Biegunka związana z antybiotykami – Rokowania, prognozy i postęp choroby

Biegunka związana z antybiotykami
Rokowania, prognozy i postęp choroby

Biegunka związana z antybiotykami (AAD) występuje u 5-35% pacjentów poddawanych terapii antybiotykowej, z ryzykiem sięgającym nawet 20% w przypadku niektórych leków, np. amoksycyliny z kwasem klawulanowym. AAD może pojawić się do 23 tygodni po zakończeniu terapii, co wymaga długotrwałej obserwacji. Clostridioides difficile odpowiada za 10-20% przypadków, z 20-25% ryzykiem nawrotów, co pogarsza rokowanie. Modele uczenia maszynowego, takie jak XGBoost, wykazują wysoką skuteczność w przewidywaniu AAD (AUC ROC 0,917, czułość 0,889, swoistość 0,806), identyfikując kluczowe czynniki ryzyka, m.in. stosowanie żywienia dojelitowego, kalcytoninogenu, hemoglobiny, interleukiny-6, wankomycyny, karbapenemów oraz wynik SOFA. Karbapenemy zwiększają ryzyko AAD trzykrotnie i zakażenia C. difficile niemal pięciokrotnie w ciągu 90 dni. Obniżony poziom bakterii Ruminococcaceae w mikrobiocie jelitowej predysponuje do rozwoju AAD, co ma istotne znaczenie prognostyczne.

Biegunka związana z antybiotykami – Rokowanie (prognoza wyniku leczenia)

Ogólne rokowanie
Modele predykcyjne w rokowaniu AAD
Wpływ konkretnych antybiotyków na rokowanie
Powikłania wpływające na rokowanie
Rokowanie w przypadku zakażenia C. difficile
Rola probiotyków w poprawie rokowania
Kierunki przyszłych badań nad poprawą rokowania
Podsumowanie czynników wpływających na rokowanie
Kolejne rozdziały

Biegunka związana z antybiotykami – Rokowanie (prognoza wyniku leczenia)

Biegunka związana z antybiotykami (ang. Antibiotic-Associated Diarrhea, AAD) stanowi częste powikłanie terapii antybiotykowej, występujące u około 5-35% pacjentów przyjmujących antybiotyki, a niektóre źródła wskazują, że dotyka ona nawet jednego na pięciu leczonych.¹² Częstość występowania zależy od rodzaju stosowanego antybiotyku, stanu zdrowia pacjenta oraz ekspozycji na patogeny. Rokowanie w przypadku AAD jest zróżnicowane i zależy od wielu czynników, które wpływają na przebieg i ostateczny wynik choroby.

Ogólne rokowanie

W większości przypadków biegunka związana z antybiotykami ma łagodny przebieg i ustępuje samoistnie w ciągu kilku dni po zakończeniu terapii antybiotykowej, nie wymagając specjalistycznego leczenia.¹ Jest to korzystna prognoza dla większości pacjentów, którzy doświadczają tego powikłania. Jednak AAD może wystąpić nawet do 23 tygodni po zakończeniu terapii antybiotykowej, a nie tylko w trakcie leczenia, co wymaga dłuższej obserwacji pacjentów po zakończeniu kuracji.³

Warto zauważyć, że w przypadkach cięższych, zwłaszcza gdy przyczyną jest infekcja Clostridioides difficile (odpowiedzialna za 10-20% wszystkich przypadków AAD), rokowanie może być mniej korzystne.⁴ Około 75-80% pacjentów dobrze reaguje na standardowe leczenie, ale 20-25% może rozwinąć nawrotowe zakażenie C. difficile, co znacząco pogarsza rokowanie.⁵

Modele predykcyjne w rokowaniu AAD

Wczesna identyfikacja pacjentów zagrożonych rozwojem AAD ma kluczowe znaczenie dla zapobiegania i wczesnej interwencji, co może poprawić rokowanie.⁶ Badania nad modelami uczenia maszynowego wykazały, że możliwe jest przewidywanie wystąpienia AAD z wysoką dokładnością. Model XGBoost przewidywał wystąpienie AAD z polem pod krzywą ROC wynoszącym 0,917, czułością 0,889, swoistością 0,806, dokładnością 0,870 i wynikiem F1 równym 0,780.⁷

Zidentyfikowano 20 najważniejszych czynników ryzyka o najwyższej wartości predykcyjnej, w tym: stosowanie żywienia dojelitowego, kalcytoninogen, hemoglobina, lipaza, płytki krwi, białko C-reaktywne, albumina, wiek, stosowanie propofolu, interleukina-6, fosfor w surowicy, stosowanie wankomycyny, butorfanolu, linezolidu, wynik SOFA, liczba białych krwinek, wskaźnik masy ciała, stosowanie flukonazolu, piperacyliny z tazobaktamem oraz remifentanylu.⁸ Modele te mogą pomóc lekarzom we wczesnej interwencji i leczeniu, potencjalnie skracając czas hospitalizacji na OIT i obniżając koszty opieki zdrowotnej dla pacjentów w podeszłym wieku.⁹

Wpływ konkretnych antybiotyków na rokowanie

Rodzaj stosowanego antybiotyku ma znaczący wpływ na ryzyko rozwoju AAD i związane z tym rokowanie. Badania wykazały, że pacjenci leczeni karbapenemami mieli trzykrotnie zwiększone ryzyko wystąpienia AAD i prawie pięciokrotnie zwiększone ryzyko zakażenia C. difficile w ciągu 90 dni w porównaniu do pacjentów nieotrzymujących karbapenemów.¹⁰¹¹

W przypadku amoksycyliny z kwasem klawulanowym (znanej jako Augmentin), jeden na trzech pacjentów, którym przepisano ten antybiotyk, rozwinie biegunkę.¹² Badania wykazały, że poziom bakterii z rodziny Ruminococcaceae w jelitach może wpływać na ryzyko wystąpienia biegunki po antybiotykoterapii. Poziom tych bakterii w stolcu pacjentów, którzy rozwinęli biegunkę, był znacząco niższy w porównaniu do tych, u których biegunka nie wystąpiła, zarówno przed, jak i w trakcie leczenia amoksycyliną z kwasem klawulanowym.¹³ Sugeruje to, że indywidualny skład mikrobioty jelitowej może predysponować do wystąpienia biegunki związanej z antybiotykami, co ma istotne znaczenie prognostyczne.¹⁴

Powikłania wpływające na rokowanie

Występowanie AAD może przedłużyć okres hospitalizacji pacjentów, co prowadzi do zwiększonego ryzyka zakażeń szpitalnych i związanych z nimi problemów zdrowotnych.¹⁵ Jednym z najczęstszych powikłań każdego rodzaju biegunki jest skrajna utrata płynów i elektrolitów (odwodnienie). Ciężkie odwodnienie może zagrażać życiu. Objawy przedmiotowe i podmiotowe obejmują bardzo suchą jamę ustną, intensywne pragnienie, skąpomocz lub brak oddawania moczu, zawroty głowy i osłabienie.¹⁶

Wystąpienie AAD u pacjentów może wiązać się z:

wydłużeniem czasu hospitalizacji
wzrostem kosztów leczenia
potencjalnie wyższą śmiertelnością

¹⁷¹⁸

Pacjenci hospitalizowani, u których wystąpiła AAD, są również bardziej narażeni na przyszłe infekcje i zwiększoną śmiertelność.¹⁹ Dlatego kluczowe jest zapobieganie wystąpieniu AAD oraz jej wczesne rozpoznanie i leczenie.²⁰

