Antibiotic-associated Diarrhea Research Articles

Can scoring system to predict the antibiotic-associated diarrhea be a boon in any resource limited setup?

Can scoring system to predict the antibiotic-associated diarrhea be a boon in any resource limited setup?

Dietary tangeretin improved antibiotic-associated diarrhea in mice by enhancing the intestinal barrier function, regulating the gut microbiota, and metabolic homeostasis.

Antibiotic-associated diarrhea is mediated by antibiotic treatment and is usually caused by the disruption of the intestinal barrier, gut microbiota, and metabolic balance. To identify a dietary strategy that can mitigate the side effects of antibiotics, this study investigated the effect of tangeretin on antibiotic-associated diarrhea in C57BL/6 mice. The results revealed that dietary tangeretin significantly ameliorated symptoms of antibiotic-associated diarrhea, as evidenced by the decreased diarrhea status scores, the reduced fecal water content, the decreased caecum/body weight ratio, and the alleviated colonic tissue damage. Dietary tangeretin also exhibited a protective effect on the intestinal barrier function by upregulating the mRNA and protein expression of claudin-1 and ZO-1. Furthermore, analysis of the gut microbiota using 16S rRNA gene sequencing indicated that dietary tangeretin modulated the gut microbiota of mice with antibiotic-associated diarrhea via increasing the gut microbiota diversity and the abundance of beneficial bacteria, e.g., Lactobacillaceae and Ruminococcaceae, and decreasing the abundance of harmful bacteria, e.g., Enterococcus and Terrisporobacter. Additionally, dietary tangeretin restored the levels of short-chain fatty acids and modulated metabolic pathways by enriching purine metabolism, bile acid metabolism, ABC transporters, and choline metabolism in cancer. Collectively, these findings provide a solid scientific basis for the rational use of tangeretin as a preventive and therapeutic agent for antibiotic-associated diarrhea.

Актуальные международные и национальные клинические рекомендации по профилактике, диагностике и лечению инфекции Clostridioides difficile у взрослых и детей: обзор, критические замечания и возможности применения в реальной клинической практике

Clostridioides difficile is the most common cause of antibiotic-associated diarrhea in both inpatients and outpatients, and an important cause of nosocomial infection worldwide. The article reviews the Clinical Guidelines of the American College of Gastroenterology and other relevant international and national guidelines for the prevention, diagnosis, and treatment of C. difficile infection in adults and children, and critically discusses their applicability in real-life clinical practice. Current algorithms for the diagnosis of C. difficile infection in adults and children are presented. The role and place of vancomycin, fidaxomicin, metronidazole, rifaximin, bezlotoxumab, fecal microbiota transplantation, and probiotics in the treatment and prevention of C. difficile infection are reviewed and discussed. The diagnosis, treatment, and prevention of recurrent C. difficile infection in patients with inflammatory bowel disease are specifically considered. Innovative methods for the prevention and treatment of C. difficile infection using probiotics and microbiome-based therapeutics may provide an effective and safe alternative to fecal microbiota transplantation. Key words: Clostridioides difficile infection, toxins A and B, binary toxin, vancomycin, fidaxomycin, metronidazole, rifaximin, bezlotoxumab, probiotics, fecal microbiota transplantation, inflammatory bowel disease

The efficacy and safety of Saccharomyces boulardii in addition to antofloxacin-based bismuth quadruple therapy for Helicobacter pylori eradication: a single-center, prospective randomized-control study.

We previously reported that antofloxacin-based bismuth quadruple therapy was safe and effective for Helicobacter pylori (H. pylori) eradication. It is not clear whether the addition of Saccharomyces boulardii (S. boulardii) to antofloxacin-based quadruple therapy can improve the eradication rate of H. pylori and reduce adverse events. To investigate the effect of adding S. boulardii to antofloxacin-based quadruple therapy on the eradication rate of H. pylori and the adverse events. Single-center, prospective randomized controlled study. A total of 172 patients with H. pylori infection were randomly assigned to the test and control groups. Patients in the control group (n = 86) received antofloxacin-based bismuth quadruple therapy for 14 days. On this basis, cases in the test group (n = 86) received S. boulardii 500 mg b.i.d. The eradication rate of H. pylori and adverse events were observed 4 weeks after the treatment. There were no statistically significant differences in the eradication rates of H. pylori and frequency of diarrhea between the test group and control group (p > 0.05). The duration of diarrhea in the test group was significantly shorter than in the control group (p < 0.001). In addition, the two groups exhibited similar adverse event rates for epigastric pain, abdominal distention, dizzy, vomiting, and rash (p > 0.05). The severity of adverse reactions was similar between the two groups (p > 0.05), and most of them had mild adverse events. Although the addition of S. boulardii to antofloxacin-based quadruple therapy could not improve the eradication rate of H. pylori, it could shorten the time of antibiotic-associated diarrhea and reduce the incidence of diarrhea. ChiCTR2200056931.

