Background Clostridium perfringens is a pathogen that secretes multiple toxins,impacting humans and animals.It can cause intestinal diseases such as necrotic enteritis.Although tannins inhibit C.perfringens proliferat...Background Clostridium perfringens is a pathogen that secretes multiple toxins,impacting humans and animals.It can cause intestinal diseases such as necrotic enteritis.Although tannins inhibit C.perfringens proliferation,the precise underlying mechanisms are unclear.Objective This study integrated transcriptomics and metabolomics to systematically investigate the mechanism by which tannins,specifically pentagalloylglucose(PGG)and tannic acid(TA),inhibit C.perfringens and potential pathways to alleviate infection in vivo.Results Ion concentration measurements,flow cytometric analysis,and transmission electron microscopy revealed that PGG and TA damaged the cell membrane structure of C.perfringens,triggering cytoplasmic content leakage.Additionally,PGG and TA significantly affected C.perfringens at the transcriptional and metabolic levels.Bioinformatics analysis revealed that PGG and TA induced amino acid restriction,disrupted energy metabolism,and impeded the ability of C.perfringens to sense and respond to the external environment.In an in vitro C.perfringens-infected intestinal cell model,PGG and TA boundαtoxin,significantly reduced the mRNA expression of inflammatory factors,and improved intestinal barrier function and cell viability.Compared to PGG,TA exhibited stronger inhibitory activity against C.perfringens and binding toαtoxin.In vivo,PGG and TA alleviated C.perfringens-induced weight loss in mice,improved intestinal villi morphology,and reduced intestinal inflammation and tight junction gene dysregulation.Conclusion These findings indicate that tannins inhibit C.perfringens,improve gut tissue integrity and reduce inflammation,demonstrating their multi-target effects of resisting intestinal diseases caused by harmful bacteria.This offers new insights for plant polyphenol-based strategies against necrotic enteritis.展开更多
BACKGROUND Clostridium difficile infection(CDI)is common in patients with inflammatory bowel disease(IBD).AIM To assess the association of CDI with clinical outcomes of IBD.METHODS PubMed,EMBASE,Web of Science,and the...BACKGROUND Clostridium difficile infection(CDI)is common in patients with inflammatory bowel disease(IBD).AIM To assess the association of CDI with clinical outcomes of IBD.METHODS PubMed,EMBASE,Web of Science,and the Cochrane Library databases were searched from inception to March 2024.Eligible articles included observational studies that reported on outcomes such as mortality,colectomy,hospitalization,intensive care unit(ICU)admission,complication rates,and length of hospital stay in IBD patients with and without CDI.Data were extracted,and a randomeffects model was used to calculate pooled odds ratios(ORs)and mean differences(MDs).RESULTS As shown in the data from 21 studies with 1249158 participants,CDI significantly increased the risk of mortality in IBD patients[pooled OR=4.569,95%confidence intervals(95%CI):2.584 to 8.079].Although the pooled OR for colectomy was 1.409(95%CI:0.922 to 2.155),it was not statistically significant.Similarly,CDI did not impact hospitalization(pooled OR=1.056,95%CI:0.512 to 2.179)and ICU admission outcomes(pooled OR=1.970,95%CI:0.420 to 9.246)of patients with IBD.The rate of complications was comparable in the two groups(pooled OR=0.658,95%CI:0.378 to 1.147).However,CDI was associated with a significantly more extended hospital stay(pooled MD=0.349 days,95%CI:0.002 to 0.696).CONCLUSION CDI is linked to increased mortality and prolonged hospitalization in IBD patients.These results emphasize the need for early detection and appropriate management.Implementing routine CDI screening during IBD flare-ups and stringent infection control measures could mitigate severe complications and reduce the healthcare burden.展开更多
