since fidaxomicin still remains more costly than vancomycin. Against this background, precisely stratifying risk groups for rCDI will represent a crucial research trajectory of future real-life studies on the treatment of first CDI episodes. In the current narrative review, we discuss the updated evidence from RCTs on the efficacy of fidaxomicin for the treatment of either the first CDI episode or rCDI, which eventually supports its positioning within current treatment algorithms and guidelines. [ABSTRACT FROM AUTHOR]

Aims: To investigate if Clostridium (Clostridioides) difficile infection (CDI), traditionally thought of as hospital‐acquired, can be genomically linked to hospital or community environmental sources, and to define possible importation routes from the community to the hospital. Methods and Results: In 2019, C. difficile was isolated from 89/300 (29.7%) floor and 96/300 (32.0%) shoe sole samples at a tertiary hospital in Western Australia. Non‐toxigenic C. difficile ribotype (RT) 010 predominated among floor (96.6%) and shoe sole (73.2%) isolates, while toxigenic RT 014/020 was most prevalent among contemporaneous clinical cases (33.0%) at the hospital. Whole‐genome sequencing and high‐resolution core genome single nucleotide polymorphism (cgSNP) analysis on C. difficile strains from hospital and community sources showed no clinical C. difficile RT 014/020 strains were genetically related, and evidence of frequent long‐distance, multi‐directional spread between humans, animals and the environment. In addition, cgSNP analysis of environmental RT 010 strains suggested transportation of C. difficile via shoe soles. Conclusions: While C. difficile RT 014/020 appears to spread via routes outside the healthcare system, RT 010 displayed a pattern of possible importation from the community into the hospital. Significance and Impact of Study: These findings suggest developing community‐based infection prevention and control strategies could significantly lower rates of CDI in the hospital setting. [ABSTRACT FROM AUTHOR]

Clostridioides difficile infections (CDIs), and particularly recurrent infections, cause a significant burden on the health-care system. Bezlotoxumab is a new agent for the prevention of recurrent CDIs that has shown strong efficacy and high tolerability in clinical trials. The purpose of this review is to evaluate the published literature for bezlotoxumab, with a focus on literature published since the release of the 2021 focused update to the CDI treatment guidelines. A Medline/PubMed search for "bezlotoxumab" was conducted, resulting in 152 articles. Seventeen studies are included in this review, after excluding non-English-language papers, phase I and II trials, and review articles. Studies published since the 2021 focused update support the recommendations in those guidelines. Furthermore, real-world studies have shown similar results to larger clinical trials. Those with more risk factors for recurrent CDI appear to benefit most from bezlotoxumab. Currently, there are no data to support the use of bezlotoxumab outside current guideline recommendations, but future trials may build on the data seen in real-world studies to further elucidate the place in therapy for bezlotoxumab. [ABSTRACT FROM AUTHOR]

Introduction: In the past decade, the incidence of community-acquired Clostridioides difficile infection (CA-CDI) has increased, suggesting a role for community reservoirs such as animals in its spread., Objective: This study aimed to isolate and characterize C. difficile strains from domestic dogs at veterinary clinics to enhance our understanding of C. difficile epidemiology in Rio de Janeiro., Material and Methods: For this study 90 stool samples from dogs were collected and cultured in a selective medium (Clostridioides difficile Brucella agar - CDBA) for isolation. Species were identified by MALDI-TOF MS, with confirmation provided by PCR targeting the tpi gene. The antibiotic susceptibility test of the strains was performed using five antibiotics: vancomycin, metronidazole, moxifloxacin, rifampicin, and erythromycin. Strains resistant to metronidazole were further analyzed for the presence of the plasmid pCD-METRO using PCR. The presence of toxin genes (tcdA, tcdB, and cdtB) was investigated, alongside ribotyping and tcdC sequencing analyses. The strains were also tested for biofilm formation and motility., Results: C. difficile was isolated in 15.5 % (14/90) of the samples. Among the strains analyzed, 87.71 % (12/14) tested positive for both toxin genes tcdA and tcdB and belonged to ribotypes 106 (10/14) and 014/020 (2/14). The remaining 14.3 % (2/14) were non-toxigenic and were identified as ribotype 010. Regarding the antibiotic profile, 42.85 % (6/14) of the strains exhibited resistance to at least one antibiotic, including vancomycin (1/14) and metronidazole (1/14). The metronidazole-resistant strain was also positive for the plasmid pCD-METRO. All strains exhibited both biofilm formation and motility. Among the 12 toxigenic strains sequenced for the tcdC gene, two exhibited a deletion in the same region as the epidemic strain, NAP1 (RT027)., Conclusion: Our study found some overlap between C. difficile ribotypes isolated from dogs and from cases of CDI in humans, and the C. difficile prevalence was higher in dogs with diarrhea (p = 0.034)., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

