Clostridium Difficile Research Articles

A Critical Review of Postbiotics as Promising Novel Therapeutic Agents for Clostridial Infections.

Clostridial infections, known for their severity and rapid progression, present significant challenges in both clinical and veterinary fields. These bacteria, which can survive without oxygen and produce protective spores, cause many diseases, ranging from simple gastrointestinal disorders to severe and potentially fatal infections including botulism, tetanus, and gas gangrene. The rising occurrence of antibiotic-resistant strains and the repetitive character of some Clostridial illnesses, including Clostridioides difficile infections (CDI), highlight the immediate need for alternate treatment approaches. Postbiotics, which are metabolites derived from probiotics, are showing great potential as effective agents against these diseases. The current study offers a comprehensive investigation of the potential of postbiotics as therapeutic agents for treating Clostridial infections, including C. difficile, Clostridium perfringens, Clostridium botulinum, and Clostridium tetani. It also examines the processes by which postbiotics exert their effects. Preliminary investigations have shown that postbiotics have promising antibacterial and antibiofilm properties, indicating their potential as adjunct agents in methods for controlling microbial growth. Nevertheless, more study is required to thoroughly demonstrate their medicinal uses.

Superiority of Frailty Over Age in Predicting Outcomes Among Clostridium Difficile Patients: Evidence from National Data.

Clostridium difficile infection (CDI) has become a significant healthcare issue with increasing morbidity and mortality in the US and Europe. Frailty, characterized by reduced physical reserves and resistance to stressors, is linked to poor outcomes but its impact on CDI patients remains underexplored. This study seeks to address this gap through a nationwide analysis. Using the National Readmission Database from 2016 to 2020, we employed the International Classification of Diseases, 10th revision, Clinical Modifications codes to identify adult patients admitted with CDI. We further stratified CDI hospitalizations based on frailty. Utilizing a regression model, we assessed the impact of frailty on CDI outcomes. We included 144,611 CDI patients of whom 98,167 (67.88%) were frail. Multivariate analysis showed that frail CDI patients had significantly higher mortality (adjusted odds ratio (aOR) 4.87), acute kidney injury requiring dialysis (aOR 9.50), septic shock (aOR 14.23), and intensive care unit admission (aOR 6.80). CDI-specific complications were more likely in frail patients, including toxic megacolon (aOR 10.22), intestinal perforation (aOR 2.30), need for colectomy (aOR 3.90) and CDI recurrence (aOR 3.65). Resource utilization, indicated by hospitalization charges, length of stay, and 30-day readmission rates, was greater among frail patients. Our study underscores the significant association between frailty and various critical endpoints of CDI, including its incidence, mortality, and recurrence. Additionally, frailty independently predicts higher resource utilization and elevated 30-day readmission. Recognizing frailty as a determinant of CDI outcomes can aid clinicians in risk stratification and guide tailored interventions for this population.

The evidence for probiotics in the treatment of digestive disorders in the pediatric population.

Health claims for many probiotic-labeled products are poorly substantiated. This technical review addressed the clinical question: "Do probiotics have a role in the management of the following conditions in childhood?" Evidence supports efficacy for probiotic strains of Saccharomyces boulardii, Lactobacillus reuteri, and Lactobacillus rhamnosus GG for improving outcomes of acute gastroenteritis, of S. boulardii and L. rhamnosus GG for antibiotic-associated diarrhea, and of S. boulardii for Clostridium difficile diarrhea. For functional constipation and GERD, a role for probiotics is questionable as evidence of efficacy is either absent or marginal and as existing treatments are effective. For infantile colic and chronic abdominal pain, where existing treatments have limited efficacy and some important side effects, the use of probiotics, given their safety, is recommended, notwithstanding the evidence is low to moderate. While there is some evidence that probiotics could improve outcomes in the management of celiac disease, obesity, and, to a lesser extent, promotion of growth, their role is adjunctive as dietary management is fundamental. The evidence also supports an adjunctive role for probiotics in the treatment of Helicobacter pylori infection and ulcerative colitis. Decisions on probiotic prescription need to take into account disease tempo, severity, and burden, as well as probiotic strain and dose. Any potential advantage will have to be weighed against the complexity and costs of an additional treatment.

Clostridioides difficile infection increases in-hospital mortality, length of stay, and hospital cost but not 30-day mortality in cirrhotic patients.