Modern Approaches to &lt;i&gt;H. pylori&lt;/i&gt; Eradication Therapy in Adults (Literature Review and Resolution of Experts Council)

Aim: to analyze current approaches to H. pylori eradication therapy in adults and present the materials of Experts Council held on December 9, 2022 in Moscow.General statements. H. pylori infection is the main etiological factor of gastritis, peptic ulcer, and gastric cancer. Eradication of H. pylori is recognized as a necessary measure to reduce the incidence of these diseases. The approaches to selecting an eradication regimen should be optimized to take into account epidemiological trends and achieve better treatment outcomes. The updated Maastricht VI Consensus Report presents the means to overcome the difficulties in selecting an approach to the treatment of H. pylori infection. However, eradication therapy remains challenging due to adverse events (primarily antibiotic-associated diarrhea), poor treatment tolerance and patient compliance. Eradication therapy can be optimized by supplementing treatment regimens with strain-specific probiotics that reduce adverse events, improve patient compliance and eradication rates, such as Saccharomyces boulardii CNCM I-745 strain with established efficacy.Conclusion. The inclusion of certain probiotics in eradication regimens improves treatment tolerance, reduces the risk of adverse events, improves patient compliance and eradication rates.

Using probiotics in paediatric populations

Abstract This statement defines probiotics and reviews the most recent literature on their use in paediatrics. Many studies have examined the potential benefit of probiotics, but significant variation in the strains and doses of probiotics used, the patient populations studied, and in study design, have led to heterogeneous results. Present evidence suggests that probiotics can decrease mortality and lower incidence of necrotizing enterocolitis in preterm and low birth weight neonates. Probiotics may also be beneficial in reducing feeding intolerance. In infants, probiotics may be considered to reduce symptoms of colic. In older children, probiotics can be considered to prevent antibiotic-associated diarrhea and Clostridium difficile-associated diarrhea. Probiotic supplements used in conjunction with standard therapy can help with Helicobacter pylori eradication and decrease the side effects of treatment. Lactobacillus species can be considered to treat irritable bowel syndrome. Probiotics can also be considered to help prevent atopic dermatitis and eczema. To optimize paediatric policy and practice, large, quality studies are needed to determine what types and combinations of probiotics are most efficacious.

Antimicrobial Activity of Tannic Acid In Vitro and Its Protective Effect on Mice against Clostridioides difficile.

Clostridioides difficile infection (CDI), recurrently reported as an urgent threat owing to its increased prevalence and mortality, has attracted significant attention. As the use of antibiotics to treat CDI has many limitations, such as high recurrence rate, the need to actively seek and develop other drugs that can effectively treat CDI with fewer side effects has become a key issue in CDI prevention and treatment. This study aimed to evaluate the inhibitory effect of Galla chinensis (GC) and its main component, tannic acid (TA), against C. difficile in vitro and its therapeutic effect on CDI in vivo. When GC and TA concentrations were 250 and 64 mg/L, respectively, the cumulative antibacterial rate against C. difficile reached 100%. The sub-MIC of TA significantly inhibited C. difficile sporulation, toxin production, and biofilm formation in vitro. Compared with the CDI control group, TA-treated mice lost less weight and presented a significantly improved survival rate. TA significantly reduced the number of spores in feces, decreased serum TcdA level, and increased serum interleukin 10 (IL-10). Based on the inhibitory effect of TA on C. difficile in vitro and its therapeutic effect on the CDI mouse model, we consider TA as a potentially effective drug for treating CDI. IMPORTANCE Clostridioides difficile is one of the major pathogens to cause antibiotic-associated diarrhea. Although antibiotic treatment is still the most commonly used and effective treatment for CDI, the destruction of indigenous intestinal microbiota by antibiotics is the main reason for the high CDI recurrence rate of about 20%, which is increasing every year. Moreover, the growing problem of drug resistance has also become a major hidden danger in antibiotic treatment. GC has been used to treat diarrhea in traditional Chinese medicine. In the present study, we evaluated the inhibitory effect of TA, the main component of GC, on dissemination and pathogenic physiological functions of C. difficile in vitro, as well as its therapeutic efficacy in a CDI model. Overall, TA is considered to be a potentially effective drug for CDI treatment.