It has been observed that novel strains of Clostridioides difficile can rapidly emerge and move between animal and human hosts. The aim of this study was to investigate the prevalence of C. difficile in pigs and dairy cattle in northern Italy and to characterize and compare C. difficile animal strains with those from patients from the same geographical area. The C. difficile strains were isolated from animals from farms and slaughterhouses (cross-sectional studies) and from neonatal animals with enteric disorders in routine diagnostic investigations (passive surveillance). Samples positive for C. difficile were found in 87% of the pig farms and in 40% of the cattle farms involved in the cross-sectional studies, with a 20% prevalence among suckling piglets and 6.7% prevalence in neonatal calves, with no significant difference between animals with and without diarrheal symptoms. The prevalence of C. difficile in older animal categories was significantly lower. This result suggests that young age is an important risk factor for C. difficile colonization. In cross-sectional studies at slaughterhouses, in both the heavy pigs and dairy cows examined, only 2% of the intestinal content samples were positive for C. difficile and no contamination was found on the surface of the carcasses. Considering passive surveillance, the prevalence rates of positive samples were 29% in piglets and 1.4% in calves. Overall, 267 strains of animal origin and 97 from humans were collected. In total, 39 ribotypes (RTs) were identified, with RT 078 and RT 018 being predominant among animals and humans, respectively. Several RTs overlapped between animals and patients. In particular, RT 569 was identified as an emergent type in our country. Resistance to erythromycin and moxifloxacin was widely diffused among C. difficile strains, regardless of origin. This study supports C. difficile as a pathogen of one-health importance and highlights the need for a collaborative approach between physicians and veterinarians to control and prevent infections that are able to cross species and geographical barriers.

Clostridioides difficile is a Gram-positive, anaerobic, spore-forming bacillus and is a major cause of healthcare-associated infections. Whereas the vegetative form of the pathogen is susceptible to treatment with antibiotics, its ability to persist in the gut as antibiotic-resistant spores means that reinfection can occur in cases were the individual fails to re-establish a protective microflora. Bacteriophages and their lysins are currently being explored as treatment options due to their specificity, which minimizes the disruption to the other members of the gut microflora that are protective. The feasibility of employing recombinant endolysins to target the vegetative form of C. difficile has been demonstrated in animal models. In this study, we cloned and expressed the enzyme active domain of LysCD6356 and confirmed its ability to lyse the vegetative forms of a diverse range of clinical isolates of C. difficile, which included members of the hypervirulent 027 ribotype. Lytic activity was adversely affected by calcium, which is naturally found in the gut and is released from the spore upon germination. Our results suggests that a strategy in which the triggering of spore germination is separated in time from the application of the lysin could be developed as a strategy to reduce the risk of relapsing C. difficile infections.

Objective: To systematically assess the current related methodological quality of guidelines for the diagnosis and treatment of Clostridioides difficile infection (CDI), revealing the heterogeneity and reasons for guideline recommendations for the diagnosis and treatment of CDI. Methods: We searched electronic databases systematically between 2017 and 2021 to find the latest guidelines for the diagnosis and treatment of CDI. The Appraisal of Guidelines for Research and Evaluation (AGREE II) tool was used for quality assessment of the included guidelines. The main recommendations for the diagnosis and treatment of CDI in the guidelines were extracted and evaluated for consistency, and the level of evidence supporting these recommendations was further extracted and analysed. Results: Fourteen guidelines for the diagnosis and treatment of CDI were finally included in this study. There were four guidelines, BSG and HIS, ASCRS, IDSA AND SHEA, and NICE, with an overall score of more than 60%, which is worthy of clinical recommendation. Further analysis of the consistency of the main recommendations for the diagnosis and treatment of CDI in the guidelines showed that the recommendations differed among guidelines. There are no unified classification criteria for the severity of CDI in current studies; some recommendations for the diagnosis and treatment of CDI do not provide evidence to support the recommendations, most recommendations cite low levels of evidence, and there is a lack of high-quality research evidence. Conclusion: The quality of guidelines for the diagnosis and treatment of CDI is uneven. Recommendations on the diagnosis and treatment of CDI have also varied in the guidelines for the past 5 years. Improvements of the aforementioned factors associated with causing heterogeneity would be a rational approach by guideline developers to further update guidelines for the diagnosis and treatment of CDI. [ABSTRACT FROM AUTHOR]