Clostridioides difficile infection (CDI) is a leading cause of nosocomial infection and is associated with both higher morbidity and mortality. Cirrhotic patients are more susceptible to CDI because of impaired gut immune response, use of proton pump inhibitor, and frequent hospitalization. We aim to investigate the impact of CDI on cirrhotic patients' in-hospital and 30-day mortality, length of stay, and hospital cost. Potentially eligible studies were identified from Embase, Medline, and Web of Sciences databases. A total of 2320 articles were identified. After reviewing, nine studies reporting in-hospital mortality and three reporting 30-day mortality of cirrhotic patients with CDI versus those without CDI were included. The meta-analysis of nine studies, consisting of 7 746 126 patients, revealed a significant association between CDI and in-hospital mortality in cirrhotic patients with the pooled OR of 1.68 (95% CI 1.29-1.85, I2 94%). Length of stay and hospital cost were also higher in the CDI group (pooled MD of 6.56days [95% CI 5.75-7.36, I2 94%] and 27.85 (×$1000) [95% CI 10.41-45.29, I2 100%], respectively). The funnel plots for the meta-analysis of the association between CDI and in-hospital mortality, length of stay, and hospitalization cost were not suggestive of publication bias. From three studies consisting of 3694 patients, we found that CDI was not associated with 30-day mortality in cirrhotic patients (pooled OR 1.20, 95% CI 0.75-2.24, I2 74%). CDI is associated with increased in-hospital mortality, length of stay, and hospital costs, but not with 30-day mortality in cirrhotic patients.

Cost-effectiveness of faecal microbiota transplantation compared with vancomycin monotherapy for early Clostridioides difficile infection: economic evaluation alongside a randomised controlled trial.

For Clostridioides difficile infection (CDI), faecal microbiota transplantation (FMT) is currently recommended for patients with three or more CDI episodes. A recent randomised controlled trial (RCT) show that FMT may be considered early, defined as intervention during the first or second CDI episode. Compared with standard care for first or second CDI, patients randomised to FMT had €1,645 lower hospital costs over 26 weeks owing to fewer admissions and hospital contacts and less medication use.

Bioengineered Probiotics for Clostridioides difficile Infection: An Overview of the Challenges and Potential for This New Treatment Approach.

The rapid increase in microbial antibiotic resistance in Clostridioides difficile (C. difficile) strains and the formation of hypervirulent strains have been associated with a global increase in the incidence of C. difficile infection (CDI) and subsequently, an increase in the rate of recurrence. These consequences have led to an urgent need to develop new and promising alternative strategies to control this pathogen. Engineered probiotics are exciting new bacterial strains produced by editing the genome of the original probiotics. Recently, engineered probiotics have been used to develop delivery vehicles for vaccines, diagnostics, and therapeutics. Recent studies have demonstrated engineered probiotics may potentially be an effective approach to control or treat CDI. This review provides a brief overview of the considerations for engineered probiotics for medicinal use, with a focus on recent preclinical research using engineered probiotics to prevent or treat CDI. We also address the challenges faced in the production of engineered strains and how they may be overcome in the application of these agents to meet patient needs in the future.

Randomized Clinical Trials Demonstrate the Safety Assessment of Alkalihalobacillus clausii AO1125 for Use as a Probiotic in Humans

(1) Background: Alkalihalobacillus clausii AO1125 is a Gram-positive, motile, spore-forming bacterium with potential as a probiotic due to its broad-spectrum antimicrobial activity, inhibiting pathogens like Listeria monocytogenes, Staphylococcus aureus, and Clostridium difficile, as well as anti-rotavirus activity. Its resilience in gastrointestinal conditions suggests benefits for gut health. This study evaluates the safety and probiotic potential of A. clausii AO1125. (2) Methods: Genome annotation identified genes linked to probiotic traits such as stress resistance, gut colonization, immune modulation, and antimicrobial production. The genome was screened for antibiotic resistance genes using CARD, bacteriocin clusters using BAGEL4, and virulence factors via VFDB. Cytotoxicity was assessed on Vero cells and erythrocytes, and a Phase I, double-blind, placebo-controlled clinical trial was conducted with 99 healthy volunteers (50 AO1125, 49 placebo). (3) Results: Genomic analysis confirmed minimal antibiotic resistance genes and the absence of virulence factors, supporting safety. A. clausii AO1125 showed no pathogenicity, cytotoxicity, or hemolytic activity and was well-tolerated in clinical settings, with mild, transient abdominal gas as the most common adverse event. (4) Conclusions: The safety profile and genetic basis for probiotic and antimicrobial properties support A. clausii AO1125 as a promising probiotic candidate for gastrointestinal health, warranting further clinical research.