Objectives:Colorectal adenomatous polyps frequently recur after removal and are precursors to colorectal cancer,highlighting the need for effective preventive strategies.This study evaluated the efficacy of probiotic ...Objectives:Colorectal adenomatous polyps frequently recur after removal and are precursors to colorectal cancer,highlighting the need for effective preventive strategies.This study evaluated the efficacy of probiotic Clostridium butyricum MIYAIRI 588(CBM588)in preventing colorectal adenoma recurrence in high-risk patients.Methods:We conducted a randomized,single-blind,two-year crossover trial in patients with a history of adenomatous polyps.Participants received CBM588 in either the first or second year,with the alternate year as observation,and underwent annual surveillance colonoscopies.Outcomes(adenoma recurrence and polyp counts)were analyzed by intention-to-treat(ITT)and per-protocol(PP)approaches.Results:A total of 398 participants were enrolled.In firstyear ITT analysis,the CBM588-first group had a lower mean polyp count(0.78 vs.1.00)and lower adenoma recurrence rate(30.00%vs.35.35%)than the control-first group,though these differences were not statistically significant(p=0.10 and p=0.26,respectively).In contrast,first-year PP analysis showed significant reductions in the CBM588-first group’s mean polyp count(0.80 vs.1.25,p<0.05)and adenoma recurrence rate(29.76%vs.44.71%,p<0.05)compared to control.After crossover,the group receiving CBM588 in the second year experienced similar benefits,and by year two both groups had comparable outcomes.No carryover effect was evident.The number needed to treat to prevent one adenoma in one year was 19 in ITT and 7 in PP.CBM588 was well tolerated,with no serious adverse events.Conclusion:CBM588 demonstrated potential to reduce colorectal adenoma recurrence in high-risk patients,supporting its role as a feasible,non-invasive preventive strategy.展开更多
The host intestinal microbiota has emerged as the third element in the interactions between hosts and enteric viruses,and potentially affects the infection processes of enteric viruses.However,the interaction of porci...The host intestinal microbiota has emerged as the third element in the interactions between hosts and enteric viruses,and potentially affects the infection processes of enteric viruses.However,the interaction of porcine enteric coronavirus with intestinal microorganisms during infection remains unclear.In this study,we used 16S-rRNA-based Illumina NovaSeq high-throughput sequencing to identify the changes in the intestinal microbiota of piglets mediated by porcine epidemic diarrhea virus(PEDV)infection and the effects of the alterations in intestinal bacteria on PEDV infection and its molecular mechanisms.The intestinal microbiota of PEDV-infected piglets had significantly less diversity than the healthy group and different bacterial community characteristics.Among the altered intestinal bacteria,the relative abundance of Clostridium perfringens was significantly increased in the PEDV-infected group.A strain of C.perfringens type A,named DQ21,was successfully isolated from the intestines of healthy piglets.The metabolites of swine C.perfringens type A strain DQ21 significantly enhanced PEDV replication in porcine intestinal epithelial cell clone J2(IPEC-J2)cells,and PEDV infection and pathogenicity in suckling piglets.Palmitic acid(PA)was identified as one of those metabolites with metabolomic technology,and significantly enhanced PEDV replication in IPEC-J2 cells and PEDV infection and pathogenicity in suckling piglets.PA also increased the neutralizing antibody titer in the immune sera of mice.Furthermore,PA mediated the palmitoylation of the PEDV S protein,which improved virion stability and membrane fusion,thereby enhancing viral infection.Overall,our study demonstrates a novel mechanism of PEDV infection,with implications for PEDV pathogenicity.展开更多
In recent years,nosocomial infections caused by Clostridium difficile(C.difficile)have risen,becoming a leading cause of hospital-acquired diarrhea.The global prevalence of C.difficile infection(CDI)varies across regi...In recent years,nosocomial infections caused by Clostridium difficile(C.difficile)have risen,becoming a leading cause of hospital-acquired diarrhea.The global prevalence of C.difficile infection(CDI)varies across regions and populations.The diagnosis relies primarily on laboratory testing,including toxin,glutamate dehy-drogenase,and nucleic acid amplification tests.Treatment strategies for CDI in-clude antimicrobial therapy(e.g.,metronidazole,vancomycin,and fidamycin),fecal transplantation,and immunotherapy(e.g.,belotozumab),depending on the patient’s specificity and severity.This paper reviews recent research on CDI’s epidemiological characteristics,risk factors,diagnosis,treatment,and prevention,aiming to support hospitals and public health initiatives in implementing effective detection,prevention,and treatment strategies.展开更多