Rokowanie w przypadku zakażenia C. difficile

Clostridioides difficile jest najczęściej identyfikowaną przyczyną AAD, odpowiedzialną za około 10-20% wszystkich przypadków.²¹²² Manifestacje kliniczne w zakażeniu C. difficile (CDI) obejmują szeroki zakres – od krótkotrwałej kolonizacji, przez ostrą biegunkę, po piorunującą biegunkę, która może być związana z rzekomobłoniastym zapaleniem jelita grubego i leukocytozą, mogącą prowadzić do zgonu, oraz nawracające CDI (rCDI).²³

Ciężkość choroby może zależeć od czynników ryzyka, takich jak wiek, status immunologiczny gospodarza, liczba wcześniejszych hospitalizacji i obecność chorób współistniejących.²⁴²⁵ Głównymi czynnikami ryzyka są zaawansowany wiek, hospitalizacja i ekspozycja na antybiotyki.²⁶

Zakażenie C. difficile związane z antybiotykami stanowi poważny problem dla placówek opieki zdrowotnej, prowadząc do obaw o bezpieczeństwo pacjentów i zwiększonych kosztów leczenia.²⁷ Dlatego wczesna diagnostyka i skuteczne leczenie są kluczowe dla poprawy rokowania.

Rola probiotyków w poprawie rokowania

Stosowanie probiotyków jako terapii uzupełniającej może mieć korzystny wpływ na zapobieganie AAD i poprawę rokowania. Wyniki przeglądów systematycznych wskazują na ochronny efekt stosowania probiotyków jako terapii adjuwantowej w zapobieganiu biegunce związanej z antybiotykami u pacjentów ambulatoryjnych w każdym wieku.²⁸

Dane z 17 badań obejmujących łącznie 3631 pacjentów wykazały, że stosowanie probiotyków może zmniejszyć ryzyko AAD o 51% (RR 0,49; 95% CI 0,36-0,66; I2 = 58%), bez widocznego zwiększenia ryzyka działań niepożądanych (RD 0,00, 95% CI -0,02 do 0,02, 2,363 uczestników).²⁹ Jakość dowodów dla głównego punktu końcowego została sklasyfikowana jako umiarkowana ze względu na umiarkowany stopień heterogeniczności i wysokie ryzyko błędu systematycznego w niektórych badaniach.³⁰

Najsilniejsze dowody dotyczą Saccharomyces boulardii i Lactobacillus rhamnosus GG, ponieważ te szczepy były wykorzystywane w większości badań.³¹ Najnowsza meta-analiza 10 randomizowanych badań kontrolowanych testujących skuteczność S. boulardii w zapobieganiu AAD wykazuje ogólne, zbiorcze względne ryzyko na poziomie 0,47.³²

Na podstawie tych wyników można stwierdzić, że kilka szczepów bakterii i jeden drożdży mają potencjał zapobiegania AAD, co może pozytywnie wpłynąć na rokowanie.³³ Jednak dowody dotyczące zapobiegania i leczenia zakażeń C. difficile są obecnie niejednoznaczne, z mniejszą liczbą przeprowadzonych badań, z których większość ma zbyt małą moc statystyczną.³⁴³⁵

Kierunki przyszłych badań nad poprawą rokowania

Aktywne obszary badań nad AAD obejmują poszukiwanie innych etiologii i skuteczniejszych metod leczenia, co może prowadzić do poprawy rokowania w przyszłości.³⁶ Kluczem do skutecznego leczenia AAD jest szybka diagnoza, po której następuje efektywne leczenie i wdrożenie środków kontroli.³⁷

Badacze pracują obecnie nad rozwojem diagnostyki typu point-of-care, która pomoże przewidywać ryzyko AAD na podstawie składu mikrobioty jelitowej pacjenta.³⁸ Bazując na obecnej wiedzy, zespoły badawcze planują przeprowadzić badania kliniczne w celu sprawdzenia, czy określone gatunki bakterii z rodziny Ruminococcaceae mogłyby być wykorzystane jako probiotyk w zapobieganiu biegunce u pacjentów otrzymujących antybiotyki.³⁹

Identyfikacja etiologii i zrozumienie patogenezy AAD pomoże w poprawie opieki zdrowotnej i zmniejszeniu obciążenia ekonomicznego.⁴⁰ Ponieważ większość przypadków AAD jest związana ze zmianami w mikrobiocie jelitowej, modulowanie mikrobioty i przyjmowanie strategii zapobiegawczych, takich jak odpowiednia dieta, prebiotyki, probiotyki i leki, może być ostatecznie konieczne dla zapewnienia optymalnego zdrowia i korzystnych wyników u osób podatnych na choroby.⁴¹

Podsumowanie czynników wpływających na rokowanie

Rokowanie w przypadku biegunki związanej z antybiotykami zależy od szeregu czynników, które można podsumować następująco:

Nasilenie objawów – od łagodnej, samoograniczającej się biegunki po ciężkie rzekomobłoniaste zapalenie jelita grubego
Patogen wywołujący – zakażenie C. difficile wiąże się z gorszym rokowaniem
Charakterystyka pacjenta – wiek, stan układu odpornościowego, choroby współistniejące
Rodzaj stosowanego antybiotyku – karbapenemy związane z wyższym ryzykiem AAD i CDI
Skład mikrobioty jelitowej – poziom bakterii Ruminococcaceae może predysponować do AAD
Czas rozpoznania i wdrożenia leczenia – wczesne rozpoznanie poprawia rokowanie
Stosowanie strategii prewencyjnych – probiotyki mogą zmniejszać ryzyko AAD

⁴²⁴³⁴⁴⁴⁵⁴⁶

Biegunka związana z antybiotykami, choć często samoograniczająca się, może w niektórych przypadkach prowadzić do poważnych powikłań i zwiększonej śmiertelności. Wczesna identyfikacja pacjentów z grupy ryzyka, szybkie rozpoznanie i odpowiednie leczenie, a także wdrożenie strategii zapobiegawczych, są kluczowe dla poprawy rokowania i zmniejszenia obciążenia systemu opieki zdrowotnej.⁴⁷⁴⁸⁴⁹