Clostridioides difficile infection (CDI) is an important community- and hospital-acquired infection. Patients receiving tube feeding often have diarrhoea, and it is still unclear whether the traditional criteria for submitting samples for Clostridioides difficile (CD) testing as determined by the frequency of the diarrhoea apply to these patients. We conducted a retrospective study comparing the clinical features of tube-fed inpatients with suspected CDI, with CDI, and those without CDI admitted between 2004 and 2020. Univariate associations were assessed using the chi-square test, Fisher's exact test, or student's t-test, and multivariate analysis was conducted using logistic regression analysis. Among 805 tube-fed inpatients with and suspected CDI, 163 (20.2%) had CDI and 642 (79.8%) did not. The following seven predictors, independently associated with CDI, were used to develop the SEASON GAP score: male (S ex) (1 point), E maciation (1 point), days from A dmission to testing ≥21 days (2 points), S tool frequency/day ≥5 times (1 point), seas ON (summer: 2 points, spring and winter: 1 point), GA strostomy (2 points), and no prior P roton pump inhibitor use (1 point). In a receiver operating characteristic curve, the area under the curve was 0.77 (95% confidence interval: 0.73–0.80). The optimal cut-off point was 3.5. A score of ≤3 had a sensitivity, specificity, and negative predictive value of 81%, 60%, and 93%, respectively. The SEASON GAP score is useful in ruling out CDI in patients with tube feeding, thus reducing unnecessary CD testing and antimicrobial use. [ABSTRACT FROM AUTHOR]

The Forkhead box protein M1 (FoxM1) is an appealing target for anti-cancer therapeutics as this cell proliferation-associated transcription factor is overexpressed in most human cancers. FoxM1 is involved in tumor invasion, angiogenesis, and metastasis. To discover novel inhibitors that disrupt the FoxM1-DNA interaction, we identified CDI, a small molecule that inhibits the FoxM1–DNA interaction. CDI was identified through an assay based on the time-resolved fluorescence energy transfer response of a labeled consensus oligonucleotide that was bound to a recombinant FoxM1-dsDNA binding domain (FoxM1-DBD) protein and exhibited potent inhibitory activity against FoxM1-DNA interaction. CDI suppressed cell proliferation and induced apoptosis in MDA-MB-231 cells obtained from a breast cancer patient. Furthermore, it decreased not only the mRNA and protein expression of FoxM1 but also that of downstream targets such as CDC25b. Additionally, global transcript profiling of MDA-MB-231 cells by RNA-Seq showed that CDI decreases the expression of FoxM1-regulated genes. The docking and MD simulation results indicated that CDI likely binds to the DNA interaction site of FoxM1-DBD and inhibits the function of FoxM1-DBD. These results of CDI being a possible effective inhibitor of FoxM1-DNA interaction will encourage its usage in pharmaceutical applications. [ABSTRACT FROM AUTHOR]

Background Many models have been developed to predict severe outcomes from Clostridioides difficile infection (CDI). These models are usually developed at a single institution and largely are not externally validated. Our aim in this study was to validate previously published risk scores in a multicenter cohort of patients with CDI. Methods This was a retrospective study on 4 inpatient cohorts with CDI from 3 distinct sites: the universities of Michigan (2010–2012 and 2016), Chicago (2012), and Wisconsin (2012). The primary composite outcome was admission to an intensive care unit, colectomy, and/or death attributed to CDI within 30 days of positive testing. Both within each cohort and combined across all cohorts, published CDI severity scores were assessed and compared to each other and the Infectious Diseases Society of America (IDSA) guideline definitions of severe and fulminant CDI. Results A total of 3646 patients were included for analysis. Including the 2 IDSA guideline definitions, 14 scores were assessed. Performance of scores varied within each cohort and in the combined set (mean area under the receiver operator characteristic curve [AuROC], 0.61; range, 0.53–0.66). Only half of the scores had performance at or better than IDSA severe and fulminant definitions (AuROCs of 0.64 and 0.63, respectively). Most of the scoring systems had more false than true positives in the combined set (mean, 81.5%; range, 0%–91.5%). Conclusions No published CDI severity score showed stable, good predictive ability for adverse outcomes across multiple cohorts/institutions or in a combined multicenter cohort. [ABSTRACT FROM AUTHOR]