Clostridium difficile infection(CDI)is a major global public health concern,accounting for 15%-25%of antibiotic-associated diarrhea,50%-75%of antibiotic-associated colitis,and nearly all cases of pseudomembranous coli...Clostridium difficile infection(CDI)is a major global public health concern,accounting for 15%-25%of antibiotic-associated diarrhea,50%-75%of antibiotic-associated colitis,and nearly all cases of pseudomembranous colitis.Over the past decade,CDI outbreaks have become increasingly prevalent in North America and Europe,with rising incidence and mortality rates.In 2019,the Centers for Disease Control and Prevention(CDC)in the United States classified CDI as a“critical”public health threat in their report on antibiotic resistance threats[1].CDI incidence varies widely across countries,healthcare settings,and age groups,with cumulative incidence rates ranging from 1.12 to 631.80 per 100,000 people annually[2].As the epidemiology of CDI continues to evolve and our understanding of the disease advances,reassessing its burden remains essential.The Global Burden of Disease,Injury,and Risk Factors Study(GBD 2021)database offers new insights into this issue.展开更多
BACKGROUND Clostridium difficile(C.difficile)infection(CDI)is a common healthcare-associated infection.Older adult hospitalized patients with pressure ulcers are more sus-ceptible because of low immunity and disordere...BACKGROUND Clostridium difficile(C.difficile)infection(CDI)is a common healthcare-associated infection.Older adult hospitalized patients with pressure ulcers are more sus-ceptible because of low immunity and disordered flora,but their specific risk factors are unknown.This study hypothesizes that the use of antibiotics for more than 2 weeks,the use of proton pump inhibitors(PPIs),and the use ofβ-lactam antibiotics are independent risk factors for CDI in this population.METHODS A total of 120 older adults hospitalized with pressure ulcers from 2020 to 2023 were enrolled in the wound repair ward of the hospital.Stool samples were collected for anaerobic culture,C.difficile glutamate dehydrogenase(GDH)anti-gen and toxin detection,and multivariate logistic regression was used to analyze risk factors.RESULTS Among 120 older adults hospitalized patients with pressure ulcers,39 tested po-sitive for C.difficile,with an incidence rate of 32.5%.Thirty-nine patients(32.5%)were positive for GDH antigen.Twelve patients(10.0%)were positive for toxin A/B.Multivariate analysis shows that the use of antibiotics for more than 2 weeks,the use of proton pump inhibitors,and the use ofβ-lactam antibiotics are independent risk factors for CDI(all P values<0.05).CONCLUSION From 2020 to 2023,the incidence of CDI in 120 hospitalized older adult patients with pressure ulcers was 32.5%,and three independent risk factors were identified.展开更多
Emerging evidence of the beneficial effects of defatted rice bran(DFRB)on gut health has advanced the development of fermented defatted rice bran as a potential functional food.However,less is known about its effects ...Emerging evidence of the beneficial effects of defatted rice bran(DFRB)on gut health has advanced the development of fermented defatted rice bran as a potential functional food.However,less is known about its effects and underlying mechanisms on gut health.In this study,a mouse model together with fecal microbiota transplantation(FMT)was utilized to study the effects and mechanisms of fermented DFRB(FR)on gut barrier function.We found that FR improved the intestinal morphology,gut tight junction proteins,mucin,antimicrobial peptides,and interleukin 22(IL-22)and promoted the gut Clostridium butyricum and butyrate.Notably,correlation analysis indicated gut C.butyricum and butyrate were two FR-induced effectors that improved gut health.FMT results suggested that C.butyricum,butyrate,and fecal microbiota from the FR group all reduced prolyl hydroxylase 2(PHD2)expression by activating peroxisome proliferator-activated receptor gamma(PPARγ)in the mouse colon.This decrease in gut PHD2 subsequently upregulated the hypoxia-inducible factor-1 alpha(HIF-1α)expression,which in turn increased the expression of its targeted downstream tight junction proteins,mucin and antimicrobial peptides,and colonic IL-22 secretion.Overall,FR-derived C.butyricum and butyrate might improve gut barrier function through the HIF-1 signaling pathway,which provides a reference for the application of fermented DFRB as a potential functional food for improving of gut barrier function.展开更多