Clostridioides difficile infections caused by hypervirulent strains: a single-centre real-life study.

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.

Audit project on the appropriateness of teicoplanin prescribing in Milton Keynes University Hospital (MKUH)

Abstract Introduction Teicoplanin is the Trust’s preferred glycopeptide antibiotic compared to vancomycin due to the once-daily dosing, less toxic side effects and monitoring requirements1. Teicoplanin dosing regimen is weight-dependent, including loading and maintenance doses adjusted according to creatinine clearance (CrCl) from Day 52. As antimicrobial resistance emergence continues to be a public health concern, appropriate teicoplanin use is vital to avoid treatment failure in line with antimicrobial stewardship3. Aim and Standards To assess teicoplanin prescribing compliance with the Trust guideline. 100% compliance was expected for the following standards: 1. Teicoplanin is prescribed for an approved indication according to Trust guideline or by a Consultant Microbiologist. 2. Loading dose of teicoplanin is prescribed for treatment initiation. 3. Appropriate teicoplanin loading dose is prescribed based on actual body weight (ABW) and indication. 4. Appropriate teicoplanin maintenance dose is prescribed until Day 4 based on ABW and indication. 5. Appropriate teicoplanin maintenance dose is prescribed from Day 5 onwards based on CrCl, ABW and indication. Method This study did not require ethics approval. To assess audit feasibility, a pilot was done looking at teicoplanin prescriptions and clinical notes against the audit standards. CrCl was calculated where appropriate. Retrospective data of 18 teicoplanin prescriptions between 08/11/2022-14/11/2022 were extracted from the Electronic Prescribing and Medicines Administration (EPMA) system onto an Excel data collection spreadsheet. No changes were made to the data collection tool. One month’s data between 11/10/2022-07/11/2022 were further extracted and process was repeated. Paediatric patients and indications for surgical prophylaxis and Clostridioides difficile infection were excluded. Results 88 patients were included in the study. 90% (n=79) of teicoplanin prescriptions were prescribed for an indication approved on the Trust’s antimicrobial guideline or by a Consultant Microbiologist. Teicoplanin loading dose was prescribed for 82% (n=71) of patients. 1 patient was excluded as loading dose was administered in another hospital. 46% (n=40) of patients were prescribed the appropriate teicoplanin loading dose. 60% (n=34) of the 57 patients who continued teicoplanin up until Day 4 were prescribed the appropriate teicoplanin maintenance dose. 56% (n=22) of the 39 patients treated with teicoplanin past Day 4 were prescribed the appropriate teicoplanin maintenance dose. None of the 5 standards were met. Conclusion The results indicate inappropriate teicoplanin prescribing against the current Trust guideline which need improvement. Training with prescribers on utilising the EPMA’s pre-populated teicoplanin dose prescription function alongside encouraging pledges to be an Antibiotic Guardian are recommended during their induction. This would help avoid prescription errors and reduce antimicrobial resistance development. The data collected did not subdivide patients under specific specialities, which could highlight areas where training should be focused on. This limitation should be addressed when the re-audit due in 1 years’ time is carried out, to evaluate the changes implemented.

The always evolving diagnosis and management of Clostridioides difficile colitis: What you need to know.

The diagnosis, pharmacologic management, and surgical options for Clostridioides difficile infection (CDI) are rapidly evolving, which presents a challenge for the busy surgeon to remain up to date on the latest clinical guidelines. This review provides an evidence-based practical guide for CDI management tailored to the needs of surgeons and surgical intensivists. Historically, the diagnosis of CDI relied on slow cell culture cytotoxicity neutralization assays, but now, the rapidly resulting nucleic acid amplification tests and enzyme immunoassays have become mainstream. In terms of antibiotic therapy, metronidazole and oral vancomycin were the main "workhorse" antibiotics in the early 2000s, but large randomized controlled trials have now demonstrated that fidaxomicin produces superior results. Regarding surgical intervention, total abdominal colectomy was once the only procedure of choice; however, diverting loop ileostomy with colonic lavage is emerging as a viable alternative. Finally, novel adjuncts such as fecal microbiota transplantation and targeted therapy against toxin B (bezlotoxumab) are playing an increasingly important role in the management of CDI.

