Clostridium difficile Infection: Epidemiology, Pathogenesis, Risk Factors, and Therapeutic Options (original) (raw)
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Clostridium difficile infection: management strategies for a difficult disease
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.
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.
Current Trends in the Epidemiology and Outcomes of Clostridium difficile Infection
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2015
Clostridium difficile is the most frequently identified cause of nosocomial diarrhea and has been associated with epidemics of diarrhea in hospitals and long-term care facilities. The continued increase in C. difficile infection (CDI) suggests that it has surpassed other pathogens in causing healthcare-associated infections. The Centers for Disease Control and Prevention recently identified CDI as an "urgent threat" in its recent report on antibiotic resistance threats in the United States, highlighting the need for urgent and aggressive action to prevent this infection. The impact of antibiotics as a risk factor for new-onset CDI is well established; however, recognizing classes of antibiotics with the highest risks and reducing unnecessary antibiotic use are important strategies for prevention of CDI and subsequent recurrence. In addition, the recognition of the community as an important setting for onset of CDI presents a challenge and is an area for future research.
Clinical and Epidemiological Aspects of Clostridium difficile
Clinical Microbiology Newsletter, 2008
Clostridium difficile-associated disease (CDAD) has increased in frequency and severity throughout North America and Europe over the last 5 years, largely due to the emergence of the NAP1 epidemic strain. This transformation of a formerly mild disease into one that can cause severe morbidity and mortality within a few days has challenged our entire approach to this serious infection. Institutions require accurate and rapid diagnostics for early detection of cases and possible outbreaks in order to initiate specific therapy and implement effective infection control. The optimal hand hygiene techniques, barrier methods and environmental cleaning practices that would diminish transmission remain uncertain. Clinicians need reliable research that can pinpoint the most important factors determining severity of disease and relapse. Epidemiologic and molecular analyses are vital in order to understand the local and international transmission of this disease, as well as its recent change in pathogenicity. As well, further examination of this infection is crucial in order to find effective prophylactic maneuvers and optimal therapies. This review discusses the changing epidemiology of CDAD across North America and internationally, as well as the common diagnostic methods and molecular typing tools for this pathogen. Finally, the current evidence supporting conventional, novel, and non-antimicrobial preventative and therapeutic options is examined.
Infection Control & Hospital Epidemiology, 2010
Since publication of the Society for Healthcare Epidemiology of America position paper onClostridium difficileinfection in 1995, significant changes have occurred in the epidemiology and treatment of this infection.C. difficileremains the most important cause of healthcare-associated diarrhea and is increasingly important as a community pathogen. A more virulent strain ofC. difficilehas been identified and has been responsible for more-severe cases of disease worldwide. Data reporting the decreased effectiveness of metronidazole in the treatment of severe disease have been published. Despite the increasing quantity of data available, areas of controversy still exist. This guideline updates recommendations regarding epidemiology, diagnosis, treatment, and infection control and environmental management.
Clostridium difficile Infection: New Insights Into Management
Mayo Clinic Proceedings, 2012
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.
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.
JAMA Network Open, 2020
Clostridium difficile (also known as Clostridioides difficile) infection (CDI) is one of the most common health care-associated (HCA) infections and is a significant cause of morbidity and mortality, especially among older adult hospitalized patients. Although the incidence of HCA CDI and its attributable hospital length of stay (LOS) have appeared to be increasing nationally in the United States, they are highly dependent on the frequency of epidemic or outbreak strains, which influence