To compare the efficacy and safety of fidaxomicin and vancomycin for the treatment of patients with Clostridium difficile infection （CD1）, randomized controlled trials （RCTs） of fidaxomicin versus vancomycin for t...To compare the efficacy and safety of fidaxomicin and vancomycin for the treatment of patients with Clostridium difficile infection （CD1）, randomized controlled trials （RCTs） of fidaxomicin versus vancomycin for the treatment of CDI published in Pubmed, Embase, Web of Science and the Cochrane library were searched. Two reviewers independently extracted the data. The primary outcome was the rates of clinical cure. The secondary endpoints were the rates of CDI recurrence in the 4 weeks period after the end of therapy and rates of global cure, adverse events. Meta-analysis was performed using the Mantle-Haenszel fixed effect method （FEM）. Odds ratios （ORs） with 95% confidence intervals （95% CIs） were reported. The results indicated that two large randomized controlled trials were included in the meta-analysis. Clinical cure with fidaxomicin was similar to with vancomycin both in the modified intention to treat （OR = 1.17, 95% CI 0.82-1.66, P = 0.40） and in the per-protocol population （OR = 1.24, 95% CI 0.80-1.92, P = 0.34）. There were no significant differences in the rates of clinical cure between fidaxomicin and vancomycin in the subgroups analyzed by age, patients＇ status, and previous CDI, infection with B 1 strain, severity baseline, and exposure to concomitant antibiotics. Recurrence of CDI was significantly less common among fidaxomicin-treated patients compared with vancomycin-treated patients both in the modified intention-to-treat population （OR = 0.47, 95% CI 0.34-0.65, P〈0.00001） and in the per-protocol population （OR = 0.45, 95% CI 0.31-0.62, P〈0.0001）. Treatment with fidaxomicin compared with vancomycin was associated with significantly higher rates of global cure both in the modifed intention-to-treat population （OR = 1.75, 95% CI 1.35-2.27, P〈0.0001） and in the per-protocol population （OR = 1.86, 95% CI 1.40-2.47, P〈0.0001）. Our recta-analysis suggests that fidaxomicin is not superior to vancomycin in rates of clinical cure, while fidaxomicin significantly decreases the rates of CDI recurrence and significantly improves the rates of global cure compared with vancomycin. Thus, fidaxomicin is a promising candidate for treatment of the CDI, especially in decreasing the rates of CDI recurrence and improving the rates of global cure.展开更多
Clostridium difficile infections(CDI)are a leading cause of antibiotic-associated and nosocomial diarrhea.Despite effective antibiotic treatments,recurrent infections are common.With the recent emergence of hypervirul...Clostridium difficile infections(CDI)are a leading cause of antibiotic-associated and nosocomial diarrhea.Despite effective antibiotic treatments,recurrent infections are common.With the recent emergence of hypervirulent isolates of C.difficile,CDI is a growing epidemic with higher rates of recurrence,increasing severity and mortality.Fecal microbiota transplantation(FMT)is an alternative treatment for recurrent CDI.A better understanding of intestinal microbiota and its role in CDI has opened the door to this promising therapeutic approach.FMT is thought to resolve dysbiosis by restoring gut microbiota diversity thereby breaking the cycle of recurrent CDI.Since the first reported use of FMT for recurrent CDI in 1958,systematic reviews of case series and case report have shown its effectiveness with high resolution rates compared to standard antibiotic treatment.This article focuses on current guidelines for CDI treatment,the role of intestinal microbiota in CDI recurrence and current evidence about FMT efficacy,adverse effects and acceptability.展开更多
基金The China Agriculture Research System Program(Project No.CARS-41-G04)Shenyang Governmental Science and Technology Program(Project No.22316-2-02)supported this work.
