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COVID-19 and Clostridioides difficile Infections – Clinical Challenges

Authors:
  • CALISIA UNIVERSITY-KALISZ, POLAND
  • Calisia University - Kalisz

Abstract

Treatment of COVID-19 patients is frequently involving broad-spectrum antibiotic therapy. We are reporting a case study of a COVID-19 patient treated with a broad spectrum antibiotic resulting in the unleashing of a number of multi-drug resistant bacteria with fatal outcome.
COVID-19 and Clostridioides
dicile Infections – Clinical
Challenges

 !"#"$
%&'()'*+,-./+-.0'()'-11/1(22-'2-&-'
-3+'2-1()-+45,/-1,-
+4//+1/6-'/&
+4/7(4+18
,/-1/9,&23(/2(4%-'"$/+-. $
Prof. Dr. Jacek Piątek
,/-1/9,&23(/2(4%-'"$/+-.
What Topics Will Be Covered In This Session?
:Our learnings
!Our Case Study: Unleashing CDI in a COVID-19 patient
Broad-spectrum antibiotic therapy as part of COVID-19 management
Gut microbiome alterations in COVID-19 patients
$Microbiota Research Group at the Calisia Univeristy in Kalisz, PL
,/-1/9,&23(/2(4%-'"$/+-.
What Topics Will Be Covered In This Session?
:Our learnings
!Our Case Study: Unleashing CDI in a COVID-19 patient
Broad-spectrum antibiotic therapy as part of COVID-19 management
Gut microbiome alterations in COVID-19 patients
$Microbiota Research Group at the Calisia Univeristy in Kalisz, PL
!,/-1/9,&23(/2(4%-'"$/+-.
Microbiota Research Group
Our Focus Areas
Persistent
Salmonella
typhimurium
Infections
Infantile
Colic
Klebsiella
pneumoniae
Infections
C. difficile
Infections
Probiotics
&
Synbiotics
Kalisz, Poland
:
https://mrg.akademia.kalisz.pl
C. difficile – Research Program
;
C. difficile
Diarrhea in
nursing
homes
Future
Research
In-vitro
pathogen
inhibition
Clinical
Research
done
ongoing
planned
Status
C. difficile
a challenge
for dentists
Survey
Preclinical
Research
,/-1/9,&23(/2(4%-'"$/+-.
Infantile Colic – Research Program
<
Infantile
Colic
Survey
Pediatricians
(D/PL)
Preclinical
Study
(In-vitro
Pathogen
Inhibition)
Clinical
Study I
Crying
Simethicone
vs. Synbiotic
Clinical
Study II
Gut-
inflammation
Simethicone
vs. Synbiotic
Work in
progress
done
ongoing
planned
Status
,/-1/9,&23(/2(4%-'"$/+-.
Microbiota Research Group
Publications 2018-2021
#
Microbiota Research Group
Authors
=
J. Piatek
A. Lipski
D. Wultanska
M. Pszczola
M. Wojciechowska
H. Sommermeyer
M. Bernatek
A. Ciechelska-Rybarczyk
B. Oleskow
L.S. Mikkelsen
K.B. Barken
Z. Chęcińska-Maciejewska P. KaczmarekH. Krauss
H.M. Pituch
P. Wojtyla-Buciora P. Maciukajc
,/-1/9,&23(/2(4%-'"$/+-.
What Topics Will Be Covered In This Session?
:Our learnings
!Our Case Study: Unleashing CDI in a COVID-19 patient
Broad-spectrum antibiotic therapy as part of COVID-19 management
Gut microbiome alterations in COVID-19 patients
$Microbiota Research Group at the Calisia Univeristy in Kalisz, PL
$",/-1/9,&23(/2(4%-'"$/+-.
Gut Microbiome Alterations in COVID-19 Patients
The gut inflammation marker calprotectin
is elevated in COVID-19 patients with diarrhea
Depletion of symbionts and dysbiosis persist
even after clearance of SARS-CoV-2
Persistant dysbiosis
Gut inflammation in COVID-
19 patients
Enrichment of opportunistic pathogens
Depletion of beneficial commensales
Significant alterations of
microbiome composition
$$
Up to 20% of patients with COVID-19
have GI-symptoms
GI-symptoms in COVID-19
patients
The gut is an extra-pulmonary site for
virus replication and activity
SARS-CoV-2 replication in
the gut
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Drivers of Dysbiosis in COVID-19 Patients
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gut
lumen
epithelium
opportunistic
pathogens
Direct effects
of SARS-CoV-2
Indirect effects
by broad-spectrum
antibiotic therapy
1 2
What Topics Will Be Covered In This Session?
:Our learnings
!Our Case Study: Unleashing CDI in a COVID-19 patient
Broad-spectrum antibiotic therapy as part of COVID-19 management
Gut microbiome alterations in COVID-19 patients
$Microbiota Research Group at the Calisia Univeristy in Kalisz, PL
$,/-1/9,&23(/2(4%-'"$/+-.
Antibiotic Therapy as Part of COVID-19 Management
Broad-spectrum, high potency antibiotics are
frequently used as part of COVID-19
treatment, especially for hospitalized
patients
2
2
The role of antibiotics in COVID-19
management is still not adequately defined
(status 04/2021)
1
1
For critical ill patients with uncertain risk of a
potential bacterial superinfection directed