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Materiały źródłowe

#1 Antibiotic-associated diarrhea: epidemiology, trends and treatment – PubMed
https://pubmed.ncbi.nlm.nih.gov/18811240/
A common complication of antibiotic use is the development of gastrointestinal disease. This complication ranges from mild diarrhea to pseudomembranous colitis. Outbreaks of antibiotic-associated diarrhea (AAD) may also occur in healthcare settings, usually caused by Clostridium difficile. AAD typically occurs in 5-35% of patients taking antibiotics and varies depending upon the specific type of antibiotic, the health of the host and exposure to pathogens. The pathogenesis of AAD may be mediated through the disruption of the normal microbiota resulting in pathogen overgrowth or metabolic imbalances. The key to addressing AAD is prompt diagnosis followed by effective treatment and institution of control measures. Areas of active research include the search for other etiologies and more effective treatments.
#1 Antibiotic-associated diarrhea – Symptoms & causes – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/antibiotic-associated-diarrhea/symptoms-causes/syc-20352231
Antibiotic-associated diarrhea refers to passing loose, watery stools three or more times a day after taking medications used to treat bacterial infections (antibiotics). […] About 1 in 5 people who take antibiotics develop antibiotic-associated diarrhea. Most often, antibiotic-associated diarrhea is mild and requires no treatment. The diarrhea typically clears up within a few days after you stop taking the antibiotic. More-serious antibiotic-associated diarrhea requires stopping or sometimes switching antibiotics. […] One of the most common complications of any type of diarrhea is extreme loss of fluids and electrolytes (dehydration). Severe dehydration can be life-threatening. Signs and symptoms include a very dry mouth, intense thirst, little or no urination, dizziness, and weakness.
#2 Antibiotic-associated diarrhea – Symptoms & causes – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/antibiotic-associated-diarrhea/symptoms-causes/syc-20352231
Antibiotic-associated diarrhea refers to passing loose, watery stools three or more times a day after taking medications used to treat bacterial infections (antibiotics). […] About 1 in 5 people who take antibiotics develop antibiotic-associated diarrhea. Most often, antibiotic-associated diarrhea is mild and requires no treatment. The diarrhea typically clears up within a few days after you stop taking the antibiotic. More-serious antibiotic-associated diarrhea requires stopping or sometimes switching antibiotics. […] One of the most common complications of any type of diarrhea is extreme loss of fluids and electrolytes (dehydration). Severe dehydration can be life-threatening. Signs and symptoms include a very dry mouth, intense thirst, little or no urination, dizziness, and weakness.
#3 Probiotics in the prevention of antibiotic-associated diarrhoea and Clostridium difficile infection
https://pmc.ncbi.nlm.nih.gov/articles/PMC3105609/
Diarrhoea, as a common side effect of antibiotics, increases treatment costs and length of stay in acute healthcare facilities. […] AAD can occur up to 23 weeks following cessation of antibiotic therapy rather than during the treatment. […] It has also been shown that hospital patients are at greater risk of future infections and increased mortality. […] CDAD is responsible for around 10-20% of all cases of AAD. […] There are three key risk factors for the development of this infection; antibiotic use, increasing age, and hospitalization. […] CDAD has become and remains a serious problem for acute healthcare providers, leading to concerns around patient safety and increased medical treatment costs. […] A total of 75-80% of patients respond well to one of these treatments but 20-25% may develop recurrent CDAD.
#4 Probiotics in the prevention of antibiotic-associated diarrhoea and Clostridium difficile infection
https://pmc.ncbi.nlm.nih.gov/articles/PMC3105609/
Diarrhoea, as a common side effect of antibiotics, increases treatment costs and length of stay in acute healthcare facilities. […] AAD can occur up to 23 weeks following cessation of antibiotic therapy rather than during the treatment. […] It has also been shown that hospital patients are at greater risk of future infections and increased mortality. […] CDAD is responsible for around 10-20% of all cases of AAD. […] There are three key risk factors for the development of this infection; antibiotic use, increasing age, and hospitalization. […] CDAD has become and remains a serious problem for acute healthcare providers, leading to concerns around patient safety and increased medical treatment costs. […] A total of 75-80% of patients respond well to one of these treatments but 20-25% may develop recurrent CDAD.
#5 Probiotics in the prevention of antibiotic-associated diarrhoea and Clostridium difficile infection
https://pmc.ncbi.nlm.nih.gov/articles/PMC3105609/
Diarrhoea, as a common side effect of antibiotics, increases treatment costs and length of stay in acute healthcare facilities. […] AAD can occur up to 23 weeks following cessation of antibiotic therapy rather than during the treatment. […] It has also been shown that hospital patients are at greater risk of future infections and increased mortality. […] CDAD is responsible for around 10-20% of all cases of AAD. […] There are three key risk factors for the development of this infection; antibiotic use, increasing age, and hospitalization. […] CDAD has become and remains a serious problem for acute healthcare providers, leading to concerns around patient safety and increased medical treatment costs. […] A total of 75-80% of patients respond well to one of these treatments but 20-25% may develop recurrent CDAD.
#6 Interpretable machine learning models for predicting the incidence of antibiotic- associated diarrhea in elderly ICU patients | BMC Geriatrics | Full Text
https://bmcgeriatr.biomedcentral.com/articles/10.1186/s12877-024-05028-8
Antibiotic-associated diarrhea (AAD) can prolong hospitalization, increase medical costs, and even lead to higher mortality rates. Therefore, it is essential to predict the incidence of AAD in elderly intensive care unit(ICU) patients. […] The occurrence of AAD prolongs hospitalization, escalates medical expenses, and may even contribute to increased mortality. […] Early identification of patients at risk of AAD is critical and may facilitate timely prevention and intervention. […] The XGBoost model predicted the incidence of AAD with an area under the receiver operating characteristic curve (ROC) of 0.917, sensitivity of 0.889, specificity of 0.806, accuracy of 0.870, and an F1 score of 0.780. […] While the XGBoost model may not excel in absolute performance, it demonstrates superior predictive capabilities compared to other models in forecasting the incidence of AAD in elderly ICU patients categorized based on their characteristics.
#7 Interpretable machine learning models for predicting the incidence of antibiotic- associated diarrhea in elderly ICU patients | BMC Geriatrics | Full Text
https://bmcgeriatr.biomedcentral.com/articles/10.1186/s12877-024-05028-8
Antibiotic-associated diarrhea (AAD) can prolong hospitalization, increase medical costs, and even lead to higher mortality rates. Therefore, it is essential to predict the incidence of AAD in elderly intensive care unit(ICU) patients. […] The occurrence of AAD prolongs hospitalization, escalates medical expenses, and may even contribute to increased mortality. […] Early identification of patients at risk of AAD is critical and may facilitate timely prevention and intervention. […] The XGBoost model predicted the incidence of AAD with an area under the receiver operating characteristic curve (ROC) of 0.917, sensitivity of 0.889, specificity of 0.806, accuracy of 0.870, and an F1 score of 0.780. […] While the XGBoost model may not excel in absolute performance, it demonstrates superior predictive capabilities compared to other models in forecasting the incidence of AAD in elderly ICU patients categorized based on their characteristics.
#8 Interpretable machine learning models for predicting the incidence of antibiotic- associated diarrhea in elderly ICU patients | BMC Geriatrics | Full Text
https://bmcgeriatr.biomedcentral.com/articles/10.1186/s12877-024-05028-8