文摘Background Clostridium perfringens is a pathogen that secretes multiple toxins,impacting humans and animals.It can cause intestinal diseases such as necrotic enteritis.Although tannins inhibit C.perfringens proliferation,the precise underlying mechanisms are unclear.Objective This study integrated transcriptomics and metabolomics to systematically investigate the mechanism by which tannins,specifically pentagalloylglucose(PGG)and tannic acid(TA),inhibit C.perfringens and potential pathways to alleviate infection in vivo.Results Ion concentration measurements,flow cytometric analysis,and transmission electron microscopy revealed that PGG and TA damaged the cell membrane structure of C.perfringens,triggering cytoplasmic content leakage.Additionally,PGG and TA significantly affected C.perfringens at the transcriptional and metabolic levels.Bioinformatics analysis revealed that PGG and TA induced amino acid restriction,disrupted energy metabolism,and impeded the ability of C.perfringens to sense and respond to the external environment.In an in vitro C.perfringens-infected intestinal cell model,PGG and TA boundαtoxin,significantly reduced the mRNA expression of inflammatory factors,and improved intestinal barrier function and cell viability.Compared to PGG,TA exhibited stronger inhibitory activity against C.perfringens and binding toαtoxin.In vivo,PGG and TA alleviated C.perfringens-induced weight loss in mice,improved intestinal villi morphology,and reduced intestinal inflammation and tight junction gene dysregulation.Conclusion These findings indicate that tannins inhibit C.perfringens,improve gut tissue integrity and reduce inflammation,demonstrating their multi-target effects of resisting intestinal diseases caused by harmful bacteria.This offers new insights for plant polyphenol-based strategies against necrotic enteritis.
文摘BACKGROUND Clostridium difficile infection(CDI)is common in patients with inflammatory bowel disease(IBD).AIM To assess the association of CDI with clinical outcomes of IBD.METHODS PubMed,EMBASE,Web of Science,and the Cochrane Library databases were searched from inception to March 2024.Eligible articles included observational studies that reported on outcomes such as mortality,colectomy,hospitalization,intensive care unit(ICU)admission,complication rates,and length of hospital stay in IBD patients with and without CDI.Data were extracted,and a randomeffects model was used to calculate pooled odds ratios(ORs)and mean differences(MDs).RESULTS As shown in the data from 21 studies with 1249158 participants,CDI significantly increased the risk of mortality in IBD patients[pooled OR=4.569,95%confidence intervals(95%CI):2.584 to 8.079].Although the pooled OR for colectomy was 1.409(95%CI:0.922 to 2.155),it was not statistically significant.Similarly,CDI did not impact hospitalization(pooled OR=1.056,95%CI:0.512 to 2.179)and ICU admission outcomes(pooled OR=1.970,95%CI:0.420 to 9.246)of patients with IBD.The rate of complications was comparable in the two groups(pooled OR=0.658,95%CI:0.378 to 1.147).However,CDI was associated with a significantly more extended hospital stay(pooled MD=0.349 days,95%CI:0.002 to 0.696).CONCLUSION CDI is linked to increased mortality and prolonged hospitalization in IBD patients.These results emphasize the need for early detection and appropriate management.Implementing routine CDI screening during IBD flare-ups and stringent infection control measures could mitigate severe complications and reduce the healthcare burden.