Predictors of hospital-onset Clostridioides difficile infection in children with antibiotic-associated diarrhea

BackgroundThis study aimed to determine the predictors of hospital-onset Clostridioides difficile infection (CDI) in pediatric patients with antibiotic-associated diarrhea (AAD) and to develop a predictive scoring system to identify at-risk patients. MethodsThis retrospective case-control study included patients aged ≥2-18 years with AAD who underwent C. difficile polymerase chain reaction testing >3 days after hospital admission. Patients with hospital-onset CDI were selected as cases and matched with the control patients without CDI. Univariate and multivariate logistic regressions were used to determine predictors of CDI and to construct a prediction score for the outcomes of interest. ResultsSixty-five patients with hospital-onset CDI and 130 controls were enrolled. Independent predictors for CDI identified and combined into the prediction score included abdominal pain (adjusted odds ratio [95% confidence interval]: 7.940 [3.254-19.374]), hospitalization for ≥14 days before the onset of diarrhea (3.441 [1.034-11.454]), antibiotic use for ≥10 days before the onset of diarrhea (6.775 [1.882-24.388]), receipt of meropenem (4.001 [1.098-14.577]) and clindamycin (14.842 [4.496-49.000]). The area under the receiver operating characteristic curve for this score was 0.883. ConclusionsThe presented scoring system can be easily applied by clinicians at the bedside to decide which patients with AAD are likely to have CDI.

685: EFFICACY OF LACTOBACILLUS GG FOR PREVENTION OF ANTIBIOTIC ASSOCIATED DIARRHEA IN THE PICU

Introduction: Antibiotic associated diarrhea (AAD) is a common adverse effect in pediatric patients. Previous meta-analysis on probiotic use for AAD have reported that lactobacillus GG (LGG) has potential for more protective effects compared to other strains of probiotics. There is limited data on the use of LGG for the prophylaxis of AAD in the pediatric intensive care unit (PICU) where there is frequent use of broad-spectrum antibiotics. The objective of this study was to assess the efficacy of LGG to prevent AAD in the PICU. Methods: This prospective randomized, double-blind, placebo-controlled trial occurred in a 15-bed PICU. Inclusion criteria was age ≤ 17 years and required antibiotic therapy ≥ 72hrs. Exclusion criteria included but was not limited to antibiotics ≥ 48 hrs prior, prior probiotics, pre-existing diarrhea, laxative therapy, immunocompromise, and GI disorders. Treatment with LGG (30 x 109 CFU) or a matching placebo capsule was administered twice daily, initiated within 24 hours of starting antibiotic therapy and continued for the duration of therapy. Diarrhea was defined as stools >200 mL or 200 g per day in a patient over 10 kg and > 20 mL/kg/day or > 20 g/kg/day in a patient < 10 kg or 3 or more loose stools in 24 hours. Patients that experienced diarrhea > 72 hours were crossed over. The primary outcome was the incidence of AAD in the LLG versus placebo groups. Potential adverse effects were monitored daily. Statistics were conducted with SPSS. Results: Thirty-one patients met the initial inclusion/exclusion criteria and were enrolled in the study. Nineteen patients were eligible for final analysis with 9 in the LGG group and 10 in the placebo group. Mean age was 0.96±1.3 and 4.7±6.4 years for the LGG and placebo groups, respectively. Mean weight was 6.95±4.21 and 22.76±29.38 kg for LGG and placebo groups, respectively. 30% vs 70% of patients experienced diarrhea in the LGG groups vs placebo (p=0.35). The median length of stay for the patients with AAD was 7.5 days compared to 6 days in placebo group (p=0.093). The odds ratio for AAD was 0.29 [95%CI 0.039-2.11]. No adverse events were reported or attributed to LGG. Conclusions: Results of this study indicate that LGG is safe and effective in reducing the incidence of AAD in the critically ill pediatric patients at our institution.

