Clostridioides difficile Infection in Patients with Chronic Kidney Disease: A Systematic Review

Clostridioides difficile infection (CDI) is a health issue of utmost significance in Europe and North America, due to its high prevalence, morbidity, and mortality rate. The clinical spectrum of CDI is broad, ranging from asymptomatic to deadly fulminant colitis. When associated with chronic kidney...

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Bibliographic Details
Published in:BioMed research international 2021, Vol.2021, p.5466656-10
Main Authors: Mihaescu, Adelina, Augustine, Arlyn Maria, Khokhar, Hassan Tahir, Zafran, Mohammed, Masood, Syed Shah Mohammed Emmad, Gilca-Blanariu, Georgiana-Emmanuela, Covic, Adrian, Nistor, Ionut
Format: Article
Language:English
Subjects:
Antibiotics
Bias
Chlorine
Chronic infection
Clinical trials
Clostridioides difficile
Clostridium Infections - complications
Clostridium Infections - prevention & control
Clostridium Infections - therapy
Colitis
Diarrhea
Disease prevention
Disinfection
Epidemiology
Health services
Humans
Hydrogen peroxide
Hydrogen peroxide vapor
Immune system
Infections
Inflammatory bowel disease
Internal medicine
Intervention
Keywords
Kidney diseases
Kidneys
Microbiota
Morbidity
Mortality
Outcome Assessment, Health Care
Patients
Prevention
Randomized Controlled Trials as Topic
Renal Insufficiency, Chronic - complications
Renal Insufficiency, Chronic - microbiology
Review
Risk analysis
Risk factors
Systematic review
Transplantation
Vancomycin
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Summary:Clostridioides difficile infection (CDI) is a health issue of utmost significance in Europe and North America, due to its high prevalence, morbidity, and mortality rate. The clinical spectrum of CDI is broad, ranging from asymptomatic to deadly fulminant colitis. When associated with chronic kidney disease (CKD), CDI is more prevalent and more severe than in the general population, due to specific risk factors such as impaired immune system, intestinal dysmotility, high antibiotic use leading to disturbed microbiota, frequent hospitalization, and PPI use. We performed a systematic review on the issue of prevention and treatment of CDI in the CKD population, analysing the suitable randomized controlled cohort studies published between 2000 and 2021. The results show that the most important aspect of prevention is isolation and disinfection with chlorine-based solution and hydrogen peroxide vapour to stop the spread of bacteria. In terms of prevention, using Lactobacillus plantarum (LP299v) proved to be more efficient than disinfection measures in transplant patients, leading to higher cure rates and less recurrent episodes of CDI. Treatment with oral fidaxomycin is more effective than with oral vancomycin for the initial episode of CDI in CKD patients. Faecal microbiota transplantation (FMT) is more effective than vancomycin in recurrent CDI in CKD patients. More large-sample RCTs are necessary to conclude on the best treatment and prevention strategy of CDI in CKD patients.
ISSN:2314-6133
2314-6141
DOI:10.1155/2021/5466656