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The burden of Clostridioides difficile infection (CDI) has greatly increased. We evaluated the risks for CDI transmission to community members after hospitalized patients are discharged. We conducted a systematic literature review in MEDLINE/PubMed, EMBASE, CINAHL plus EBSCO, Web of Science, Cochrane Library, and gray literature during January 2000‒February 2019 and identified 4,798 citations were identified. We eliminated 4,554 citations through title and abstract screening; 217 additional citations did not meet full criteria. We reviewed texts for the 27 remaining articles qualitatively for internal/external validity. A few identified studies describing risks to community members lacked accurate risk measurement or preventative strategies. Primary data are needed to assess efficacy of and inform current expertise-driven CDI prevention practices. Raising awareness among providers and researchers, conducting clinical and health services research, linking up integrated monitoring and evaluation processes at hospitals and outpatient settings, and developing and integrating CDI surveillance systems are warranted.

Nikhitha Mantri,1 Harish Patel,1,2 Kanthi Rekha Badipatla,1,2 Haozhe Sun,1 Danial Shaikh,1,2 Sudharsan Gongati,1 Suresh Kumar Nayudu1,2 1Department of Medicine, Bronx Care Health System, Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, NY, USA; 2Division of Gastroenterology, Bronx Care Health System, Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, NY, USACorrespondence: Suresh Kumar NayuduBronx Care Health System, Affiliated with Icahn School of Medicine at Mount Sinai, 1650 Selwyn Ave, Bronx, NY, USATel +1 2122035476Fax +1 7189602055Email SNAYUDU@bronxleb.orgPurpose: Clostridioides difficile infection (CDI) is one of the most common health care-associated infections in the United States. Studies revealed a higher mortality when CDI is associated with liver cirrhosis. We aim to present the outcomes of CDI among patients with and without liver cirrhosis and to analyze the association of Model for End-Stage Liver Disease (MELD) and Child-Pugh (CPT) scoring with the severity of CDI.Methods: A retrospective observational study was conducted in hospitalized patients with CDI diagnosed via a 2-step method – glutamate dehydrogenase (GDH) and toxin polymerase chain reaction (PCR). Patients with liver cirrhosis were identified based on ICD codes and chart review. MELD and CPT scores were calculated using laboratory parameters at the time of hospitalization. We compared CDI-related mortality in patients with and without cirrhosis and reviewed the CDI severity distribution in cirrhosis patients.Results: A total of 526 patients were included in the study, of which 478 (90.87%) were non-cirrhotic and 48 (9.13%) were cirrhotic patients. Mortality rate was higher in cirrhosis group compared to the non-cirrhosis group (39.6% vs. 14.6%,P = 0.001). Among cirrhosis patients, those who survived had lower MELD score compared to the expired group (14.9 vs. 18.58, P = 0.106). There was no correlation of mortality based on CPT score in the cirrhosis group (P = 0.062). In post hoc analysis comparing the severity of CDI to liver cirrhosis, cirrhosis patients are more likely to present with severe-complicated disease. Multivariate logistic regression identified liver cirrhosis, severe-complicated CDI and serum albumin level as independent predictors of mortality.Conclusion: Our study noted a more severe disease presentation and higher mortality in patients with cirrhosis admitted with CDI. Further studies are required for better understanding of the clinical course of CDI in cirrhosis and to evaluate the need for early intervention in this patient group.Keywords: clostridioides difficile infection; CDI, cirrhosis, mortality, severity, Model for End-Stage Liver Disease; MELD, Child-Pugh; CPT

Information on Clostridioides difficile infection (CDI) in patients with COVID-19 is scarce and points to an overall decrease of episodes during the pandemic. This situation results paradoxical, as COVID-19 patients had long periods of hospital stay and high use of antibiotics. We conducted a retrospective study from January 1st 2019 to December 31st 2020 comparing the incidence of hospital-acquired episodes of CDI (HA-CDI) among patients with and without COVID-19 admitted to our institution. During the study period, there were 47,048 patient admissions in 2019, 35,662 admissions of patients without COVID-19 in 2020 and 6,763 of COVID-19 patients. There were 68 episodes of HA-CDI in COVID-19 patients (14.75/10,000 days), 159 in 2020-non-COVID-19 patients (5.54/10,000 days) and 238 in 2019 (6.80/10,000 days). Comparison of HA-CDI in COVID-19 and non-COVID-19 patients indicates it occurs more frequently, in terms of CDI disease severity, COVID-19 does not seem to have a negative impact.