The occurrence of AAD in patients can extend the length of hospital stay, raise healthcare expenses, and potentially contribute to higher mortality. […] As a result, it is essential to prevent the occurrence of AAD and to identify and treat it as early as possible. […] The top 20 risk factors with the highest predictive value were enteral nutrition use, calcitoninogen, hemoglobin, lipase, platelets, C-reactive protein, albumin, age, propofol use, interleukin-6, serum phosphorus, vancomycin use, butorphanol use, linezolid use, SOFA score, white blood cell count, body mass index, fluconazole use, piperacillin sodium tazobactam sodium use, and remifentanil use. […] The best machine learning algorithm with good performance is selected. We hope that this model can aid physicians in early intervention and treatment, potentially reducing the length of ICU hospitalization and healthcare costs for elderly patients.
#9 Interpretable machine learning models for predicting the incidence of antibiotic- associated diarrhea in elderly ICU patients | BMC Geriatrics | Full Text
https://bmcgeriatr.biomedcentral.com/articles/10.1186/s12877-024-05028-8
The occurrence of AAD in patients can extend the length of hospital stay, raise healthcare expenses, and potentially contribute to higher mortality. […] As a result, it is essential to prevent the occurrence of AAD and to identify and treat it as early as possible. […] The top 20 risk factors with the highest predictive value were enteral nutrition use, calcitoninogen, hemoglobin, lipase, platelets, C-reactive protein, albumin, age, propofol use, interleukin-6, serum phosphorus, vancomycin use, butorphanol use, linezolid use, SOFA score, white blood cell count, body mass index, fluconazole use, piperacillin sodium tazobactam sodium use, and remifentanil use. […] The best machine learning algorithm with good performance is selected. We hope that this model can aid physicians in early intervention and treatment, potentially reducing the length of ICU hospitalization and healthcare costs for elderly patients.
#10 Incidence and predictive biomarkers of Clostridioides difficile infection in hospitalized patients receiving broad-spectrum antibiotics | Nature Communications
https://www.nature.com/articles/s41467-021-22269-y
Here, we demonstrate that the 90-day incidence of CDI and antibiotic-associated diarrhea (AAD) in patients 50 years of age treated with predefined broad-spectrum antibiotic classes is 1.9% (95% CI: 1.1-3.0) and 14.1% (95% CI: 12.0-16.4), and that carbapenem treatment, toxigenic C. difficile carriage, and the composition and diversity of the gut microbiota predict CDI but not AAD. […] AAD could not be predicted reliably with any of the studied parameters. The involvement of different infectious and non-infectious causes of AAD may hamper accurate biomarker-based prediction of AAD. […] Although all evaluated antibiotic classes have been associated with CDI, in our study, only patients treated with carbapenems had a threefold increased risk of AAD and an almost fivefold increased risk of CDI within 90 days as compared to patients not receiving carbapenems at baseline. […] The incidence of AAD was increased threefold in subjects receiving carbapenems at baseline compared to patients not receiving carbapenems at baseline.
#11 Incidence and predictive biomarkers of Clostridioides difficile infection in hospitalized patients receiving broad-spectrum antibiotics | Nature Communications
https://www.nature.com/articles/s41467-021-22269-y
Here, we demonstrate that the 90-day incidence of CDI and antibiotic-associated diarrhea (AAD) in patients 50 years of age treated with predefined broad-spectrum antibiotic classes is 1.9% (95% CI: 1.1-3.0) and 14.1% (95% CI: 12.0-16.4), and that carbapenem treatment, toxigenic C. difficile carriage, and the composition and diversity of the gut microbiota predict CDI but not AAD. […] AAD could not be predicted reliably with any of the studied parameters. The involvement of different infectious and non-infectious causes of AAD may hamper accurate biomarker-based prediction of AAD. […] Although all evaluated antibiotic classes have been associated with CDI, in our study, only patients treated with carbapenems had a threefold increased risk of AAD and an almost fivefold increased risk of CDI within 90 days as compared to patients not receiving carbapenems at baseline. […] The incidence of AAD was increased threefold in subjects receiving carbapenems at baseline compared to patients not receiving carbapenems at baseline.
#12 Study sheds light on antibiotics-associated diarrhea | MIT News | Massachusetts Institute of Technology
https://news.mit.edu/2022/study-sheds-light-antibiotics-associated-diarrhea-0228
Globally, one in three patients prescribed amoxicillin-clavulanate will develop diarrhea. […] The diarrhea could also prolong patients hospital stays, leading to an increased risk of other infections as a result. […] Building upon what is now known, the team now hopes to conduct a clinical trial to see if certain species of bacteria within the Ruminococcaceae family could be used as a probiotic to prevent diarrhea in patients receiving antibiotics.
#13 Study sheds light on antibiotics-associated diarrhea | MIT News | Massachusetts Institute of Technology
https://news.mit.edu/2022/study-sheds-light-antibiotics-associated-diarrhea-0228
Results showed that Ruminococcaceae levels in the stools of study volunteers who developed diarrhea were significantly lower when compared to those who did not, both before and during treatment with amoxicillin-clavulanate. This suggests that individuals may, depending on their gut composition, be predisposed to antibiotic-associated diarrhea. […] Understanding this response and the ability to predict those at risk will help guide the development of point-of-care diagnostics, says Eric J. Alm, professor of biological engineering at MIT, principal investigator at SMART Antimicrobial Resistance (AMR) interdisciplinary research group, and co-corresponding author of the study. […] Our findings provide evidence that an individuals gut microbial composition can influence the risk of developing antibiotics-associated diarrhea.
#14 Study sheds light on antibiotics-associated diarrhea | MIT News | Massachusetts Institute of Technology
https://news.mit.edu/2022/study-sheds-light-antibiotics-associated-diarrhea-0228
Results showed that Ruminococcaceae levels in the stools of study volunteers who developed diarrhea were significantly lower when compared to those who did not, both before and during treatment with amoxicillin-clavulanate. This suggests that individuals may, depending on their gut composition, be predisposed to antibiotic-associated diarrhea. […] Understanding this response and the ability to predict those at risk will help guide the development of point-of-care diagnostics, says Eric J. Alm, professor of biological engineering at MIT, principal investigator at SMART Antimicrobial Resistance (AMR) interdisciplinary research group, and co-corresponding author of the study. […] Our findings provide evidence that an individuals gut microbial composition can influence the risk of developing antibiotics-associated diarrhea.
#15 Study sheds light on antibiotics-associated diarrhea | MIT News | Massachusetts Institute of Technology
https://news.mit.edu/2022/study-sheds-light-antibiotics-associated-diarrhea-0228
Globally, one in three patients prescribed amoxicillin-clavulanate will develop diarrhea. […] The diarrhea could also prolong patients hospital stays, leading to an increased risk of other infections as a result. […] Building upon what is now known, the team now hopes to conduct a clinical trial to see if certain species of bacteria within the Ruminococcaceae family could be used as a probiotic to prevent diarrhea in patients receiving antibiotics.
#16 Antibiotic-associated diarrhea – Symptoms & causes – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/antibiotic-associated-diarrhea/symptoms-causes/syc-20352231
Antibiotic-associated diarrhea refers to passing loose, watery stools three or more times a day after taking medications used to treat bacterial infections (antibiotics). […] About 1 in 5 people who take antibiotics develop antibiotic-associated diarrhea. Most often, antibiotic-associated diarrhea is mild and requires no treatment. The diarrhea typically clears up within a few days after you stop taking the antibiotic. More-serious antibiotic-associated diarrhea requires stopping or sometimes switching antibiotics. […] One of the most common complications of any type of diarrhea is extreme loss of fluids and electrolytes (dehydration). Severe dehydration can be life-threatening. Signs and symptoms include a very dry mouth, intense thirst, little or no urination, dizziness, and weakness.
