Clostridium difficile infection: a review of the literature (original) (raw)
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Diagnosis of Clostridium difficile infection in patients with hospital-acquired diarrhea
2018
Clostridium difficile infection (CDI) is a rapidly emerging infection that may have devastating consequences. Prompt and accurate diagnosis is crucial for management and control. The aim of this study was to determine the incidence of C. difficile associated diarrhea among hospitalized patients, and to compare different diagnostic laboratory methods for detection of toxin producing strains in clinical specimens. The study was conducted at a university hospital in Cairo during the period from May 2013 till June 2015. Subjects were under antibiotic therapy and presented with hospital-acquired diarrhea. Four hundred and sixty-five stool specimens were processed by different microbiological methods. C. difficile was recovered in culture in 51 of stool specimens. Of these, 86.3% to 98% were positive for toxin production by 2 different methods. This study showed that antibiotic intake is the major risk factor for development of hospital-acquired diarrhea. We evaluated different microbiological methods for diagnosis of C. difficile. We recommend the use of toxigenic culture as a gold standard for microbiological diagnosis of C. difficile.
Indian Journal of Gastroenterology, 2011
The spectrum of Clostridium difficile-associated diarrhea (CDAD) is changing. Apart from antibiotic use, other risk factors such as use of proton pump inhibitors (PPI) and immunosuppressive agents, intensive care unit (ICU) stay and inflammatory bowel disease are being recognized. We retrospectively analyzed data on patients whose stool samples were tested for C. difficile toxin (CDT) by enzyme linked immunosorbent assay between June 2006 and May 2008. Demographic and clinical data, and risk factors (antibiotic use, underlying malignancy, chemotherapy, use of PPI, ICU stay) were noted. The details of treatment for CDAD, response, complication and follow up were recorded. Patients whose stool samples were CDT-positive were grouped as study subjects and those with negative stool samples were included in the control group. Of the 99 patients (mean age 46.7 years; 58 men) whose stool samples were tested during this period, 17 (17%) were positive for CDT. As compared with control subjects (n=82), study subjects were more likely to have fever, prolonged ICU stay, underlying malignancy, and exposure to immunosuppressive and chemotherapeutic agents. On multivariate analysis, exposure to immunosuppressive agents was the only risk factor associated with CDAD. Fifteen patients were treated with metronidazole and two with vancomycin. Two patients did not respond to metronidazole but responded to vancomycin. No patient developed any complication. The prevalence of C. difficile toxin in diarrheal stools sent for C. difficile toxin testing was 17%. Exposure to immunosuppressive agents was a risk factor for the infection. Metronidazole was effective in a majority of patients.
Updates on the pathogenesis, epidemiology and diagnosis of Clostridium Difficile infection
Romanian Journal of Infectious Diseases, 2018
The infection with Clostridium difficile (CDI) is a cause of acute gastroenteritis (AGE), which is likely to severely develop into pseudomembranouse colitis (PMC), ileus and toxic megacolon. At the begining, CDI was considered a nosocomial infection, later proven to be communitary-acquired infections. The susceptibility for CDI is related to the alteration in intestinal microbiota after antibiotics or immunosuppressant treatments, postoperative disruption of mucosal barriers, trauma, tumour proliferation, ischemia or necrosis, as well as in other conditions caused by aging, alcoholism, diabetes, neoplasias, immunosuppression, angiopathies. Concern regarding the outbreak of new CDI-epidemics is still high, due to genetic and bacterial variability and spores resistance in outer environment. The diagnosis of CDI is a continuous challenge for clinicians, based on the correlation between clinical, epidemiological data and complex laboratory investigations.
The Indian journal of medical research, 2008
Frequent use of broad spectrum antibiotics in hospitalized patients has increased the incidence of Clostridium difficile diarrhoea in recent years. In our tertiary care hospital in north India, C. difficile was responsible for 15 per cent of cases of nosocomial diarrhoea in 1999. A retrospective study was carried out to determine the frequency of C. difficile associated diarrhoea (CdAD) in our hospital, and to assess the effect of awareness among the hospital personnel and control measures taken to present C. difficile infection following the previous report. A retrospective chart review of all suspected cases of CdAD diagnosed at the hospital from January 2001 to December 2005 was done. Clinical specimens comprised 524 stool samples. All the samples were analyzed for C. difficile using culture and ELISA for toxin A and B. Attempts were made to type isolates using antibiogram, SDS-PAGE, gas liquid chromatography (GLC), PCR for toxin A and B gene fragments and restriction fragment le...
Bali Medical Journal, 2022
Clostridium difficile is an anaerobic gram-positive bacillus, capable of forming spores and toxins, transmitted to humans by the faecal-oral route C. difficile infection (CDI) is recognized as a typical cause healthcare-associated infections (HAIs) and contributes to a significant proportion of morbidity and mortality of hospitalized patients. C. difficile culture and toxin examinations are still minimal in many hospitals in various Asian countries. As a result, reports of C. difficile in Asia are still rare, while reports of cases of CDI in Indonesia are still rare. Several risk factors including advanced age, antibiotic exposure, and hospitalization are strongly associated with CDI. C. difficile has the ability to colonize the large intestine, then release exotoxin proteins (TcdA, TcdB) causing colitis in people with risk factors. A diagnosis of suspected C. difficile infection in a patient with diarrhea without a clear alternative explanation, with relevant risk factors (including long antibiotic consumption, hospitalization events, and elderly age), was then performed microbiological examination to carry out proper management and control of infection. This study aims to review C. difficile virulence factors as the cause of antibiotic-associated diarrhea.
Inpatient diarrhoea and Clostridium difficile
Clinical Medicine, 2012
Risk factors in the development of C.difficile infection The most important risk factor for CDI is antibiotic use. Other predisposing factors include increasing age, prolonged length of stay in hospital prior to acquisition, comorbidities such as renal failure, use of proton pump inhibitors (PPIs), chemotherapy, immunosuppression, enteral feeds and inflammatory bowel disease (IBD). 12-14 Antibiotics Concurrent or recent antibiotic use is by far the biggest risk factor for developing CDI. Antibiotics alter gut bacterial flora, allowing C.difficile to flourish in the colon. The increased risk of CDI persists for up to three months after antibiotic use. 15 Of the stool samples examined by the CDRN in 2011, 70% were from patients with a history of antibiotic exposureindeed, 59% of patients had been exposed to more than one antibiotic. 2 Until recently, cephalosporins were the agents most strongly implicated in CDI but, with their more restricted prescribing, co-amoxiclav and piperacillin-tazobactam are now the antibiotics most commonly associated with CDI. 2 Pre-existing inflammatory bowel disease CDI is more common in patients with active IBD, particularly ulcerative colitis, and its outcome in IBD inpatients may be worse than in people without IBD. 16 Identified IBD-specific risk factors include immunosuppressants and antibiotics. Sigmoidoscopy (see below) rarely shows pseudomembranes and is unhelpful for diagnosing CDI in IBD. 16