ABSTRACT The severity of Clostridioides difficile infections (CDI) has increased over the last few decades. Patient age, white blood cell count, and creatinine levels as well as C. difficile ribotype and toxin genes have been associated with disease severity. However, it is unclear whether specific members of the gut microbiota are associated with variations in disease severity. The gut microbiota is known to interact with C. difficile during infection. Perturbations to the gut microbiota are necessary for C. difficile to colonize the gut. The gut microbiota can inhibit C. difficile colonization through bile acid metabolism, nutrient consumption, and bacteriocin production. Here, we sought to demonstrate that members of the gut bacterial communities can also contribute to disease severity. We derived diverse gut communities by colonizing germfree mice with different human fecal communities. The mice were then infected with a single C. difficile ribotype 027 clinical isolate, which resulted in moribundity and histopathologic differences. The variation in severity was associated with the human fecal community that the mice received. Generally, bacterial populations with pathogenic potential, such as Enterococcus, Helicobacter, and Klebsiella, were associated with more-severe outcomes. Bacterial groups associated with fiber degradation and bile acid metabolism, such as Anaerotignum, Blautia, Lactonifactor, and Monoglobus, were associated with less-severe outcomes. These data indicate that, in addition to the host and C. difficile subtype, populations of gut bacteria can influence CDI disease severity. IMPORTANCE Clostridioides difficile colonization can be asymptomatic or develop into an infection ranging in severity from mild diarrhea to toxic megacolon, sepsis, and death. Models that predict severity and guide treatment decisions are based on clinical factors and C. difficile characteristics. Although the gut microbiome plays a role in protecting against CDI, its effect on CDI disease severity is unclear and has not been incorporated into disease severity models. We demonstrated that variation in the microbiome of mice colonized with human feces yielded a range of disease outcomes. These results revealed groups of bacteria associated with both severe and mild C. difficile infection outcomes. Gut bacterial community data from patients with CDI could improve our ability to identify patients at risk of developing more severe disease and improve interventions that target C. difficile and the gut bacteria to reduce host damage.

• Activated carbon derived from agriculture by-products obtain high surface area, high porosity, and low density. • Deionization efficiency of CDI, MCDI, and FCDI reached 80–90 % and water recovery rate 90 %. • The roller, spray coating, and mill ball grinding are useful to fabricate electrodes for industry applications. • The adsorption capacities of AC and AC-modified electrodes were 25–40 mg/g. • Life span and deionization efficiency of the flow electrode are higher than electrode plate. Capacitive deionization (CDI), membrane capacitive deionization (MCDI), and flow capacitive deionization (FCDI) are emerging technologies applied to remove ions from brackish water or saline wastewater based on electrode double layer (EDL) mechanisms. The electrode itself can be seen as the most important factor that determines the deionization efficiency of the CDI system. Electrode fabrication using activated carbon derived from agriculture byproducts is a useful solution to decrease cost, restrict environmental pollution, and enable agriculture waste recovery. In this review, the primary parameter's impact on activated carbon (AC) and the electrode fabrication process from the agriculture byproducts is detailed in a discussion to find the most optimal conditions. With excellent characteristics for the activated carbon such as a surface area of up to 2500 m2/g, it can be used to fabricate electrodes that have a high adsorption capacity of approximately 25 mg/g, able to be advanced to 40 mg/g with a modified AC. It can achieve a cycle performance of 95–97 %. The deionization efficiency of the CDI, MCDI, and FCDI systems can be up to 90 % with an input salt concentration from 2000 to 3000 mg/L where the water recovery ratio achieved is 50–90 %, alongside a salt rejection rate of about 7–75 %. AC can be modified to increase its special properties such as surface area, conductivity, and ion selectivity using different methods. The drawbacks and challenges of the CDI technology are also mentioned along with useful solutions such as electrode coating techniques using an anilox roller and a spray, for use in industry applications. [Display omitted] [ABSTRACT FROM AUTHOR]