#17 Interpretable machine learning models for predicting the incidence of antibiotic- associated diarrhea in elderly ICU patients | BMC Geriatrics | Full Text
https://bmcgeriatr.biomedcentral.com/articles/10.1186/s12877-024-05028-8
The occurrence of AAD in patients can extend the length of hospital stay, raise healthcare expenses, and potentially contribute to higher mortality. […] As a result, it is essential to prevent the occurrence of AAD and to identify and treat it as early as possible. […] The top 20 risk factors with the highest predictive value were enteral nutrition use, calcitoninogen, hemoglobin, lipase, platelets, C-reactive protein, albumin, age, propofol use, interleukin-6, serum phosphorus, vancomycin use, butorphanol use, linezolid use, SOFA score, white blood cell count, body mass index, fluconazole use, piperacillin sodium tazobactam sodium use, and remifentanil use. […] The best machine learning algorithm with good performance is selected. We hope that this model can aid physicians in early intervention and treatment, potentially reducing the length of ICU hospitalization and healthcare costs for elderly patients.
#18 Interpretable machine learning models for predicting the incidence of antibiotic- associated diarrhea in elderly ICU patients | BMC Geriatrics | Full Text
https://bmcgeriatr.biomedcentral.com/articles/10.1186/s12877-024-05028-8
Antibiotic-associated diarrhea (AAD) can prolong hospitalization, increase medical costs, and even lead to higher mortality rates. Therefore, it is essential to predict the incidence of AAD in elderly intensive care unit(ICU) patients. […] The occurrence of AAD prolongs hospitalization, escalates medical expenses, and may even contribute to increased mortality. […] Early identification of patients at risk of AAD is critical and may facilitate timely prevention and intervention. […] The XGBoost model predicted the incidence of AAD with an area under the receiver operating characteristic curve (ROC) of 0.917, sensitivity of 0.889, specificity of 0.806, accuracy of 0.870, and an F1 score of 0.780. […] While the XGBoost model may not excel in absolute performance, it demonstrates superior predictive capabilities compared to other models in forecasting the incidence of AAD in elderly ICU patients categorized based on their characteristics.
#19 Probiotics in the prevention of antibiotic-associated diarrhoea and Clostridium difficile infection
https://pmc.ncbi.nlm.nih.gov/articles/PMC3105609/
Diarrhoea, as a common side effect of antibiotics, increases treatment costs and length of stay in acute healthcare facilities. […] AAD can occur up to 23 weeks following cessation of antibiotic therapy rather than during the treatment. […] It has also been shown that hospital patients are at greater risk of future infections and increased mortality. […] CDAD is responsible for around 10-20% of all cases of AAD. […] There are three key risk factors for the development of this infection; antibiotic use, increasing age, and hospitalization. […] CDAD has become and remains a serious problem for acute healthcare providers, leading to concerns around patient safety and increased medical treatment costs. […] A total of 75-80% of patients respond well to one of these treatments but 20-25% may develop recurrent CDAD.
#20 Interpretable machine learning models for predicting the incidence of antibiotic- associated diarrhea in elderly ICU patients | BMC Geriatrics | Full Text
https://bmcgeriatr.biomedcentral.com/articles/10.1186/s12877-024-05028-8
The occurrence of AAD in patients can extend the length of hospital stay, raise healthcare expenses, and potentially contribute to higher mortality. […] As a result, it is essential to prevent the occurrence of AAD and to identify and treat it as early as possible. […] The top 20 risk factors with the highest predictive value were enteral nutrition use, calcitoninogen, hemoglobin, lipase, platelets, C-reactive protein, albumin, age, propofol use, interleukin-6, serum phosphorus, vancomycin use, butorphanol use, linezolid use, SOFA score, white blood cell count, body mass index, fluconazole use, piperacillin sodium tazobactam sodium use, and remifentanil use. […] The best machine learning algorithm with good performance is selected. We hope that this model can aid physicians in early intervention and treatment, potentially reducing the length of ICU hospitalization and healthcare costs for elderly patients.
#21 Probiotics in the prevention of antibiotic-associated diarrhoea and Clostridium difficile infection
https://pmc.ncbi.nlm.nih.gov/articles/PMC3105609/
Diarrhoea, as a common side effect of antibiotics, increases treatment costs and length of stay in acute healthcare facilities. […] AAD can occur up to 23 weeks following cessation of antibiotic therapy rather than during the treatment. […] It has also been shown that hospital patients are at greater risk of future infections and increased mortality. […] CDAD is responsible for around 10-20% of all cases of AAD. […] There are three key risk factors for the development of this infection; antibiotic use, increasing age, and hospitalization. […] CDAD has become and remains a serious problem for acute healthcare providers, leading to concerns around patient safety and increased medical treatment costs. […] A total of 75-80% of patients respond well to one of these treatments but 20-25% may develop recurrent CDAD.
#22 Antibiotic-Associated Diarrhea Beyond C. Difficile: A Scoping Review | Published in Journal of Brown Hospital Medicine
https://bhm.scholasticahq.com/article/39745-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. Currently fewer than 33% of AAD cases can be attributable to Clostridioides difficile leaving a large number of cases undiagnosed and poorly treated. AAD may range from mild, self-limiting illness to fulminant, pseudomembranous colitis that can be life threatening. The likely pathogenesis of AAD includes alteration of intestinal microbiota, direct drug toxicity on the gut and development of a superinfection by a pathogenic microbe. Identifying the etiology and understanding the pathogenesis of AAD will help in improving healthcare and in reducing the economic burden. Only 40% of AAD can be accounted for by the above causes leaving a majority of AAD cases without an etiology. The unique features of the current review were to summarize the existing data on AAD and provide concise descriptions of the pathogenesis of CDI as well as non-CDI AAD. Because a majority of the AAD cases are due to altered intestinal microbiota, modulating the microbiota, and adopting preventive strategies such as diet, prebiotics, probiotics, and drugs may be ultimately necessary to ensure optimal health and favorable outcomes in disease prone individuals.
#23 Antibiotic-Associated Diarrhea Beyond C. Difficile: A Scoping Review | Published in Journal of Brown Hospital Medicine
https://bhm.scholasticahq.com/article/39745
C. difficile is the most identified cause of AAD. Clinical manifestations in CDI range from short-term colonization, acute diarrhea, fulminant diarrhea, which may be associated with pseudomembranous colitis and leukocytosis and may lead to death, and recurrent CDI (rCDI). The severity of illness may depend on risk factors such as age, host immune status, number of prior hospitalizations and presence of co-morbidities. […] Only 40% of AAD can be accounted for by the above causes leaving a majority of AAD cases without an etiology.
#24 Antibiotic-Associated Diarrhea Beyond C. Difficile: A Scoping Review | Published in Journal of Brown Hospital Medicine
https://bhm.scholasticahq.com/article/39745
C. difficile is the most identified cause of AAD. Clinical manifestations in CDI range from short-term colonization, acute diarrhea, fulminant diarrhea, which may be associated with pseudomembranous colitis and leukocytosis and may lead to death, and recurrent CDI (rCDI). The severity of illness may depend on risk factors such as age, host immune status, number of prior hospitalizations and presence of co-morbidities. […] Only 40% of AAD can be accounted for by the above causes leaving a majority of AAD cases without an etiology.
#25 Antibiotic-Associated Diarrhea Beyond C. Difficile: A Scoping Review | Published in Journal of Brown Hospital Medicine
https://bhm.scholasticahq.com/article/39745-antibiotic-associated-diarrhea-beyond-c-difficile-a-scoping-review