基金funded by KaohsiungMedical University Hospital,grant Numbers KMUH110-0T05,KMUH-DK(C)114005.
文摘Objectives:Colorectal adenomatous polyps frequently recur after removal and are precursors to colorectal cancer,highlighting the need for effective preventive strategies.This study evaluated the efficacy of probiotic Clostridium butyricum MIYAIRI 588(CBM588)in preventing colorectal adenoma recurrence in high-risk patients.Methods:We conducted a randomized,single-blind,two-year crossover trial in patients with a history of adenomatous polyps.Participants received CBM588 in either the first or second year,with the alternate year as observation,and underwent annual surveillance colonoscopies.Outcomes(adenoma recurrence and polyp counts)were analyzed by intention-to-treat(ITT)and per-protocol(PP)approaches.Results:A total of 398 participants were enrolled.In firstyear ITT analysis,the CBM588-first group had a lower mean polyp count(0.78 vs.1.00)and lower adenoma recurrence rate(30.00%vs.35.35%)than the control-first group,though these differences were not statistically significant(p=0.10 and p=0.26,respectively).In contrast,first-year PP analysis showed significant reductions in the CBM588-first group’s mean polyp count(0.80 vs.1.25,p<0.05)and adenoma recurrence rate(29.76%vs.44.71%,p<0.05)compared to control.After crossover,the group receiving CBM588 in the second year experienced similar benefits,and by year two both groups had comparable outcomes.No carryover effect was evident.The number needed to treat to prevent one adenoma in one year was 19 in ITT and 7 in PP.CBM588 was well tolerated,with no serious adverse events.Conclusion:CBM588 demonstrated potential to reduce colorectal adenoma recurrence in high-risk patients,supporting its role as a feasible,non-invasive preventive strategy.
基金supported by the National Natural Science Foundation of China(U23A20236)the Key Research and Development Program,Guidance Projects of Heilongjiang Province,China(GZ20220029)。
文摘The host intestinal microbiota has emerged as the third element in the interactions between hosts and enteric viruses,and potentially affects the infection processes of enteric viruses.However,the interaction of porcine enteric coronavirus with intestinal microorganisms during infection remains unclear.In this study,we used 16S-rRNA-based Illumina NovaSeq high-throughput sequencing to identify the changes in the intestinal microbiota of piglets mediated by porcine epidemic diarrhea virus(PEDV)infection and the effects of the alterations in intestinal bacteria on PEDV infection and its molecular mechanisms.The intestinal microbiota of PEDV-infected piglets had significantly less diversity than the healthy group and different bacterial community characteristics.Among the altered intestinal bacteria,the relative abundance of Clostridium perfringens was significantly increased in the PEDV-infected group.A strain of C.perfringens type A,named DQ21,was successfully isolated from the intestines of healthy piglets.The metabolites of swine C.perfringens type A strain DQ21 significantly enhanced PEDV replication in porcine intestinal epithelial cell clone J2(IPEC-J2)cells,and PEDV infection and pathogenicity in suckling piglets.Palmitic acid(PA)was identified as one of those metabolites with metabolomic technology,and significantly enhanced PEDV replication in IPEC-J2 cells and PEDV infection and pathogenicity in suckling piglets.PA also increased the neutralizing antibody titer in the immune sera of mice.Furthermore,PA mediated the palmitoylation of the PEDV S protein,which improved virion stability and membrane fusion,thereby enhancing viral infection.Overall,our study demonstrates a novel mechanism of PEDV infection,with implications for PEDV pathogenicity.