Fidaxomicin resistance in Clostridioides difficile: a systematic review and predictive modeling with RNA polymerase binding sites.

Fidaxomicin (FDX), an RNA polymerase (RNAP) inhibitor antibiotic, is a guideline-recommended therapy for Clostridioides difficile infection. Mutations associated with reduced FDX minimum inhibitory concentrations (MICs) have been identified. However, the molecular characterization of these mutations on FDX binding and the development of FDX resistance have not been studied. The purpose of this systematic review was to identify FDX resistance in C. difficile isolates and determine whether single nucleotide polymorphisms associated with increased FDX MIC aligned with the RNAP binding pocket interacting residues. A systematic literature search was done in PubMed (1991-2023) with identified articles and their bibliographies searched for papers that included C. difficile genetic mutations and increased FDX MIC. Visualization of FDX-RNAP interactions was performed on Schrödinger Maestro using the publicly available C. difficile RNAP with fidaxomicin sequence (code 7L7B) on the Protein Data Bank. Seven articles were identified after applying inclusion and exclusion criteria. The most common mutation in clinical and laboratory isolates was at position V1143 of the β subunit, which accounted for approximately 50% of the identified mutations. Most other mutations occurred within the β' subunit of RNAP. Approximately one-third of the identified mutation aligned directly with FDX interacting residues with C. difficile RNAP (7/20) with most of the remainder occurring within 5 Å of the binding residues. C. difficile strains with elevated FDX MIC align closely with the known RNAP binding residues. These data demonstrate the potential to identify genomic methods to identify emerging FDX resistance.

Loop Ileostomy With Colonic Lavage: Case Report of an Alternative to Total Colectomy in the Setting of Fulminant Clostridium difficile Colitis

Loop Ileostomy With Colonic Lavage: Case Report of an Alternative to Total Colectomy in the Setting of Fulminant Clostridium difficile Colitis

Probiotics and Fecal microbiota transplants: Mechanisms underlying the Therapeutic Benefits in Manipulating the Gut Microbiome

The mechanisms underlying therapeutic benefits in manipulating the human gut microbiome through Fecal microbiota transplantation (FMT) and probiotic administration has been a subject of great study. Dysbiosis, as in imbalance of the human gut bacterial composition, has been linked to immunodeficiency and increased susceptibility to chronic infections. Manipulating the microbiome works as a means of reversing this effect for therapeutic benefits. Competitive exclusion refers to the microbiota outcompeting pathogens for nutrients and creating an unfavorable environment for pathogenic growth. Preliminary studies show, toxin inactivation can occur through protease activity, while pathogen viability can be impacted directly through the stimulation of host-cell defenses and bacteriocin-like mechanisms. FMT has been established as a way to treat Clostridium difficile infections and along with probiotic-use it has been assessed to if and how it can carry therapeutic benefits in conditions such as inflammatory bowel disease (IBS), obesity, metabolic syndrome, gastrointestinal disorders, and even mental health disorders. Studies suggest a need for further investigation into the underlying mechanisms of treating dysbiosis in conferring therapeutic benefits.

The Use of Cefiderocol in Gram-Negative Bacterial Infections at International Medical Center, Jeddah, Saudi Arabia

Background/Objectives: The necessity for ground-breaking treatments for Gram-negative infections is evident. The World Health Organization, the Infectious Diseases Society of America, and the European Commission have highlighted the critical insufficiency of efficient antibiotics, urging pharmaceutical businesses to manufacture new antibiotics. Therefore, developing new antibiotics with broad efficacy against Gram-negative pathogens is essential. Thus, this research aimed to evaluate the safety and effectiveness of cefiderocol in treating multidrug-resistant Gram-negative bacterial infections at the International Medical Center (IMC), Jeddah, Saudi Arabia. Methods: A retrospective analysis was conducted on patients treated from January 2021 to February 2023. Thirteen case groups treated with cefiderocol were compared to twenty control groups treated with other antibiotics. Results: The results indicated no statistically significant differences in ICU stay, comorbidity indices, or mortality rates between the two groups. Cefiderocol showed high clinical and microbiological cure rates, despite the severity of the patients’ conditions. Carbapenem-resistant Klebsiella pneumoniae and difficult-to-treat resistance Pseudomonas aeruginosa were the most prevalent pathogens in the case and control group, respectively. Two patients treated with cefiderocol developed Clostridioides difficile infection, emphasizing the need for close monitoring of potential adverse effects. Conclusions: The results of this study support cefiderocol as a viable alternative for managing serious infections instigated by multidrug-resistant Gram-negative bacteria.