The severity of illness may depend on risk factors such as age, host immune status, number of prior hospitalizations and presence of co-morbidities. Major risk factors include advanced age, hospitalization, and exposure to antibiotics. […] The role of Candida spp. in AAD has been debated since the 1950s and continues to be controversial.
#26 Antibiotic-Associated Diarrhea Beyond C. Difficile: A Scoping Review | Published in Journal of Brown Hospital Medicine
https://bhm.scholasticahq.com/article/39745-antibiotic-associated-diarrhea-beyond-c-difficile-a-scoping-review
The severity of illness may depend on risk factors such as age, host immune status, number of prior hospitalizations and presence of co-morbidities. Major risk factors include advanced age, hospitalization, and exposure to antibiotics. […] The role of Candida spp. in AAD has been debated since the 1950s and continues to be controversial.
#27 Probiotics in the prevention of antibiotic-associated diarrhoea and Clostridium difficile infection
https://pmc.ncbi.nlm.nih.gov/articles/PMC3105609/
Diarrhoea, as a common side effect of antibiotics, increases treatment costs and length of stay in acute healthcare facilities. […] AAD can occur up to 23 weeks following cessation of antibiotic therapy rather than during the treatment. […] It has also been shown that hospital patients are at greater risk of future infections and increased mortality. […] CDAD is responsible for around 10-20% of all cases of AAD. […] There are three key risk factors for the development of this infection; antibiotic use, increasing age, and hospitalization. […] CDAD has become and remains a serious problem for acute healthcare providers, leading to concerns around patient safety and increased medical treatment costs. […] A total of 75-80% of patients respond well to one of these treatments but 20-25% may develop recurrent CDAD.
#28 Probiotics for the Prevention of Antibiotic-Associated Diarrhea in OutpatientsâA Systematic Review and Meta-Analysis
https://www.mdpi.com/2079-6382/6/4/21
A common adverse effect of antibiotic use is diarrhea. Probiotics are living microorganisms, which, upon oral ingestion, may prevent antibiotic-associated diarrhea (AAD) by the normalization of an unbalanced gastrointestinal flora. The objective of this systematic review was to assess the benefits and harms of probiotics used for the prevention of AAD in an outpatient setting. […] The results suggest that probiotic use may be beneficial in the prevention of AAD among outpatients. Furthermore, the use of probiotics appears safe. […] The results of this review point towards a protective effect of the use of probiotics as adjunct therapy to prevent antibiotic-associated diarrhea in outpatients of all ages. Data from 17 studies with a total of 3631 patients found that the use of a probiotic may reduce the risk of AAD by 51% (RR 0.49; 95% CI 0.36 to 0.66; I2 = 58%), with no apparent increase in the risk of side effects (RD 0.00, 95% CI -0.02 to 0.02, 2.363 participants). […] The quality of evidence for the main outcome was categorized as moderate due to a moderate degree of heterogeneity and a high risk of bias in some trials.
#29 Probiotics for the Prevention of Antibiotic-Associated Diarrhea in OutpatientsâA Systematic Review and Meta-Analysis
https://www.mdpi.com/2079-6382/6/4/21
A common adverse effect of antibiotic use is diarrhea. Probiotics are living microorganisms, which, upon oral ingestion, may prevent antibiotic-associated diarrhea (AAD) by the normalization of an unbalanced gastrointestinal flora. The objective of this systematic review was to assess the benefits and harms of probiotics used for the prevention of AAD in an outpatient setting. […] The results suggest that probiotic use may be beneficial in the prevention of AAD among outpatients. Furthermore, the use of probiotics appears safe. […] The results of this review point towards a protective effect of the use of probiotics as adjunct therapy to prevent antibiotic-associated diarrhea in outpatients of all ages. Data from 17 studies with a total of 3631 patients found that the use of a probiotic may reduce the risk of AAD by 51% (RR 0.49; 95% CI 0.36 to 0.66; I2 = 58%), with no apparent increase in the risk of side effects (RD 0.00, 95% CI -0.02 to 0.02, 2.363 participants). […] The quality of evidence for the main outcome was categorized as moderate due to a moderate degree of heterogeneity and a high risk of bias in some trials.
#30 Probiotics for the Prevention of Antibiotic-Associated Diarrhea in OutpatientsâA Systematic Review and Meta-Analysis
https://www.mdpi.com/2079-6382/6/4/21
A common adverse effect of antibiotic use is diarrhea. Probiotics are living microorganisms, which, upon oral ingestion, may prevent antibiotic-associated diarrhea (AAD) by the normalization of an unbalanced gastrointestinal flora. The objective of this systematic review was to assess the benefits and harms of probiotics used for the prevention of AAD in an outpatient setting. […] The results suggest that probiotic use may be beneficial in the prevention of AAD among outpatients. Furthermore, the use of probiotics appears safe. […] The results of this review point towards a protective effect of the use of probiotics as adjunct therapy to prevent antibiotic-associated diarrhea in outpatients of all ages. Data from 17 studies with a total of 3631 patients found that the use of a probiotic may reduce the risk of AAD by 51% (RR 0.49; 95% CI 0.36 to 0.66; I2 = 58%), with no apparent increase in the risk of side effects (RD 0.00, 95% CI -0.02 to 0.02, 2.363 participants). […] The quality of evidence for the main outcome was categorized as moderate due to a moderate degree of heterogeneity and a high risk of bias in some trials.
#31 Probiotics in the prevention of antibiotic-associated diarrhoea and Clostridium difficile infection
https://pmc.ncbi.nlm.nih.gov/articles/PMC3105609/
The strongest evidence is for S. boulardii and L. rhamnosus GG because these have been used in most studies. […] The latest meta-analysis of 10 randomized control trials testing the efficacy of S. boulardii in preventing AAD shows an overall, pooled relative risk of 0.47. […] It can be concluded from these results that several bacterial strains and one yeast have the potential to prevent AAD. […] The evidence for prevention and treatment of CDAD is currently equivocal. […] The data for C. difficile infection is less robust with fewer trials conducted and most being underpowered. […] Further large, well powered studies with rigorous methodology are required for each specific bacterial strain or mixture with promising preliminary data. […] The risk of using a probiotic should be carefully weighed against the benefits it may provide in avoiding these serious and unpleasant side effects.
#32 Probiotics in the prevention of antibiotic-associated diarrhoea and Clostridium difficile infection
https://pmc.ncbi.nlm.nih.gov/articles/PMC3105609/
The strongest evidence is for S. boulardii and L. rhamnosus GG because these have been used in most studies. […] The latest meta-analysis of 10 randomized control trials testing the efficacy of S. boulardii in preventing AAD shows an overall, pooled relative risk of 0.47. […] It can be concluded from these results that several bacterial strains and one yeast have the potential to prevent AAD. […] The evidence for prevention and treatment of CDAD is currently equivocal. […] The data for C. difficile infection is less robust with fewer trials conducted and most being underpowered. […] Further large, well powered studies with rigorous methodology are required for each specific bacterial strain or mixture with promising preliminary data. […] The risk of using a probiotic should be carefully weighed against the benefits it may provide in avoiding these serious and unpleasant side effects.
#33 Probiotics in the prevention of antibiotic-associated diarrhoea and Clostridium difficile infection
https://pmc.ncbi.nlm.nih.gov/articles/PMC3105609/
The strongest evidence is for S. boulardii and L. rhamnosus GG because these have been used in most studies. […] The latest meta-analysis of 10 randomized control trials testing the efficacy of S. boulardii in preventing AAD shows an overall, pooled relative risk of 0.47. […] It can be concluded from these results that several bacterial strains and one yeast have the potential to prevent AAD. […] The evidence for prevention and treatment of CDAD is currently equivocal. […] The data for C. difficile infection is less robust with fewer trials conducted and most being underpowered. […] Further large, well powered studies with rigorous methodology are required for each specific bacterial strain or mixture with promising preliminary data. […] The risk of using a probiotic should be carefully weighed against the benefits it may provide in avoiding these serious and unpleasant side effects.