Features of treatment of C. difficile associated diarrhea in patients with new coronavirus infection

The pandemic of a new coronavirus infection in recent years has led to more frequent and aggressive prescription of antibiotic therapy, which could not but affect the intestinal microbiota. In addition, the direct effect of coronavirus on enterocytes leads to the development of subclinical inflammation in the intestinal wall, contributing to the disruption of the qualitative and quantitative composition of the normal intestinal microflora. Against this background, the number of patients with antibiotic-associated diarrhea, including diarrhea caused by C. difficile, including severe ones. Moreover, the number of clostridial diarrhea resistant to classical vancomycin therapy has increased, which dictates the need to find new ways to treat patients and methods for further prevention of such conditions.

Effects of apple juice fermented with Lactobacillus plantarum CICC21809 on antibiotic-associated diarrhea of mice

• Fermented apple juice alleviates the diarrhea induced by ceftriaxone sodium. • Fermented apple juice improved the destroyed gut microbiota of mice. • There were 136 significantly changed compounds identified in fermented apple juice compared to unfermented apple juice. • Five bioactive compounds are partly responsible for the fermented apple juice performances. This study aimed to optimize the fermentation conditions of apple juice by Lactobacillus plantarum to obtain fermented apple juice (FAJ) with high probiotic content and tannic acid content. The apple juice and FAJ compounds were identified and relatively quantified by UHPLC-ESI-Q TRAP-MS/MS. Treating mice with ceftriaxone sodium induced diarrhea. However, ingestion of FAJ helped alleviate these symptoms. Furthermore, via 16S rRNA sequencing, FAJ reduced the proportion of Bacillota to Bacteroidota at the phyla level. Moreover, at the genus level, FAJ also caused a lower relative abundance of Enterococcus and Clostridium , and a higher relative abundance of Lactobacillus and Prevotella . Additionally, FAJ improved the intestinal morphology and intestinal barrier function. Five up-regulated bioactive compounds ( l -isoleucine, l -leucine, l -valine, 4-Guanidinobutyric acid, and Phenyllactate) are partly responsible for the performances of FAJ. All these findings implied that FAJ could be a dietary supplement for lessening antibiotic-associated diarrhea by regulating intestinal microbiota and barrier function.

Probiotics for the Prevention of Antibiotic-Associated Diarrhea

Probiotics for the Prevention of Antibiotic-Associated Diarrhea

Isolation, molecular typing and antimicrobial resistance of Clostridium difficile in dogs and cats in Lanzhou city of Northwest China.

Clostridium difficile infection (CDI) in human and animals belonged usually to antibiotic-associated diarrhea, ranging in severity from mild to life-threatening intestinal tract illnesses. This study aimed to isolation and characterization, toxin genes test, molecular typing, and drug sensitivity of Clostridium difficile (C. difficile) which were isolated from clinical diseased dogs and cats. A total of 247 clinical samples were collected from five animal hospitals in Lanzhou City of Northwest China, of which dogs and cats accounted for 74.9% (185/247) and 25.1% (62/247), respectively. We successfully identified 24 C. difficile strains by 16S rRNA and Matrix-Assisted Laser Desorption/Ionization Time of Fight Mass Spectroscopy (MALDI-TOF-MS). 10.3% (19/185) of dogs and 8.1% (5/62) of cats were positive for C. difficile. Among them, 16 strains were toxic and 8 were non-toxic, with a toxic rate of 57.9% (11/19) in dogs and 100% (5/5) in cats. A total of 10 STs and 10 RTs were identified in this study. The percentages of ST42 (RT106) and ST2 (RT014/LW01) among 16 toxic strains were 41.7 and 12.5%, respectively. However, ST3 (RT001), ST1 (RT027), ST133 (LW04), and ST-UN (LW04) had only one strain. ST42 (RT106) was the most common genotype and RT027 strain was first isolated in China from pets. Antimicrobial susceptibility test showed that isolates were extremely sensitive to vancomycin and metronidazole but were resistant to erythromycin and ciprofloxacin. The drug resistant rates to clindamycin, levofloxacin, moxifloxacin and meropenem were 62.5, 20.8, 16.7, and 8.3%, respectively. In conclusion, C. difficile was quietly prevalent in dogs and cats in Lanzhou city with RT106 and RT014 as the main ribotypes. The CDI in pets should be paying more attention and further studies are needed.

