Treatment of recurrent Clostridium difficile infection: a systematic review (original) (raw)
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A Review of Management of Clostridium difficile Infection: Primary and Recurrence
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Clostridium difficile infection (CDI) is a potentially fatal illness, especially in the elderly and hospitalized individuals. The recurrence and rates of CDI are increasing. In addition, some cases of CDI are refractory to the currently available antibiotics. The search for improved modalities for the management of primary and recurrent CDI is underway. This review discusses the current antibiotics, fecal microbiota transplantation (FMT) and other options such as immunotherapy and administration of non-toxigenic Clostridium difficile (CD) for the management of both primary and recurrent CDI.
Clostridium difficile Infection: New Insights Into Management
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Clostridium difficile was first described as a cause of diarrhea in 1978 and is now among the leading 3 hospital-acquired infections in the United States, along with methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci. In the past 2 decades, there has been an increase in the incidence, severity, and recurrence rates of C difficile infection, all of which are associated with poor outcomes. In addition, several novel risk factors and newer treatment methods are emerging, including fidaxomicin therapy, treatment using monoclonal antibodies, and fecal microbiota transplantation, that have shown promise for the treatment of C difficile infection. This review focuses on the changing epidemiology, risk factors, and newer methods for treatment of C difficile infection.
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Therapeutic Advances in Gastroenterology, 2013
Clostridium difficile was first described as a cause of diarrhea in 1978 and in the last three decades has reached an epidemic state with increasing incidence and severity in both healthcare and community settings. There also has been a rise in severe outcomes from C. difficile infection (CDI). There have been tremendous advancements in the field of CDI with the identification of newer risk factors, recognition of CDI in populations previously thought not at risk and development of better diagnostic modalities. Several treatment options are available for CDI apart from metronidazole and vancomycin, and include new drugs such as fidaxomicin and other options such as fecal microbiota transplantation. This review discusses the epidemiology, risk factors and outcomes from CDI, and focuses primarily on existing and evolving treatment modalities.
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Human Vaccines & Immunotherapeutics, 2018
Clostridium difficile infection (CDI) is the most common infectious disease cause of nosocomial diarrhea in adults in developed countries. Judging from the clinical trials on drugs used in CDIs, no approved treatment for recurrences exists, possibly indicating that a combination of treatment approaches are mandatory especially in severe infections, with current studies not being fully representative. Among the new strategies researched intensively fidaxomicin is presented, which demonstrates reduced CDI recurrences. Moreover, biotherapeutic strategies, mainly fecal microbiota transplantation but also competitive inhibition with non-toxigenic strains of C. difficile, and finally monoclonal antibodies against C. difficile toxins which offer protection against recurrences. Careful interpretation of the results based on lessons learned from previous trials conducted seems crucial. Questions are raised regarding how the results of future studies regarding new strategies researched will be managed and interpreted especially with regard to recurrence management as relevant data must be monitored for at least 30 days after end of treatment.
Clostridium difficile Infection and Fecal Bacteriotherapy
Gastroenterology Nursing, 2013
Clostridium difficile, also called "C. diff," is a gram-positive bacillus associated with nosocomial infections involving diarrhea, most often seen in developing countries. The severity of C. diff-associated diarrhea varies tremendously from mild and self-limiting to fulminant and life-threatening. C. diff has become an extremely important pathogen in community health but can be minimized with attention to proper hygiene. This article presents a case study regarding the treatment and management options of C. diff infection using a recent update of clinical guidelines for patient management.
Clostridium difficile: A Growing Health Concern
Journal of Advanced Scientific Research, 2019
Clostridium difficile is a potent nosocomial pathogen being one of the major causes of Antibiotic Associated Diarrhea. Excessive utilization of broad spectrum antibiotics destabilizes the gut microflora and compromises immunity thereby facilitating the growth and proliferation of this bacterium culminating in the disease. Infection is usually transmitted through transfer of spores via the fecal oral route. Toxin A and B are the predominant toxins responsible for the disease that disseminate intestinal barrier and initiate Rho GTPases activated Interleukin mediated inflammatory pathway. Improper sanitary conditions, contaminated food, animal manure and unclean medical setups are the primary sources of infection. This microorganism is generally diagnosed on taurocholate enrichment agar in combination with advanced techniques including Real Time PCR, enzyme immunoassays and restriction endonuclease analysis. Although Vancomycin and Metronidazole are the first lines of treatment, their efficacy has been found to be compromised mainly because of emergence of novel strains with increased virulence as well as resistance. New drugs including Fidaxomicin and Ribaxamase and advanced techniques like Fecal Microbiota Transplantation are now often used in combination with the former in order to curtail the above. Microbial replacement and utilization of outer membrane of the pathogen are recent breakthroughs towards containment of the disease. Since Clostridium difficile has now become one of the major health concerns, knowledge of pathogenesis, minimization of risk factor and development of alternative therapeutics may reduce the negative health consequences inferred by this infectious pathogen.
Clostridium difficile Infection: Epidemiology, Pathogenesis, Risk Factors, and Therapeutic Options
Scientifica, 2014
The incidence and mortality rate ofClostridium difficileinfection have increased remarkably in both hospital and community settings during the last two decades. The growth of infection may be caused by multiple factors including inappropriate antibiotic usage, poor standards of environmental cleanliness, changes in infection control practices, large outbreaks ofC. difficileinfection in hospitals, alteration of circulating strains ofC. difficile, and spread of hypervirulent strains. Detection of high-risk populations could be helpful for prompt diagnosis and consequent treatment of patients suffering fromC. difficileinfection. Metronidazole and oral vancomycin are recommended antibiotics for the treatment of initial infection. Current treatments forC. difficileinfection consist of supportive care, discontinuing the unnecessary antibiotic, and specific antimicrobial therapy. Moreover, novel approaches include fidaxomicin therapy, monoclonal antibodies, and fecal microbiota transplanta...
Scandinavian Journal of Infectious Diseases, 2014
Background: Recurrent Clostridium diffi cile infection (CDI) is a signifi cant problem due to its increased incidence and severity. Failure rates for standard antibiotic therapies are high. In our hospital, faecal microbiota transplantation (FMT), or instillation of a culture mixture of known enteric bacteria in saline as rectal bacteriotherapy (RBT), has long been used as ' rescue therapy ' in patients with recurrent disease, in whom repeated courses of standard antibiotic treatment have failed. We wanted to evaluate the effectiveness of FMT and RBT for recurrent CDI. Methods: The records of 31 patients treated with either FMT or RBT for recurrent CDI were reviewed retrospectively. FMT was based on faecal donation by a close relative and RBT on a defi ned saline mixture of 10 individually cultured enteric bacterial strains originally isolated from healthy persons. Both types of instillation were carried out through a rectal catheter. FMT (500 ml) was given as 1 installation. RBT (200 ml) was given as 2 or 3 installations with an interval of 2 days between courses. Treatment success was defi ned as a sustained loss of symptoms and discontinuation of diarrhoea within 3 days. Results: Of 31 patients, 23 (74%) responded successfully to the treatment: 16 of 23 (70%) receiving FMT and 7 of 8 (88%) receiving RBT. Conclusion: We found FMT to be effective in patients with recurrent CDI. RBT based on a predefi ned bacterial suspension was as effective as or better than FMT based on faecal donation; however, multiple installations may be needed.