and emperical antibiotic therapy is
recommended
$!
Physicians Treating COVID-19 Patients with Broad Spectrum
Antibiotics Should Keep in Mind…
… the COVID-19 patient might be a (symptomatic or
asymptomatic) carrier of a multi-drug resistant bacterial
pathogen at the time antibiotic therapy is initiated
1
…antibiotic therapy can result in the loss of colonization
resistance, resulting in overgrowth of the gut by a bacterial
pathogen, followed by disease manifestation
2
$:,/-1/9,&23(/2(4%-'"$/+-.
Recommendation of China‘s National Health Commission
(April 2020)
Treatment of COVID-19 patients should avoid the
unselective and inappropriate
use of antibiotics,
especially the use of broad-spectrum antibiotics
$;,/-1/9,&23(/2(4%-'"$/+-.
What Topics Will Be Covered In This Session?
:Our learnings
!Our Case Study: Unleashing CDI in a COVID-19 patient
Broad-spectrum antibiotic therapy as part of COVID-19 management
Gut microbiome alterations in COVID-19 patients
$Microbiota Research Group at the Calisia Univeristy in Kalisz, PL
$<,/-1/9,&23(/2(4%-'"$/+-.
Our Case Study: First Admission to Hospital in Jarocin
$#
First admission
District Hospital
Jarocin
Patient characteristics:
<!&-+')-2+4-
Reason for admission:
,-'-1+4)+/4'--6-'--3/+'/,3+/14(()
+33-/-+18%(8&>-/5
Diagnostics:
Routine laboratory tests
-2(4(%/1?=#284
'-+/1/1-?<$284
&3-'.+4-2/+?<!22(44
COVID-19 test
 (@ 1-+/6-
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Our Case Study: COVID-19 Infection and Transfer to Poznan
Hospital
$=
COVID-19 infection
District Hospital
Jarocin
Events
18+&$;()5(3/+4+&
3+/-1>+--83(//6-
)(' (@ 
(&23(2()3+/-1
>+'-3/'+('&-A,/-1
+/-1'+1)-''-8(
4/3-,/+ 4/(3/+4/1
(71+1B++18+'8
3'(,-8'-+5-/2-C
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COVID-19 Treatment
Multispecialist Hospital
Poznan
Our Case Study: First Admission to Hospital in Jarocin
"
Multispecialist Hospital
Poznan
Admission to Poznan hospital:
+/-1D-'-8)'(28/+''5-+,(1/8-'-8(%-
'-4+-8(@ $=/1)-,/(1
Treatment:
82/1/'+/(1B+2(1(5-'2-8/,+/(1C()5-
%'(+8 3-,'2+1/%/(/,,-)'/+E(1-$B%/8/6C
8/+''5-+3-'/-8+82/1/'+/(1()3'(%/(/,B
'5+21(C+8+&() 5-'+3&>/5(
%-1-9,/+4-D-,
18+&!() 5-'+3&,(19'2+/(1())-,+4
8/A,/4-(E/1
'-+2-1/1//+-8>/52-'(1/8+7(4-:""2
B/83(C8-(4+,.()/23'(6-2-16+1,(2&,/1
$:2BF/83(C>++88-8)(44(>-8%&
'-+2-1>/56+1,(2&,/1(14&)('$8+&
Discharge from hospital:
-1-'+4,(18//(1()5-3+/-1/23'(6-85-
>+'-4-+-8+)-'$=8+&/15-(71+15(3/+4
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Our Case Study: Second Admission to Hospital in Jarocin
$
Second admission
District Hospital
Jarocin
)-'"8+&+5(2-3+/-1>+'- +82/-8(5-
5(3/+48-(8/+''5-++18+%8(2/1+43+/1
Diagnostics:
'--1,-()8/A,/4-(E/1,(19'2-8/1((4
+234-
Treatment:
'-+2-1()>/56+1,(2&,/1:"2BF/8
3(C+182-'(1/8+7(4-:""2B/8/6C
(/23'(62--1()3+/-1G,(18//(1
Diagnostics:
4'-()3+5(4(/,+4%+,-'/+)'(2((4+234-
'-6-+4-83'--1,-() 3'(8,/1
31-2(1/+-6+1,(2&,/1 '-/+1)+-,/2
8/A,/4-,(481(%-,4/6+-8
Outcome
-3/-/1-1/6-'-+2-15-3+/1G,(18//(1
8--'/('+-8+185-8/-8$#8+&+)-'5-'-,(18
+82//(1(5-(3/+4/1*+'(,/1
,/-1/9,&23(/2(4%-'"$/+-.
Case Study - Chain of Events Leading to the Death of the Patient
,/-1/9,&23(/2(4%-'"$/+-.
Our publication is availalbe as open access
http://www.anncaserep.com/open-access/can-treatment-
of-covid-19-patients-with-broad-spectrum-antibiotics-
unleash-multi-drug-6803.pdf
,/-1/9,&23(/2(4%-'"$/+-.
What Topics Will Be Covered In This Session?
:Our learnings
!Our Case Study: Unleashing CDI in a COVID-19 patient
Broad-spectrum antibiotic therapy as part of COVID-19 management
Gut microbiome alterations in COVID-19 patients
$Microbiota Research Group at the Calisia Univeristy in Kalisz, PL
!,/-1/9,&23(/2(4%-'"$/+-.
Key Learnings
Broad-spectrum antibiotic therapy carries the risk of
destroying the colonization resistance provided by the gut
microbiota
1
A destroyed colonization resistance can result in
uncontrolled proliferation of bacterial pathogenis
2
Administration of products containing probiotic
microorganisms should be considered to counteract these
unwanted side effect of broad-spectrum antibiotic therapy
3
:,/-1/9,&23(/2(4%-'"$/+-.
Successful therapy with probiotic microorganisms, depends on…
…early therapy initiation
2
2
…appropriate product selection
1
1
…sufficient dosing and
length of administration
;,/-1/9,&23(/2(4%-'"$/+-.
E-mail: drpiatek@interia.eu
Questions, Comments & Suggestions
<,/-1/9,&23(/2(4%-'"$/+-.
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