#34 Probiotics in the prevention of antibiotic-associated diarrhoea and Clostridium difficile infection
https://pmc.ncbi.nlm.nih.gov/articles/PMC3105609/
The strongest evidence is for S. boulardii and L. rhamnosus GG because these have been used in most studies. […] The latest meta-analysis of 10 randomized control trials testing the efficacy of S. boulardii in preventing AAD shows an overall, pooled relative risk of 0.47. […] It can be concluded from these results that several bacterial strains and one yeast have the potential to prevent AAD. […] The evidence for prevention and treatment of CDAD is currently equivocal. […] The data for C. difficile infection is less robust with fewer trials conducted and most being underpowered. […] Further large, well powered studies with rigorous methodology are required for each specific bacterial strain or mixture with promising preliminary data. […] The risk of using a probiotic should be carefully weighed against the benefits it may provide in avoiding these serious and unpleasant side effects.
#35 Probiotics in the prevention of antibiotic-associated diarrhoea and Clostridium difficile infection
https://pmc.ncbi.nlm.nih.gov/articles/PMC3105609/
The strongest evidence is for S. boulardii and L. rhamnosus GG because these have been used in most studies. […] The latest meta-analysis of 10 randomized control trials testing the efficacy of S. boulardii in preventing AAD shows an overall, pooled relative risk of 0.47. […] It can be concluded from these results that several bacterial strains and one yeast have the potential to prevent AAD. […] The evidence for prevention and treatment of CDAD is currently equivocal. […] The data for C. difficile infection is less robust with fewer trials conducted and most being underpowered. […] Further large, well powered studies with rigorous methodology are required for each specific bacterial strain or mixture with promising preliminary data. […] The risk of using a probiotic should be carefully weighed against the benefits it may provide in avoiding these serious and unpleasant side effects.
#36 Antibiotic-associated diarrhea: epidemiology, trends and treatment – PubMed
https://pubmed.ncbi.nlm.nih.gov/18811240/
A common complication of antibiotic use is the development of gastrointestinal disease. This complication ranges from mild diarrhea to pseudomembranous colitis. Outbreaks of antibiotic-associated diarrhea (AAD) may also occur in healthcare settings, usually caused by Clostridium difficile. AAD typically occurs in 5-35% of patients taking antibiotics and varies depending upon the specific type of antibiotic, the health of the host and exposure to pathogens. The pathogenesis of AAD may be mediated through the disruption of the normal microbiota resulting in pathogen overgrowth or metabolic imbalances. The key to addressing AAD is prompt diagnosis followed by effective treatment and institution of control measures. Areas of active research include the search for other etiologies and more effective treatments.
#37 Antibiotic-associated diarrhea: epidemiology, trends and treatment – PubMed
https://pubmed.ncbi.nlm.nih.gov/18811240/
A common complication of antibiotic use is the development of gastrointestinal disease. This complication ranges from mild diarrhea to pseudomembranous colitis. Outbreaks of antibiotic-associated diarrhea (AAD) may also occur in healthcare settings, usually caused by Clostridium difficile. AAD typically occurs in 5-35% of patients taking antibiotics and varies depending upon the specific type of antibiotic, the health of the host and exposure to pathogens. The pathogenesis of AAD may be mediated through the disruption of the normal microbiota resulting in pathogen overgrowth or metabolic imbalances. The key to addressing AAD is prompt diagnosis followed by effective treatment and institution of control measures. Areas of active research include the search for other etiologies and more effective treatments.
#38 Study sheds light on antibiotics-associated diarrhea | MIT News | Massachusetts Institute of Technology
https://news.mit.edu/2022/study-sheds-light-antibiotics-associated-diarrhea-0228
Results showed that Ruminococcaceae levels in the stools of study volunteers who developed diarrhea were significantly lower when compared to those who did not, both before and during treatment with amoxicillin-clavulanate. This suggests that individuals may, depending on their gut composition, be predisposed to antibiotic-associated diarrhea. […] Understanding this response and the ability to predict those at risk will help guide the development of point-of-care diagnostics, says Eric J. Alm, professor of biological engineering at MIT, principal investigator at SMART Antimicrobial Resistance (AMR) interdisciplinary research group, and co-corresponding author of the study. […] Our findings provide evidence that an individuals gut microbial composition can influence the risk of developing antibiotics-associated diarrhea.
#39 Study sheds light on antibiotics-associated diarrhea | MIT News | Massachusetts Institute of Technology
https://news.mit.edu/2022/study-sheds-light-antibiotics-associated-diarrhea-0228
Globally, one in three patients prescribed amoxicillin-clavulanate will develop diarrhea. […] The diarrhea could also prolong patients hospital stays, leading to an increased risk of other infections as a result. […] Building upon what is now known, the team now hopes to conduct a clinical trial to see if certain species of bacteria within the Ruminococcaceae family could be used as a probiotic to prevent diarrhea in patients receiving antibiotics.
#40 Antibiotic-Associated Diarrhea Beyond C. Difficile: A Scoping Review | Published in Journal of Brown Hospital Medicine
https://bhm.scholasticahq.com/article/39745-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. Currently fewer than 33% of AAD cases can be attributable to Clostridioides difficile leaving a large number of cases undiagnosed and poorly treated. AAD may range from mild, self-limiting illness to fulminant, pseudomembranous colitis that can be life threatening. The likely pathogenesis of AAD includes alteration of intestinal microbiota, direct drug toxicity on the gut and development of a superinfection by a pathogenic microbe. Identifying the etiology and understanding the pathogenesis of AAD will help in improving healthcare and in reducing the economic burden. Only 40% of AAD can be accounted for by the above causes leaving a majority of AAD cases without an etiology. The unique features of the current review were to summarize the existing data on AAD and provide concise descriptions of the pathogenesis of CDI as well as non-CDI AAD. Because a majority of the AAD cases are due to altered intestinal microbiota, modulating the microbiota, and adopting preventive strategies such as diet, prebiotics, probiotics, and drugs may be ultimately necessary to ensure optimal health and favorable outcomes in disease prone individuals.
#41 Antibiotic-Associated Diarrhea Beyond C. Difficile: A Scoping Review | Published in Journal of Brown Hospital Medicine
https://bhm.scholasticahq.com/article/39745-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. Currently fewer than 33% of AAD cases can be attributable to Clostridioides difficile leaving a large number of cases undiagnosed and poorly treated. AAD may range from mild, self-limiting illness to fulminant, pseudomembranous colitis that can be life threatening. The likely pathogenesis of AAD includes alteration of intestinal microbiota, direct drug toxicity on the gut and development of a superinfection by a pathogenic microbe. Identifying the etiology and understanding the pathogenesis of AAD will help in improving healthcare and in reducing the economic burden. Only 40% of AAD can be accounted for by the above causes leaving a majority of AAD cases without an etiology. The unique features of the current review were to summarize the existing data on AAD and provide concise descriptions of the pathogenesis of CDI as well as non-CDI AAD. Because a majority of the AAD cases are due to altered intestinal microbiota, modulating the microbiota, and adopting preventive strategies such as diet, prebiotics, probiotics, and drugs may be ultimately necessary to ensure optimal health and favorable outcomes in disease prone individuals.