Comparative analysis and trends in liver transplant hospitalizations with Clostridium difficile infections: A 10-year national cross-sectional study.

Clostridium difficile infection (CDI) is the leading cause of antibiotic-associated diarrhea in the United States. We aimed to determine comparative trends in inpatient outcomes of liver transplant (LT) patients based on CDI during hospitalizations. The national inpatient sample database was used to conduct the present retrospective study regarding CDI among the LT hospitalizations from 2009 to 2019. Primary outcomes included 10-year comparative trends of the length of stay (LOS) and mean inpatient charges (MIC). Secondary outcomes included comparative mortality and LT rejection trends. There was a 14.05% decrease in CDI in LT hospitalizations over the study period (p=.05). The trend in LOS did not significantly vary (p=.9). MIC increased significantly over the last decade in LT hospitalizations with CDI (p<.001). LT hospitalizations of autoimmune etiology compared against non-autoimmune did not increase association with CDI, adjusted odds ratio (aOR) 0.97 (95% confidence interval [CI] 0.75-1.26, p=.87). CDI was associated with increased mortality in LT hospitalizations, aOR 1.84 (95% CI 1.52-2.24, p<.001). In-hospital mortality for LT hospitalizations with CDI decreased by 7.75% over the study period (p=.3). CDI increased transplant rejections, aOR 1.3 (95% CI 1.08-1.65, p<.001). There was a declining trend in transplant rejection for LT hospitalization with CDI from 5% to 3% over the study period (p=.0048). CDI prevalence does not increase based on autoimmune LT etiology. It increases mortality in LT hospitalizations; however, trend for mortality and transplant rejections has been declining over the last decade.

Peroxisome proliferator-activated receptor-γ as the gatekeeper of tight junction in Clostridioides difficile infection.

Clostridioides difficile is a major causative pathogen of nosocomial antibiotic-associated diarrhea and severe colitis. Despite the use of vancomycin and fidaxomicin as standard drugs for the treatment of C. difficile infection (CDI), clinical relapse rates remain high. Therefore, new alternative therapeutics to treat CDI are urgently required. The nuclear receptor, peroxisome proliferator-activated receptor-γ (PPAR-γ), is mainly expressed in the adipose tissue and modulates lipid metabolism and insulin sensitization. Previous studies have shown that PPAR-γ is highly expressed in colonic tissues and regulates tight junction function in epithelial cells. However, the role of PPAR-γ in CDI pathogenesis remains unclear. In this study, we used a mouse model of CDI and found that both expression levels of PPAR-γ and the tight junction protein, occludin, were decreased in colonic tissues. Furthermore, to investigate the role of PPAR-γ in CDI, we used PPAR-γ defective mice and found that intestinal permeability and bacterial dissemination in these mice were significantly higher than those in wild-type mice during CDI. Administration of the PPAR-γ agonist, pioglitazone, to activate PPAR-γ activity improved the phenotypes of CDI, including bodyweight loss, inflammation, and intestinal integrity. Taken together, these results demonstrate that PPAR-γ is a potential therapeutic target in CDI, as it modulates colonic inflammation and integrity.