High-Resolution Melting PCR as a Fast and Simple Molecular Biology-Based Method for the Identification of Hypervirulent Clostridioides difficile Strains Directly in Stool Samples

Clostridioides difficile became one of the main causes of nosocomial infections in all clinical settings worldwide, especially among patients undergoing antibiotic therapy. The incidence and severity of C. difficile infections, from mild diarrhea to life-threatening pseudomembranous colitis, correlate with the spread of the hypervirulent binary toxin (CDT)-producing strains. The use of the real-time HRM-PCR method enables the identification of hypervirulent C. difficile strains directly in the diarrheal stool samples of patients suspected of being infected with this bacterium. For this purpose, the cdtA and cdtB genes encoding CDT subunits, as well as the species-specific gluD gene, were detected to identify the presence of this bacterium in the tested samples. The sensitivity, specificity, negative predictive value (NPV) and positive predictive value (PPV) of the established method were also assessed. The obtained results were compared with the results of eazyplex® C. difficile complete test (AmplexDiagnostics GmbH) based on the LAMP method, used in standard microbiological diagnostics. The values of the assessed diagnostic parameters for the detected genes ranged from 58.82% to 98.85%. The lowest value (58.82%) was obtained for the PPV of cdtB and the highest (98.85%) for the NPV of this gene. The real-time HRM-PCR method enables fast and simple detection of the investigated genes of hypervirulent C. difficile strains and, after careful optimization, may demonstrate high potential for usefulness in routine microbiological diagnostics.

Fecal Microbiota Transplantation: A Systematic Review of Therapeutic Potential, Preparation Techniques, and Delivery Methods Across Medical Conditions

Fecal microbiota transplantation (FMT) is revolutionizing the treatment of gastrointestinal disorders by leveraging the gut microbiome in innovative ways. This systematic review evaluates the clinical effectiveness and safety of FMT across various medical conditions, offering insights into its therapeutic potential and limitations. A comprehensive search of PubMed, Web of Science, Scopus, Embase, and ClinicalTrials.gov from January 2000 to December 2023 identified 97 relevant studies on FMT's efficacy, safety, and microbiome changes after eliminating duplicates. FMT has demonstrated high success rates, particularly in treating recurrent and refractory Clostridium difficile infections (CDI), with up to 90% effectiveness, establishing it as a primary treatment for antibiotic-resistant cases. FMT’s applications are expanding to inflammatory bowel diseases (IBD), including ulcerative colitis and Crohn's disease, as well as metabolic disorders and neuropsychiatric conditions. Remission rates for IBD range from 37-45%, with outcomes influenced by donor characteristics, stool preparation, and disease subtype. with mild, self-limiting side effects such as transient diarrhea and abdominal cramping. However, rare serious adverse events underscore the need for rigorous donor screening and standardized preparation protocols to mitigate risks. FMT’s ability to restore healthy gut flora highlights its promise in both gastrointestinal and systemic disease management. However, further research is essential to establish optimized procedures, standardized guidelines, and long-term safety data to facilitate its integration into mainstream medical practice.

Antimicrobial Combinations as Novel Indicators for Clostridioides difficile infection development: Population-Based, Nested Case-Controlled Study in Japan—The Shizuoka Kokuho Database Study