文摘In recent years,nosocomial infections caused by Clostridium difficile(C.difficile)have risen,becoming a leading cause of hospital-acquired diarrhea.The global prevalence of C.difficile infection(CDI)varies across regions and populations.The diagnosis relies primarily on laboratory testing,including toxin,glutamate dehy-drogenase,and nucleic acid amplification tests.Treatment strategies for CDI in-clude antimicrobial therapy(e.g.,metronidazole,vancomycin,and fidamycin),fecal transplantation,and immunotherapy(e.g.,belotozumab),depending on the patient’s specificity and severity.This paper reviews recent research on CDI’s epidemiological characteristics,risk factors,diagnosis,treatment,and prevention,aiming to support hospitals and public health initiatives in implementing effective detection,prevention,and treatment strategies.
基金supported by the Beijing Natural Science Foundation(No.L202008)the Chinese Center for Disease Control and Prevention Foundation(No.201833).
文摘Clostridium difficile infection(CDI)is a major global public health concern,accounting for 15%-25%of antibiotic-associated diarrhea,50%-75%of antibiotic-associated colitis,and nearly all cases of pseudomembranous colitis.Over the past decade,CDI outbreaks have become increasingly prevalent in North America and Europe,with rising incidence and mortality rates.In 2019,the Centers for Disease Control and Prevention(CDC)in the United States classified CDI as a“critical”public health threat in their report on antibiotic resistance threats[1].CDI incidence varies widely across countries,healthcare settings,and age groups,with cumulative incidence rates ranging from 1.12 to 631.80 per 100,000 people annually[2].As the epidemiology of CDI continues to evolve and our understanding of the disease advances,reassessing its burden remains essential.The Global Burden of Disease,Injury,and Risk Factors Study(GBD 2021)database offers new insights into this issue.
基金Supported by the Zhejiang Province Medical and Health Science and Technology Plan Project,No.2018KY644 and No.2020KY234。
文摘BACKGROUND Clostridium difficile(C.difficile)infection(CDI)is a common healthcare-associated infection.Older adult hospitalized patients with pressure ulcers are more sus-ceptible because of low immunity and disordered flora,but their specific risk factors are unknown.This study hypothesizes that the use of antibiotics for more than 2 weeks,the use of proton pump inhibitors(PPIs),and the use ofβ-lactam antibiotics are independent risk factors for CDI in this population.METHODS A total of 120 older adults hospitalized with pressure ulcers from 2020 to 2023 were enrolled in the wound repair ward of the hospital.Stool samples were collected for anaerobic culture,C.difficile glutamate dehydrogenase(GDH)anti-gen and toxin detection,and multivariate logistic regression was used to analyze risk factors.RESULTS Among 120 older adults hospitalized patients with pressure ulcers,39 tested po-sitive for C.difficile,with an incidence rate of 32.5%.Thirty-nine patients(32.5%)were positive for GDH antigen.Twelve patients(10.0%)were positive for toxin A/B.Multivariate analysis shows that the use of antibiotics for more than 2 weeks,the use of proton pump inhibitors,and the use ofβ-lactam antibiotics are independent risk factors for CDI(all P values<0.05).CONCLUSION From 2020 to 2023,the incidence of CDI in 120 hospitalized older adult patients with pressure ulcers was 32.5%,and three independent risk factors were identified.
基金supported by grants from the National Key R&D Program(2023YFD1301303)National Natural Science Foundation of China(32472950,U21A20249)+1 种基金China Agriculture Research System of MOF and MARA(CARS-35)National Center of Technology Innovation for Pigs,Zhejiang Agricultural Talents,Taishan Industrial Leading Talents Project.