Possibilities of adjuvant use of a combination of butyric acid and inulin in antibacterial therapy of inflammatory diseases of the pelvic organs

Aim. To evaluate the efficacy and tolerability of antibiotic therapy in patients with pelvic inflammatory disease during the use of a fixed combination of butyric acid and inulin (Zakofalk) as an adjuvant therapy.&#x0D; Materials and methods. The study included 60 patients with inflammatory diseases of the pelvic organs who underwent antibiotic therapy. The diagnosis was confirmed by an objective examination, ultrasound of the pelvic organs, the results of a smear from the cervical canal. After inclusion in the study, the patients were randomized into 2 groups: the main group received standard antibiotic therapy and Zakofalk, the control group received only standard antibiotic therapy.&#x0D; Results. The incidence of dyspeptic symptoms in the first week of observation in the main and control groups did not differ significantly. When comparing the severity of antibiotic-associated side effects in the second week of observation, statistically significant differences (p0.01) were found in terms of: bloating, rumbling, stools up to three times a day, which were more common in the control group. In addition, a more significant decrease in the level of leukocytes in the cervical mucus was recorded in the main group compared to the control group. The absence of pathogenic and opportunistic pathogens in the first control study, in comparison with the primary diagnosis, was also more pronounced in the main group. Adherence to treatment in the control group, 3.8 points on the MoriskyGreen scale insufficiently adherent, was lower than in the main group 5 points compliant.&#x0D; Conclusion. The inclusion of Zakofalk as an adjuvant drug in the antimicrobial therapy regimen for pelvic inflammatory diseases improves the tolerability of this type of treatment, prevents the aggravation of symptoms of idiopathic antibiotic-associated diarrhea, increases the effectiveness of eradication of the pathogen and contributes to the normalization of the vaginal microbiota.

Beneficial Effect of Paeonol on Antibiotic-Associated Inflammatory Response in Mice with Diarrhea.

Diarrhea is a common adverse effect of antibiotics particularly that acts on anaerobes. Moutan Radicis Cortex (MRC) is an herbal medicine used for its anti-inflammatory and antibacterial actions. The purpose of this study was to analyze the active components of MRC to determine their effect on antibiotic-associated diarrhea (AAD) and anti-inflammatory effects. Of the various components of MRC, seven compounds (gallic acid, oxypaeoniflorin, paeoniflorin, ethyl gallate, benzoic acid, benzoylpaeoniflorin, paeonol) were identified and assessed for anti-inflammation effects. Paeonol was found to effectively reduce nitric oxide production and levels of IL-6 and TNF-α in a concentration-dependent manner. Paeonol also effectively reduced the mRNA expression level of IL-6, IL-1β, and TNF-α. Western blotting analysis confirmed the reduction of COX-2 and NF-κB levels; p-p38 MAPK levels increased in the presence of a low concentration (25 μM) of paeonol but decreased in the presence of a high concentration (50 μM). In the mouse model of lincomycin-induced AAD, all experimental groups treated with paeonol (25, 50, and 100 mg/kg concentrations) showed diminished diarrhea status scores. Finally, the expression levels of TNF-α and IL-4 were reduced compared with those in the control group. Therefore, paeonol may have active compounds of MRC to alleviate the diarrhea symptoms of AAD and reduce inflammatory mediators. Other components of the MRC extract could contribute to its known anti-inflammatory and antibacterial activity and should be tested for their possible activity.

Antibiotic-Associated Diarrhea Beyond C. Difficile: A Scoping Review

A common complication of antibiotic use is the development of diarrheal illness. The pathogenesis of antibiotic associated diarrhea (AAD) may be mediated through alteration of intestinal microbiota, overgrowth of opportunistic pathogens, and direct drug toxicity on the gut. Alterations in the intestinal microbiota result in metabolic imbalances, loss of colonization resistance and in turn allow proliferation of opportunistic pathogens. Currently fewer than 33% of AAD cases can be attributable to Clostridioides difficile leaving a large number of cases undiagnosed and poorly treated. Although the pathogenesis of Clostridioides difficile infection (CDI) has been well documented, the role of other putative microbial etiologies (Clostridium perfringens, Staphylococcus aureus, Klebsiella oxytoca, Candida species) and their pathogenic mechanisms in AAD has been unclear. This review provides a comprehensive and systematic approach to the existing data on AAD and includes concise descriptions of the pathogenesis of CDI and non-CDI AAD in the form of figures.

