Clostridium difficile infection: A critical overview

Abstract

Clostridium difficile is a gram-positive, spore-forming, toxin-producing anaerobic bacillus identified as the causal agent of a variety of manifestations typically isolated to the colon, but in its severe form, it can lead to sepsis and death. C. difficile infection due to a toxin gene variant strain (BI/NAP1) has been identified at the center of outbreaks and has resulted in increased mortality. Many questions remain as to how this strain appeared so quickly and has harmed or killed so many patients. We present a review of C. difficile infection, discussing its clinical presentation, diagnosis, management, and prevention.

Clostridium difficile-associated disease in human stem cell transplant recipients: coming epidemic or false alarm?

“…[1][2][3][4][5] In this instance, toxigenic strains are induced to produce two large clostridial exotoxins, C. difficile toxin A (TcdA) and toxin B (TcdB). [12][13][14] These toxins are directly responsible for the colonic inflammation and necrosis that are typical of CDAD.…”

“…A variety of insults are known to disrupt the integrity of the colonic epithelium, but exposure to antibiotics, cytotoxic chemotherapy and gastrointestinal surgery are the commonest predisposing factors. [1][2][3][4][5] In addition to these primary factors, a number of additional co-factors are known to increase the risk of CDAD in an individual patient and include advanced age, medical comorbidities, long hospital stays, suppression of gastric acid production by H2 blockers and proton pump inhibitors, enteral intubation or feeding, and the number, type and duration of antibiotic exposure. [1][2][3][4][5][8][9][10][11] Specific antibiotic exposure risk varies somewhat between studies, but the antibiotics most commonly showing an increased risk for CDAD include clindamycin, extended spectrum cephalosporins and quinolones.…”

“…[1][2][3][4][5] In addition to these primary factors, a number of additional co-factors are known to increase the risk of CDAD in an individual patient and include advanced age, medical comorbidities, long hospital stays, suppression of gastric acid production by H2 blockers and proton pump inhibitors, enteral intubation or feeding, and the number, type and duration of antibiotic exposure. [1][2][3][4][5][8][9][10][11] Specific antibiotic exposure risk varies somewhat between studies, but the antibiotics most commonly showing an increased risk for CDAD include clindamycin, extended spectrum cephalosporins and quinolones. [1][2][3][4][5][8][9][10][11] Antibiotics believed to have a decreased risk of CDAD include vancomycin, tetracyclines, macrolides and aminoglycosides.…”

“…Over the past several years, the incidence and severity of C. difficile-associated disease (CDAD) have risen significantly in North America as well as in Europe. [1][2][3][4][5] The re-emergence of CDAD has been associated, in part, with the detection of a new hypervirulent strain of C. difficile known as the North American pulsed-field gel electrophoresis type 1 (NAP-1) strain. [6][7][8][9][10][11] In addition, there is growing concern regarding the selection of the optimal therapy for severe CDAD as well as the significant rate of recurrent disease after initially successful treatment regimens.…”

“…[6][7][8][9][10][11] In addition, there is growing concern regarding the selection of the optimal therapy for severe CDAD as well as the significant rate of recurrent disease after initially successful treatment regimens. [1][2][3][4][5] Hematologic stem cell transplant (HSCT) recipients have a large number of well-recognized risk factors for the development of CDAD. However, despite the newfound appreciation of CDAD as a cause of nosocomial diarrhea and colitis, the role of C. difficile-mediated gastrointestinal morbidity and mortality among HSCT recipients remains incompletely understood.…”