We aimed to determine whether the Sequential Organ Failure Assessment (SOFA) score predicts the prognosis of patients with Clostridioides difficile infection (CDI). In addition, the association between the type of antibiotic used and PCR ribotypes was analyzed. We conducted a propensity score (PS)-matched study and machine learning analysis using clinical data from all adult patients with confirmed CDI in three South Korean hospitals. A total of 5,337 adult patients with CDI were included in this study, and 828 (15.5%) were classified as having severe CDI. The top variables selected by the machine learning models were maximum body temperature, platelet count, eosinophil count, oxygen saturation, Glasgow Coma Scale, serum albumin, and respiratory rate. After propensity score-matching, the SOFA score, white blood cell (WBC) count, serum albumin level, and ventilator use were significantly associated with severe CDI (P < 0.001 for all). The log-rank test of SOFA score ≥ 4 significantly differentiated severe CDI patients from the non-severe group. The use of fluoroquinolone was more related to CDI patients with ribotype 018 strains than to ribotype 014/020 (P < 0.001). Even after controlling for other variables using propensity score matching analysis, we found that the SOFA score was a clinical predictor of severe CDI. We also demonstrated that the use of fluoroquinolones in hospital settings could be associated with the PCR ribotype in patients with CDI. [ABSTRACT FROM AUTHOR]

Background Bezlotoxumab (BEZ) is a monoclonal antibody used to prevent recurrent Clostridioides difficile infection (rCDI). This study investigates BEZ effectiveness in relation to rCDI and patient-specific risk factors in a real-world setting. Methods A matched, retrospective cohort study was conducted from 2015 to 2019 to compare BEZ to historical standard of care (SoC) therapy with vancomycin or fidaxomicin. The primary outcome was incidence of 90-day rCDI. Secondary outcomes were incidence of all-cause hospital readmission and all-cause mortality at 90 days, infusion-related reactions, and incidence of heart failure exacerbation. Baseline confounding was addressed using inverse probability of treatment weighting (IPTW). Results Overall, 107 participants were included (54 BEZ and 53 SoC). Mean number of prior CDI episodes was 2, median number of risk factors for rCDI was 4, and 28% of participants had severe CDI. Incidence of 90-day rCDI was 11% BEZ vs 43% SoC (P = <.001) and 90-day all-cause readmission was 40% BEZ vs 64% SoC (P =.011). In IPTW-adjusted analyses, BEZ was associated with significantly reduced odds of rCDI (odds ratio [OR], 0.14 [95% confidence interval {CI}:.05–.41]) and all-cause readmission (OR, 0.36 [95% CI:.16–.81]). No safety signals were detected with BEZ use. Conclusions BEZ is effective for the prevention of rCDI and reduction in all-cause hospital readmission for patients at high risk for recurrence, supporting current guideline recommendations. [ABSTRACT FROM AUTHOR]

The study aimed to determine the influence of a pulsed electric field (PEF) treatment on vacuum drying (VD) of apples and their selected quality parameters. The apples were treated with a PEF at 1 kV-cm-1 (with a variable amount of the specific energy input: 1, 3.5, and 6 kJ·kg-1) before VD at 4 kPa (with a variable drying temperature: 40 °C, 55 °C, and 70 °C). The drying time, microstructure, retention of total phenolics (TPC) as well as the antioxidant activity of the obtained dried materials were studied. As a result of opening the cell structure of the apple tissues, the PEF significantly (P < 0.05) reduced the drying time - depending on the used process parameters - by 6-22%. Moreover, an increase in the drying temperature also shortened the drying time. The electroporation led to obtaining porous materials after drying, and with the higher amount of specific energy during the PEF pre-treatment that was applied, a higher porosity was observed in the dried apples. After the PEF-assisted VD, a significant (P < 0.05) decrease in the TPC (by 12-40%) and antioxidant activity (by 23-81%) were observed. [ABSTRACT FROM AUTHOR]

Clostridioides difficile infection is a serious medical and epidemiological problem, with severe consequences. It can divert essential resources and thus represent a considerable burden for healthcare systems, impacting their normal functioning and the provision of safe and effective care. Prevention, proper diagnosis, adequate treatment and effective control measures are the core elements required to reduce the risk of this disease, prevent the infection from spreading and diminish probability of recurrence. This update on disease management is focused on epidemiology, pathophysiology and risk factors, as well as diagnosis, treatment, prevention and infection control measures. This review draws on a great diversity of sources to enabled the integration of the best available evidence regarding Clostridioides difficile infection (CDI) prevention and control, reflecting recommendations and guidelines from regional, national and international entities and specialised bodies. Nurses play a paramount role in prevention and management of CDI. They take part in all stages of care, by identifying high-risk patients and the disease's first signs and symptoms, monitoring its evolution, implementing effective infection-control measures and providing patient and family education. [ABSTRACT FROM AUTHOR]