#42 Antibiotic-associated diarrhea: epidemiology, trends and treatment – PubMed
https://pubmed.ncbi.nlm.nih.gov/18811240/
A common complication of antibiotic use is the development of gastrointestinal disease. This complication ranges from mild diarrhea to pseudomembranous colitis. Outbreaks of antibiotic-associated diarrhea (AAD) may also occur in healthcare settings, usually caused by Clostridium difficile. AAD typically occurs in 5-35% of patients taking antibiotics and varies depending upon the specific type of antibiotic, the health of the host and exposure to pathogens. The pathogenesis of AAD may be mediated through the disruption of the normal microbiota resulting in pathogen overgrowth or metabolic imbalances. The key to addressing AAD is prompt diagnosis followed by effective treatment and institution of control measures. Areas of active research include the search for other etiologies and more effective treatments.
#43 Probiotics in the prevention of antibiotic-associated diarrhoea and Clostridium difficile infection
https://pmc.ncbi.nlm.nih.gov/articles/PMC3105609/
Diarrhoea, as a common side effect of antibiotics, increases treatment costs and length of stay in acute healthcare facilities. […] AAD can occur up to 23 weeks following cessation of antibiotic therapy rather than during the treatment. […] It has also been shown that hospital patients are at greater risk of future infections and increased mortality. […] CDAD is responsible for around 10-20% of all cases of AAD. […] There are three key risk factors for the development of this infection; antibiotic use, increasing age, and hospitalization. […] CDAD has become and remains a serious problem for acute healthcare providers, leading to concerns around patient safety and increased medical treatment costs. […] A total of 75-80% of patients respond well to one of these treatments but 20-25% may develop recurrent CDAD.
#44 Interpretable machine learning models for predicting the incidence of antibiotic- associated diarrhea in elderly ICU patients | BMC Geriatrics | Full Text
https://bmcgeriatr.biomedcentral.com/articles/10.1186/s12877-024-05028-8
The occurrence of AAD in patients can extend the length of hospital stay, raise healthcare expenses, and potentially contribute to higher mortality. […] As a result, it is essential to prevent the occurrence of AAD and to identify and treat it as early as possible. […] The top 20 risk factors with the highest predictive value were enteral nutrition use, calcitoninogen, hemoglobin, lipase, platelets, C-reactive protein, albumin, age, propofol use, interleukin-6, serum phosphorus, vancomycin use, butorphanol use, linezolid use, SOFA score, white blood cell count, body mass index, fluconazole use, piperacillin sodium tazobactam sodium use, and remifentanil use. […] The best machine learning algorithm with good performance is selected. We hope that this model can aid physicians in early intervention and treatment, potentially reducing the length of ICU hospitalization and healthcare costs for elderly patients.
#45 Incidence and predictive biomarkers of Clostridioides difficile infection in hospitalized patients receiving broad-spectrum antibiotics | Nature Communications
https://www.nature.com/articles/s41467-021-22269-y
Here, we demonstrate that the 90-day incidence of CDI and antibiotic-associated diarrhea (AAD) in patients 50 years of age treated with predefined broad-spectrum antibiotic classes is 1.9% (95% CI: 1.1-3.0) and 14.1% (95% CI: 12.0-16.4), and that carbapenem treatment, toxigenic C. difficile carriage, and the composition and diversity of the gut microbiota predict CDI but not AAD. […] AAD could not be predicted reliably with any of the studied parameters. The involvement of different infectious and non-infectious causes of AAD may hamper accurate biomarker-based prediction of AAD. […] Although all evaluated antibiotic classes have been associated with CDI, in our study, only patients treated with carbapenems had a threefold increased risk of AAD and an almost fivefold increased risk of CDI within 90 days as compared to patients not receiving carbapenems at baseline. […] The incidence of AAD was increased threefold in subjects receiving carbapenems at baseline compared to patients not receiving carbapenems at baseline.
#46 Study sheds light on antibiotics-associated diarrhea | MIT News | Massachusetts Institute of Technology
https://news.mit.edu/2022/study-sheds-light-antibiotics-associated-diarrhea-0228
Results showed that Ruminococcaceae levels in the stools of study volunteers who developed diarrhea were significantly lower when compared to those who did not, both before and during treatment with amoxicillin-clavulanate. This suggests that individuals may, depending on their gut composition, be predisposed to antibiotic-associated diarrhea. […] Understanding this response and the ability to predict those at risk will help guide the development of point-of-care diagnostics, says Eric J. Alm, professor of biological engineering at MIT, principal investigator at SMART Antimicrobial Resistance (AMR) interdisciplinary research group, and co-corresponding author of the study. […] Our findings provide evidence that an individuals gut microbial composition can influence the risk of developing antibiotics-associated diarrhea.
#47 Interpretable machine learning models for predicting the incidence of antibiotic- associated diarrhea in elderly ICU patients | BMC Geriatrics | Full Text
https://bmcgeriatr.biomedcentral.com/articles/10.1186/s12877-024-05028-8
Antibiotic-associated diarrhea (AAD) can prolong hospitalization, increase medical costs, and even lead to higher mortality rates. Therefore, it is essential to predict the incidence of AAD in elderly intensive care unit(ICU) patients. […] The occurrence of AAD prolongs hospitalization, escalates medical expenses, and may even contribute to increased mortality. […] Early identification of patients at risk of AAD is critical and may facilitate timely prevention and intervention. […] The XGBoost model predicted the incidence of AAD with an area under the receiver operating characteristic curve (ROC) of 0.917, sensitivity of 0.889, specificity of 0.806, accuracy of 0.870, and an F1 score of 0.780. […] While the XGBoost model may not excel in absolute performance, it demonstrates superior predictive capabilities compared to other models in forecasting the incidence of AAD in elderly ICU patients categorized based on their characteristics.
#48 Interpretable machine learning models for predicting the incidence of antibiotic- associated diarrhea in elderly ICU patients | BMC Geriatrics | Full Text
https://bmcgeriatr.biomedcentral.com/articles/10.1186/s12877-024-05028-8
The occurrence of AAD in patients can extend the length of hospital stay, raise healthcare expenses, and potentially contribute to higher mortality. […] As a result, it is essential to prevent the occurrence of AAD and to identify and treat it as early as possible. […] The top 20 risk factors with the highest predictive value were enteral nutrition use, calcitoninogen, hemoglobin, lipase, platelets, C-reactive protein, albumin, age, propofol use, interleukin-6, serum phosphorus, vancomycin use, butorphanol use, linezolid use, SOFA score, white blood cell count, body mass index, fluconazole use, piperacillin sodium tazobactam sodium use, and remifentanil use. […] The best machine learning algorithm with good performance is selected. We hope that this model can aid physicians in early intervention and treatment, potentially reducing the length of ICU hospitalization and healthcare costs for elderly patients.
#49 Probiotics in the prevention of antibiotic-associated diarrhoea and Clostridium difficile infection
https://pmc.ncbi.nlm.nih.gov/articles/PMC3105609/
Diarrhoea, as a common side effect of antibiotics, increases treatment costs and length of stay in acute healthcare facilities. […] AAD can occur up to 23 weeks following cessation of antibiotic therapy rather than during the treatment. […] It has also been shown that hospital patients are at greater risk of future infections and increased mortality. […] CDAD is responsible for around 10-20% of all cases of AAD. […] There are three key risk factors for the development of this infection; antibiotic use, increasing age, and hospitalization. […] CDAD has become and remains a serious problem for acute healthcare providers, leading to concerns around patient safety and increased medical treatment costs. […] A total of 75-80% of patients respond well to one of these treatments but 20-25% may develop recurrent CDAD.