Regulative effect of active components of Cistanche deserticola on intestinal dysbacteriosis induced by antibiotics in mice

Objective: To study the effects of Cistanche deserticola and its active components Cistanche deserticola polysaccharide and Echinacoside on intestinal flora of antibiotic-associated diarrhea (AAD) mice. Methods: Forty-eight Balb/c mice were randomly divided into control (Con) group, AAD Group, inulin (Inu) group, Cistanche deserticola (RCR) group, Cistanche deserticola polysaccharide (RCRDT) group and Echinacoside (Ech) group with 8 mice in each group. The diarrhea model of mice was induced by intragastric administration of lincomycin hydrochloride(3 g/kg) for 7 days, and then treated by intragastric administration of INU(5 g/kg), RCR(5 g/kg), RCRDT(200 mg/kg) and ECH (60 mg/kg),0.2 ml once a day for 7 days, Con group and AAD group were given the same volume of normal saline. By observing general signs of mice, colon HE staining, 16S rDNA high-throughput sequencing analysis, the effects of Cistanche deserticola, Cistanche deserticola polysaccharide and Echinacea glycoside on the imbalance of intestinal flora induced by antibiotics in mice were evaluated. Results: Compared with Con group, AAD group mice lost weight, presented obvious diarrhea symptoms, inflammatory changes in colon tissue and decreased intestinal flora diversity (P＜0.05) indicating the success of the model. Compared with AAD group, the weight and diarrhea of INU, RCR, RCRDT and ECH groups were significantly improved, and the colon pathology of ECH group was restored to normal level. Compared with AAD group, RCR group, RCRDT group and ECH group had significantly decreased intestinal Firmicutes, increased Blautia and Lachnoclostridium, and decreased Clostridium_sensu_stricto_1 (P＜0.05) . In ECH group, the abundance and diversity of intestinal microflora were returned to normal level, and the structure of intestinal microflora was well adjusted, the contents of Bacteroides, Flavonifractor, Agathobacter, Lachnoclostridium and Prevotella-9 were increased (P＜0.01). Conclusion: Both Cistanche deserticola and its active components cistanche deserticola polysaccharide and echinacoside can regulate the intestinal flora imbalance caused by antibiotics and improve the symptoms of AAD, especially echinacoside.

Reducing Recurrence and Complications Related to Clostridioides difficile Infection: A Panel Discussion Summary.

The Centers for Disease Control and Prevention identifies Clostridioides difficile infection (CDI) as an urgent threat to people and health care systems. CDI leads to high health care utilizations and results in significantly reduced quality of life for patients. The high burden of disease is seen across all health care settings, outside of the hospital, in the community, and in younger people. Individuals with CDI transition from hospitals to long-term care facilities to the community, and management of these transitions can reduce the incidence of recurrence and rehospitalization. The most common cause of diarrhea occurring in a health care setting is Clostridioides difficile and is also the cause of antibiotic-associated colitis (L. C. McDonald, 2021). The infection results from a disruption in the microbial flora of the gastrointestinal tract, mostly after antibiotic use or other medications such as proton pump inhibitors (PPIs). As a result, infected individuals are colonized and shed the spores into the environment, exposing others-goals of treatment focus on reducing the exposure and individual susceptibility. Although the incidence of C. diff is stable, recurrence is increasing significantly, with severe complications also a concern. The increased incidence and potential for life-threatening conditions require reducing initial exposure, supporting prescribed treatment, and preventing recurrence. C. diff infection can be contracted in health care facilities and in the community. Case managers from nearly all practice settings may encounter patients with the infection. To avert the devastating complications of Clostridioides difficile infection, case managers play an essential role in the prevention of recurrence with education, advocacy of best practices, effective care coordination, and thorough transitions of care. Each recurrence of C. diff infection leaves the patient vulnerable to the potential for surgical intervention, sepsis, and death. Mitigating the risk for readmission and recurrence will enhance C. diff infection care, safety, and outcomes to improve a patient's health care journey and quality of life. Case managers need to take a primary role in the transition and care coordination processes, including patient and support system education, coordination of any postdischarge services, connection to providers, adherence support activities, and follow-up for improvement or changes in condition. Supportive adherence activities and prevention education can result in the avoidance of recurrence. Case managers are well-equipped to locate resources to assist those patients challenged with the cost of medications, inability to attend appointments, or access basic needs. Although not directly related to C. diff, these challenges contribute to recurrence and readmission. Mitigating risk for readmission and recurrence results in an improved quality of life.