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European Journal of Clinical... Jul 2019Clostridium difficile (C. difficile) is a Gram-positive, spore-forming, anaerobic bacillus, which is widely distributed in the intestinal tract of humans and animals and... (Review)
Review
Clostridium difficile (C. difficile) is a Gram-positive, spore-forming, anaerobic bacillus, which is widely distributed in the intestinal tract of humans and animals and in the environment. In the last decade, the frequency and severity of C. difficile infection has been increasing worldwide to become one of the most common hospital-acquired infections. Transmission of this pathogen occurs by the fecal-oral route and the most important risk factors include antibiotic therapy, old age, and hospital or nursing home stay. The clinical picture is diverse and ranges from asymptomatic carrier status, through various degrees of diarrhea, to the most severe, life threatening colitis resulting with death. Diagnosis is based on direct detection of C. difficile toxins in feces, most commonly with the use of EIA assay, but no single test is suitable as a stand-alone test confirming CDI. Antibiotics of choice are vancomycin, fidaxomicin, and metronidazole, though metronidazole is considered as inferior. The goal of this review is to update physicians on current scientific knowledge of C. difficile infection, focusing also on fecal microbiota transplantation which is a promising therapy.
Topics: Anti-Bacterial Agents; Clostridioides difficile; Clostridium Infections; Colitis; Cross Infection; Diarrhea; Disease Reservoirs; Fecal Microbiota Transplantation; Feces; Humans; Risk Factors; Virulence
PubMed: 30945014
DOI: 10.1007/s10096-019-03539-6 -
Gut and Liver Jan 2014Clostridium difficile, an anaerobic toxigenic bacterium, causes a severe infectious colitis that leads to significant morbidity and mortality worldwide. Both enhanced... (Review)
Review
Clostridium difficile, an anaerobic toxigenic bacterium, causes a severe infectious colitis that leads to significant morbidity and mortality worldwide. Both enhanced bacterial toxins and diminished host immune response contribute to symptomatic disease. C. difficile has been a well-established pathogen in North America and Europe for decades, but is just emerging in Asia. This article reviews the epidemiology, microbiology, pathophysiology, and clinical management of C. difficile. Prompt recognition of C. difficile is necessary to implement appropriate infection control practices.
Topics: Asia; Clostridioides difficile; Clostridium Infections; Europe; Global Health; Humans; North America
PubMed: 24516694
DOI: 10.5009/gnl.2014.8.1.1 -
Gut and Liver Jan 2019The most common cause of antibiotic-associated diarrhea is infection (CDI). Recurrent infection (rCDI) often occurs after successful treatment of CDI. Due to the... (Review)
Review
The most common cause of antibiotic-associated diarrhea is infection (CDI). Recurrent infection (rCDI) often occurs after successful treatment of CDI. Due to the increased incidence and the difficulty in treating rCDI, it is becoming an important clinical issue. Identifying risk factors is helpful for early detection, treatment, and prevention of rCDI. Advanced age, use of antibiotics, gastric acid suppression, and infection with a hypervirulent strain are currently regarded as the major risk factors for rCDI. Several treatment modalities, including vancomycin, fidaxomicin, and fecal microbiota transplant (FMT), are suggested for rCDI treatment. However, there is currently no definitive treatment method with sufficient evidence for rCDI. Recent studies have focused on FMT and have shown positive results for rCDI. Prevention of rCDI by measures such as hand washing and isolation of patients is very important. However, these preventive measures are often overlooked in clinical practice. Here, we review the risk factors, treatment, and prevention of rCDI.
Topics: Anti-Bacterial Agents; Clostridioides difficile; Clostridium Infections; Enterocolitis, Pseudomembranous; Fecal Microbiota Transplantation; Humans; Recurrence; Risk Factors; Secondary Prevention
PubMed: 30400734
DOI: 10.5009/gnl18071 -
Clinical Medicine (London, England) Jun 2018Antibiotic-associated diarrhoea is among the most common adverse events related to antibiotic use. Most cases are mild, but infection causes a spectrum of disease,... (Review)
Review
Antibiotic-associated diarrhoea is among the most common adverse events related to antibiotic use. Most cases are mild, but infection causes a spectrum of disease, ranging from occasional diarrhoea to colitis, toxic megacolon, and potentially death. Recent developments in our understanding of the biology of the gut microbiota have provided new insights into the pathogenesis of these conditions, and have revealed a role for manipulation of the gut microbiota as a novel therapeutic approach. This review will give an overview of the assessment of these conditions, before focusing on the rapidly developing area of their treatment.
Topics: Anti-Bacterial Agents; Clostridioides difficile; Clostridium Infections; Diarrhea; Enterocolitis, Pseudomembranous; Fecal Microbiota Transplantation; Fidaxomicin; Humans; Metronidazole; Probiotics; Vancomycin
PubMed: 29858434
DOI: 10.7861/clinmedicine.18-3-237 -
Annals of Internal Medicine Oct 2018Clostridioides difficile (formerly Clostridium difficile) infection is the most frequently identified health care-associated infection in the United States. C difficile... (Review)
Review
Clostridioides difficile (formerly Clostridium difficile) infection is the most frequently identified health care-associated infection in the United States. C difficile has also emerged as a cause of community-associated diarrhea, resulting in increased incidence of community-associated infection. Clinical illness ranges in severity from mild diarrhea to fulminant colitis and death. Appropriate management of infection requires understanding of the various diagnostic assays and therapeutic options as well as relevant measures to infection prevention. This article provides updated recommendations regarding the prevention, diagnosis, and treatment of incident and recurrent C difficile infection.