An uncommon case of monomicrobial Clostridioides difficile septicemia in a 63-year-old man was reported in Zhejiang, China. Once diagnosed, vancomycin treatment cleared the infections. The patient had no remarkable medical history, and the inspection showed no overt gastrointestinal symptoms, though C. difficile was detected in his stool samples. However, we later defined that the C. difficile strain isolated from the blood sample was different from the one isolated from his stool using the whole genome sequencing analysis. By retrospective analysis of his medical record, we noticed that the man had a recent tooth extraction thus the bacterium may have invaded through the root canal. Therefore, we suggest that oral C. difficile colonization may be a potential risk factor for severe C. difficile septicemia, which could be clinically alarming. [ABSTRACT FROM AUTHOR]

Background: Physical exercise therapy is of proven efficacy in the treatment of adults with depression, but corresponding evidence is lacking in depressed adolescent inpatients. The aim of this study was to document the effect of add-on treatment with structured physical exercise in a clinical population of adolescents hospitalized for depression and anxiety in a psychiatric hospital.Methods: A group of 52 adolescent inpatients was randomly assigned to a physical exercise or control program three to four times per week over a six-week period (20 hours in total). The primary outcome was the Hospital Anxiety Depression Scale (HADS) for evaluation of depression and anxiety symptoms. Secondary outcomes were psychological self-assessments, diagnostic interviews, and physical examinations.Results: Six participants were lost in each group, leaving 20 inpatients each in the intervention and control groups. A linear mixed model with F-test revealed a significant interaction in favor of physical exercise in reducing the mean depression score (HADS-D) by 3.8 points [95% (CI), range 1.8 to 5.7], compared to a mean reduction score of 0.7 [95% (CI), range -0,7 to 2.0] in the control group. No significant interaction was found for anxiety symptoms (HADS-A).Limitations: The investigation was limited to the six-week hospital window and the small sample size prevented exploring differences in social characteristics.Conclusion: Structured physical exercise add-on therapy integrated into the psychiatric hospitalization of adolescents has led to a reduction in their depressive symptoms, demonstrating its effectiveness in the care of adolescent inpatients with depression. [ABSTRACT FROM AUTHOR]

Background: Severe and fulminant Clostridioides difficile infection (CDI) is associated with significant morbidity and mortality. While fecal microbiota transplantation (FMT) has proved to be a highly effective treatment for recurrent CDI, its efficacy in severe or fulminant CDI remains uncertain. Aims: To perform a systematic review with meta-analysis evaluating clinical outcomes and safety of FMT in severe and fulminant CDI. Methods: A systemic review with meta-analysis was performed through comprehensive search of Embase, Medline (Ovid), trial registers, and conference abstracts through January 2020. Studies on FMT in severe and fulminant CDI were included. Meta-analysis was done with random effects models given heterogeneity to estimate rates of cure, mortality, and colectomy. Publication bias was assessed using Egger's test. Results: Sixteen studies comprised of one randomized controlled trial, four cohort studies, and eleven case series were analyzed. In total, 676 patients underwent FMT for severe or fulminant CDI. The overall rate of clinical cure after single FMT was 61.3% (95% CI 43.2–78.0%) with 10.9% (95% CI 0.2–30.2%) of patients experiencing major adverse events. The overall pooled colectomy rate after FMT was 8.2% (95% CI 0.1–23.7%) with a pooled all-cause mortality rate after FMT of 15.6% (95% CI 7.8–25.0%). Conclusion: Low-quality data support the use of fecal microbiota transplantation in patients with severe and fulminant Clostridioides difficile infection. [ABSTRACT FROM AUTHOR]

