Clostridium difficile infection: a review

Abstract

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.

Molecular typing of Clostridioides difficile isolates from clinical and non‐clinical samples in Iran

“…In France, Belgium, Netherlands, United States, and Canada, more RT027 have been reported . The predominant RTs in Asia appeared to be 017, 018, 014, 002, and 001 . There are rare data about the most prevalent RTs of C. difficile strains in the Middle East .…”

“…In the Middle East, few epidemiologic published studies showed significant differences in characteristics from those of other regions (9). In Iran, limited studies on CDI in human, animals, and food have indicated that it is a significant nosocomial pathogen with a comparatively higher prevalence rate (2,6).…”

“…Clostridioides (previously Clostridium ) difficile is a major nosocomial pathogen that is the main causative agent of antibiotic‐associated diarrhea and pseudomembranous colitis worldwide . In the last decades, incidence of Clostridium difficile infection (CDI) dramatically increased which was often associated with hospital outbreaks due to the emergence and spread of hypervirulent C. difficile strains .…”

“…Due to these limitations, we are using the capillary gel electrophoresis (CE)‐based PCR‐ribotyping (because it is highly reproducible, independent of the reagents used, and has a much higher discriminatory power than the conventional agarose gel electrophoresis) . The information on true prevalence of the CDI remains unknown in Asia . In the Middle East, few epidemiologic published studies showed significant differences in characteristics from those of other regions .…”

“…In the Middle East, few epidemiologic published studies showed significant differences in characteristics from those of other regions . In Iran, limited studies on CDI in human, animals, and food have indicated that it is a significant nosocomial pathogen with a comparatively higher prevalence rate . Thus, for a better understanding of the local C. difficile epidemiology, we aimed to perform an epidemiological study of the toxigenic C. difficile (TXCD) isolated from clinical and non‐clinical samples in Tehran hospitals.…”