文摘Emerging evidence of the beneficial effects of defatted rice bran(DFRB)on gut health has advanced the development of fermented defatted rice bran as a potential functional food.However,less is known about its effects and underlying mechanisms on gut health.In this study,a mouse model together with fecal microbiota transplantation(FMT)was utilized to study the effects and mechanisms of fermented DFRB(FR)on gut barrier function.We found that FR improved the intestinal morphology,gut tight junction proteins,mucin,antimicrobial peptides,and interleukin 22(IL-22)and promoted the gut Clostridium butyricum and butyrate.Notably,correlation analysis indicated gut C.butyricum and butyrate were two FR-induced effectors that improved gut health.FMT results suggested that C.butyricum,butyrate,and fecal microbiota from the FR group all reduced prolyl hydroxylase 2(PHD2)expression by activating peroxisome proliferator-activated receptor gamma(PPARγ)in the mouse colon.This decrease in gut PHD2 subsequently upregulated the hypoxia-inducible factor-1 alpha(HIF-1α)expression,which in turn increased the expression of its targeted downstream tight junction proteins,mucin and antimicrobial peptides,and colonic IL-22 secretion.Overall,FR-derived C.butyricum and butyrate might improve gut barrier function through the HIF-1 signaling pathway,which provides a reference for the application of fermented DFRB as a potential functional food for improving of gut barrier function.
文摘To compare the efficacy and safety of fidaxomicin and vancomycin for the treatment of patients with Clostridium difficile infection （CD1）, randomized controlled trials （RCTs） of fidaxomicin versus vancomycin for the treatment of CDI published in Pubmed, Embase, Web of Science and the Cochrane library were searched. Two reviewers independently extracted the data. The primary outcome was the rates of clinical cure. The secondary endpoints were the rates of CDI recurrence in the 4 weeks period after the end of therapy and rates of global cure, adverse events. Meta-analysis was performed using the Mantle-Haenszel fixed effect method （FEM）. Odds ratios （ORs） with 95% confidence intervals （95% CIs） were reported. The results indicated that two large randomized controlled trials were included in the meta-analysis. Clinical cure with fidaxomicin was similar to with vancomycin both in the modified intention to treat （OR = 1.17, 95% CI 0.82-1.66, P = 0.40） and in the per-protocol population （OR = 1.24, 95% CI 0.80-1.92, P = 0.34）. There were no significant differences in the rates of clinical cure between fidaxomicin and vancomycin in the subgroups analyzed by age, patients＇ status, and previous CDI, infection with B 1 strain, severity baseline, and exposure to concomitant antibiotics. Recurrence of CDI was significantly less common among fidaxomicin-treated patients compared with vancomycin-treated patients both in the modified intention-to-treat population （OR = 0.47, 95% CI 0.34-0.65, P〈0.00001） and in the per-protocol population （OR = 0.45, 95% CI 0.31-0.62, P〈0.0001）. Treatment with fidaxomicin compared with vancomycin was associated with significantly higher rates of global cure both in the modifed intention-to-treat population （OR = 1.75, 95% CI 1.35-2.27, P〈0.0001） and in the per-protocol population （OR = 1.86, 95% CI 1.40-2.47, P〈0.0001）. Our recta-analysis suggests that fidaxomicin is not superior to vancomycin in rates of clinical cure, while fidaxomicin significantly decreases the rates of CDI recurrence and significantly improves the rates of global cure compared with vancomycin. Thus, fidaxomicin is a promising candidate for treatment of the CDI, especially in decreasing the rates of CDI recurrence and improving the rates of global cure.
文摘Clostridium difficile infections(CDI)are a leading cause of antibiotic-associated and nosocomial diarrhea.Despite effective antibiotic treatments,recurrent infections are common.With the recent emergence of hypervirulent isolates of C.difficile,CDI is a growing epidemic with higher rates of recurrence,increasing severity and mortality.Fecal microbiota transplantation(FMT)is an alternative treatment for recurrent CDI.A better understanding of intestinal microbiota and its role in CDI has opened the door to this promising therapeutic approach.FMT is thought to resolve dysbiosis by restoring gut microbiota diversity thereby breaking the cycle of recurrent CDI.Since the first reported use of FMT for recurrent CDI in 1958,systematic reviews of case series and case report have shown its effectiveness with high resolution rates compared to standard antibiotic treatment.This article focuses on current guidelines for CDI treatment,the role of intestinal microbiota in CDI recurrence and current evidence about FMT efficacy,adverse effects and acceptability.