Background The incidence of Clostridioides difficile infection (CDI) has increased over the past 2 decades and is considered an urgent threat by the Centers for Disease Control and Prevention. Hypervirulent strains such as ribotype 027, which possess genes for the additional toxin C. difficile binary toxin (CDT), are contributing to increased morbidity and mortality. Methods We retrospectively tested stool from 215 CDI patients for CDT by enzyme-linked immunosorbent assay (ELISA). Stratifying patients by CDT status, we assessed if disease severity and clinical outcomes correlated with CDT positivity. Additionally, we completed quantitative PCR (PCR) DNA extracted from patient stool to detect cdtB gene. Lastly, we performed 16 S rRNA gene sequencing to examine if CDT-positive samples had an altered fecal microbiota. Results We found that patients with CdtB, the pore-forming component of CDT, detected in their stool by ELISA, were more likely to have severe disease with higher 90-day mortality. CDT-positive patients also had higher C. difficile bacterial burden and white blood cell counts. There was no significant difference in gut microbiome diversity between CDT-positive and -negative patients. Conclusions Patients with fecal samples that were positive for CDT had increased disease severity and worse clinical outcomes. Utilization of PCR and testing for C. difficile toxins A and B may not reveal the entire picture when diagnosing CDI; detection of CDT-expressing strains is valuable in identifying patients at risk of more severe disease. [ABSTRACT FROM AUTHOR]

• Clostridioides difficile is a leading cause of infectious diarrhea in hospitalized patients. • Machine learning algorithms can predict Clostridioides difficile with excellent discrimination. • XGBoost maintained predictive performance across a hold-out test set and an external dataset Interventions to better prevent or manage Clostridioides difficile infection (CDI) may significantly reduce morbidity, mortality, and healthcare spending. We present a retrospective study using electronic health record data from over 700 United States hospitals. A subset of hospitals was used to develop machine learning algorithms (MLAs); the remaining hospitals served as an external test set. Three MLAs were evaluated: gradient-boosted decision trees (XGBoost), Deep Long Short Term Memory neural network, and one-dimensional convolutional neural network. MLA performance was evaluated with area under the receiver operating characteristic curve (AUROC), sensitivity, specificity, diagnostic odds ratios and likelihood ratios. The development dataset contained 13,664,840 inpatient encounters with 80,046 CDI encounters; the external dataset contained 1,149,088 inpatient encounters with 7,107 CDI encounters. The highest AUROCs were achieved for XGB, Deep Long Short Term Memory neural network, and one-dimensional convolutional neural network via abstaining from use of specialized training techniques, resampling in isolation, and resampling and output bias in combination, respectively. XGBoost achieved the highest AUROC. MLAs can predict future CDI in hospitalized patients using just 6 hours of data. In clinical practice, a machine-learning based tool may support prophylactic measures, earlier diagnosis, and more timely implementation of infection control measures. [ABSTRACT FROM AUTHOR]

Background: Advanced age is an important factor affecting Clostridioides difficile infection (CDI) risk and outcome. While fever and leukocytosis are prominent findings in young individuals with CDI, they are usually blunted in the elderly. Furthermore, chronic kidney disease often exists among this population prior to the CDI episode onset. Aim: We aimed to examine whether the accepted definition of severe CDI (leukocytosis ≥ 15,000 cells/μl or serum creatinine > 1.5 mg/dl) predicts poor outcomes in the elderly. Methods: All CDI hospitalized individuals between January-2013 and May-2020 were included. The study population was dichotomized into older group (≥ 65 years) and younger group (< 65 years). Primary composite outcome was 30-day mortality, colectomy due to severe colitis, or intensive care unit admission. The older group was divided according to the primary outcome to evaluate the effect of CDI severity criteria. Results: The study included 853 patients. Of them, 571 were in the older group and 282 in the younger one. The primary outcome was significantly more common in the older group (93/571, 16% vs. 31/282, 11%; p = 0.04). Ninety days mortality was significantly higher in the older group [116/571, 20% vs. 30/282, 11%; p < 0.01]. In multivariate analysis, accepted CDI severity criteria were not significantly associated with poor outcomes (odds ratio [OR] = 1.2, 95% confidence interval [CI] 0.7–2.2, p = 0.5). Advanced dementia and low serum albumin were significant predictors of poor outcomes (OR = 3, 95%CI 1.5–6, p = 0.002 and OR = 3.1, 95%CI 1.7–5.8, p < 0.01). Conclusion: The accepted definition of CDI severity was not useful in predicting CDI poor outcomes in older adults. In this population, we suggest advanced dementia and low albumin among others as CDI severity markers. [ABSTRACT FROM AUTHOR]