Topics: Anti-Bacterial Agents; Clostridioides difficile; Clostridium Infections; Gastrointestinal Microbiome; Humans
PubMed: 30285209
DOI: 10.7326/AITC201810020 -
Clinical Microbiology Reviews Apr 2018is the main causative agent of antibiotic-associated and health care-associated infective diarrhea. Recently, there has been growing interest in alternative sources of... (Review)
Review
is the main causative agent of antibiotic-associated and health care-associated infective diarrhea. Recently, there has been growing interest in alternative sources of other than patients with infection (CDI) and the hospital environment. Notably, the role of -colonized patients as a possible source of transmission has received attention. In this review, we present a comprehensive overview of the current understanding of colonization. Findings from gut microbiota studies yield more insights into determinants that are important for acquiring or resisting colonization and progression to CDI. In discussions on the prevalence of colonization among populations and its associated risk factors, colonized patients at hospital admission merit more attention, as findings from the literature have pointed to their role in both health care-associated transmission of and a higher risk of progression to CDI once admitted. colonization among patients at admission may have clinical implications, although further research is needed to identify if interventions are beneficial for preventing transmission or overcoming progression to CDI.
Topics: Clostridioides difficile; Clostridium Infections; Cross Infection; Gastrointestinal Tract; Humans; Risk Factors
PubMed: 29540433
DOI: 10.1128/CMR.00021-17 -
Nature Reviews. Gastroenterology &... Apr 2016Clostridium difficile infection (CDI) continues to affect patients in hospitals and communities worldwide. The spectrum of clinical disease ranges from mild diarrhoea to... (Review)
Review
Clostridium difficile infection (CDI) continues to affect patients in hospitals and communities worldwide. The spectrum of clinical disease ranges from mild diarrhoea to toxic megacolon, colonic perforation and death. However, this bacterium might also be carried asymptomatically in the gut, potentially leading to 'silent' onward transmission. Modern technologies, such as whole-genome sequencing and multi-locus variable-number tandem-repeat analysis, are helping to track C. difficile transmission across health-care facilities, countries and continents, offering the potential to illuminate previously under-recognized sources of infection. These typing strategies have also demonstrated heterogeneity in terms of CDI incidence and strain types reflecting different stages of epidemic spread. However, comparison of CDI epidemiology, particularly between countries, is challenging due to wide-ranging approaches to sampling and testing. Diagnostic strategies for C. difficile are complicated both by the wide range of bacterial targets and tests available and the need to differentiate between toxin-producing and non-toxigenic strains. Multistep diagnostic algorithms have been recommended to improve sensitivity and specificity. In this Review, we describe the latest advances in the understanding of C. difficile epidemiology, transmission and diagnosis, and discuss the effect of these developments on the clinical management of CDI.
Topics: Bacterial Typing Techniques; Clostridioides difficile; Clostridium Infections; Community-Acquired Infections; Cross Infection; Global Health; Humans
PubMed: 26956066
DOI: 10.1038/nrgastro.2016.25 -
FEMS Microbiology Reviews Nov 2017Clostridium difficile is a bacterial pathogen that is the leading cause of nosocomial antibiotic-associated diarrhea and pseudomembranous colitis worldwide. The... (Review)
Review
Clostridium difficile is a bacterial pathogen that is the leading cause of nosocomial antibiotic-associated diarrhea and pseudomembranous colitis worldwide. The incidence, severity, mortality and healthcare costs associated with C. difficile infection (CDI) are rising, making C. difficile a major threat to public health. Traditional treatments for CDI involve use of antibiotics such as metronidazole and vancomycin, but disease recurrence occurs in about 30% of patients, highlighting the need for new therapies. The pathogenesis of C. difficile is primarily mediated by the actions of two large clostridial glucosylating toxins, toxin A (TcdA) and toxin B (TcdB). Some strains produce a third toxin, the binary toxin C. difficile transferase, which can also contribute to C. difficile virulence and disease. These toxins act on the colonic epithelium and immune cells and induce a complex cascade of cellular events that result in fluid secretion, inflammation and tissue damage, which are the hallmark features of the disease. In this review, we summarize our current understanding of the structure and mechanism of action of the C. difficile toxins and their role in disease.
Topics: Bacterial Toxins; Clostridioides difficile; Clostridium Infections; Humans; Immunity; Intestinal Mucosa
PubMed: 29048477
DOI: 10.1093/femsre/fux048 -
AACN Advanced Critical Care Jul 2016Clostridium difficile infection (CDI) is a major source of morbidity and mortality for hospitalized patients. Although most patients have a clinical response to existing... (Review)
Review
Clostridium difficile infection (CDI) is a major source of morbidity and mortality for hospitalized patients. Although most patients have a clinical response to existing antimicrobial therapies, recurrent infection develops in up to 30% of patients. Fecal microbiota transplant is a novel approach to this complex problem, with an efficacy rate of nearly 90% in the setting of multiple recurrent CDI. This review covers the current epidemiology of CDI (including toxigenic and nontoxigenic strains, risk factors for infection, and recurrent infection), methods of diagnosis, existing first-line therapies in CDI, the role of fecal microbiota transplant for multiple recurrent CDIs, and the potential use of fecal microbial transplant for patients with severe or refractory infection.
Topics: Adult; Aged; Aged, 80 and over; Clostridioides difficile; Clostridium Infections; Education, Medical, Continuing; Fecal Microbiota Transplantation; Feces; Female; Humans; Male; Microbiota; Middle Aged; Risk Factors; Treatment Outcome; United States
PubMed: 27959316
DOI: 10.4037/aacnacc2016703 -
Frontiers in Cellular and Infection... 2022
Topics: Asia; Clostridioides difficile; Clostridium Infections; Enterocolitis, Pseudomembranous; Humans
PubMed: 35959370
DOI: 10.3389/fcimb.2022.983563