BackgroundClostridioides difficile is a major cause of antimicrobial-associated colitis. While antimicrobial stewardship has reduced the incidence of C. difficile infection (CDI), managing CDI is challenging because knowledge about preventing it is limited among healthcare professionals. To address this, we examined associations between antimicrobial use and CDI development. MethodsThis observational, nested case-controlled study was conducted using the Shizuoka Kokuho Database (SKDB). Individuals with no record of CDI or antimicrobial-associated enterocolitis within 1 year after SKDB enrolment, but who subsequently developed CDI, were included as the Case group. The Control group comprised individuals selected via 1:4 matching sampling without replacement for sex, age, and month of CDI onset. Conditional logistic regression analysis was performed to assess associations between antimicrobial use (number and combination) and CDI development, controlling for matched variables, background factors, and underlying conditions. ResultsOf the 2,398,393 individuals, 4917 were assigned to the Case group and 19,668 to the Control group. The adjusted odds ratios (ORs) for CDI were 3.65 for one antimicrobial and 8.58, 17.3, and 38.9 for combinations of two, three, or four or more agents (all p < 0.001). Penicillins, fourth-generation cephems, and carbapenems exhibited high ORs. Similar results were observed in certain demographic and comorbidity-free subgroups. Several combinations (penicillins + carbapenems, penicillins + cephems + carbapenems, cephems + fluoroquinolones, and penicillins + cephems + carbapenems) were notably associated with CDI development. ConclusionCDI prevalence increased with the number of antimicrobial classes used in combination. Certain types or combinations of antimicrobials may increase the OR for CDI.

Fecal Microbiota, Live-jslm (RBL; REBYOTA™) for Recurrent Clostridioides difficile Infection

Clostridioides difficile infection (CDI) is one of the most common causes of health care–associated infections and is often precipitated by recent antibiotic use. CDI occurs after the healthy gut microbiota is disrupted and becomes dysbiotic. Standard-of-care antibiotics for CDI may perpetuate dysbiosis, fueling risk of recurrent CDI (rCDI). New therapeutic options for preventing rCDI include fecal microbiota, live-jslm (RBL), a US Food and Drug Administration–approved, single-dose, rectally administered, microbiota-based live biotherapeutic product. RBL, which is easily given by any health care professional, is hypothesized to assist in restoring dysbiosis and has proven efficacy, safety, and tolerability across diverse patient populations to prevent rCDI.

Postburn Abdominal Pain of Gastrointestinal Origin: A Scoping Review.

After burn injury, patients may have abdominal pain due to several causes and etiologies, some of which could be life-threatening, including pancreatitis, stress ulcers, Clostridium difficile infection, and so forth. This pain sometimes poses a major diagnostic challenge. This scoping review is the first reported review to address and discuss this entity of patients after burn injury in abdominal pain of gastrointestinal origin. A scoping review of PubMed, Google Scholar, and other electronic research sites was performed. All relevant articles of any study design were included in this review. Variables included in this study were sex distribution, age, related total burn surface area, incidence rate, characteristics of pain, diagnosis, management, outcomes, and mortality rate. The medical literature identified 114 articles. According to our inclusion criteria, 91 articles were reviewed in this article. Through these articles, we reviewed in detail the characteristics of postburn abdominal pain, the relevant diseases responsible for this complaint, the epidemiologic features of these diseases, and potential management approaches aiming to help burn specialists in making earlier diagnosis and, thus, timely treatment. Early recognition of postburn abdominal pain, as well as timely diagnosis and treatment, play a significant role in prognosis and mortality. Thus, it is extremely important for burn specialists and plastic surgeons to thoroughly investigate postburn abdominal pain. Also, one of the aims of this review was to shed light on the important role of the multidisciplinary team in burn patient management to improve the prognosis.

Impact of D-allulose consumption on Enteric pathogens in human gut Microbiota: A randomized controlled trial study

D-allulose, a rare sugar recognized as Generally Recognized as Safe, has emerged as a potential alternative to sucrose. Despite its growing popularity, research on its effects on the human gut microbiota, including pathogens, remains scarce. To address these concerns, we conducted a 12-week randomized, double-blind, parallel, placebo-controlled study assessing D-allulose’s safety on gut microbiota in humans. Participants consumed 15 g/day of D-allulose or sucralose (placebo) for 12 weeks. Gut microbiota analysis in stool samples, performed through shotgun metagenomics sequencing before and after the intervention, evaluated microbial diversity, taxonomy of prevalent species, changes in pathogenic bacteria (Clostridium difficile, Helicobacter hepaticus, Klebsiella pneumoniae, Bacteroides fragilis, Staphylococcus aureus, and Salmonella enterica), and short-chain fatty acid production. Our findings revealed no significant differences in microbial diversity, pathogenic bacteria levels, or short-chain fatty acid production, suggesting that D-allulose consumption is safe and does not adversely affect the gut microbiome or pathogen presence.