Clinical update for the diagnosis and treatment ofClostridium difficileinfection

Abstract

Clostridium difficile infection (CDI) presents a rapidly evolving challenge in the battle against hospitalacquired infections. Recent advances in CDI diagnosis and management include rapid changes in diagnostic approach with the introduction of newer tests, such as detection of glutamate dehydrogenase in stool and polymerase chain reaction to detect the gene for toxin production, which will soon revolutionize the diagnostic approach to CDI. New medications and multiple medical society guidelines have introduced changing concepts in the definitions of severity of CDI and the choice of therapeutic agents, while rapid expansion of data on the efficacy of fecal microbiota transplantation heralds a revolutionary change in the management of patients suffering multiple relapses of CDI. Through a comprehensive review of current medical literature, this article aims to offer an intensive review of the current state of CDI diagnosis, discuss the strengths and limitations of available laboratory tests, compare both current and future treatments options and offer recommendations for best practice strategies.

Clostridium difficile colonization and antibiotics response in PolyFermS continuous model mimicking elderly intestinal fermentation

“…Our data demonstrate that application of antibiotic may not be required for CD spore germination and colonization of an in vitro continuous colonic fermentation model mimicking TDC conditions of an elderly microbiota. This is in contrast to in vivo data in humans and animal models suggesting that CD infection is promoted by a disturbed microbiota mainly due to antibiotic treatment [6, 33]. This discrepancy between in vitro and in vivo CD colonization may be a consequence of host-specific mechanisms, including the epithelial cell layer and immune responses, both of which are lacking in in vitro models.…”

“…The treatment recommendations for metronidazole during CDI range between 500 and 750 mg three times per day [6, 43] and it was suggested that 6–15% of the antibiotic metabolites are extracted in feces [44]. We chose to apply a metronidazole concentration higher than tested in feces in vivo to account for absorption and possible degradation of the antibiotic during colonic transit (see discussion section).…”

“…Treatment with broad-spectrum antibiotics, such as ampicillin, clindamycin and third-generation cephalosporins (ceftriaxone, cefotaxime and ceftazidime) are considered to be main risk factors for CDI [6]. The elderly population is especially at risk of developing CDI, with CD colonization rates of up to 73% in inpatients above 65 years [7].…”

Clostridium difficile infection

“…Immunocompromised patients, either from cancer chemotherapy or, especially, after transplantation, also were prone to develop CDI. Other risk factors include: preceding inflammatory bowel disease (IBD) and other comorbidities, advanced age, enteral feeding (especially post pyloric), prior gastrointestinal surgery, and proton pump inhibitor users 2 , 3 , 11…”

“…Watery diarrhea is a cardinal manifestation accompanied by cramps and lower abdominal pain. Acute abdomen, requiring emergency surgery, has been described 11 , 12. Symptoms generally start 2-10 days after antibiotic use.…”