Clostridium difficile infection: epidemiology, diagnosis and understanding transmission

Martin, Jessica; Monaghan, Tanya; Wilcox, Mark H.

doi:10.1038/nrgastro.2016.25

Cited by 274 publications

(275 citation statements)

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“…43 It is well known that, both the characteristics of C. difficile strain and the host s immune response, influence CDI severity, recurrence risk and mortality. 40 Vancomycin and metronidazole have been used as effective treatment for CDI for over 30 y. However, a high CDI recurrence rates in patients who respond to initial treatment with these 2 antibiotics has been observed.…”

Section: The Gut Microbiome: Composition Functionality and Evolutionmentioning

confidence: 99%

“…42 The incidence, severity and mortality of CDI have significantly increased over the last decade. These epidemiologic changes in CDI incidence have been partially explained by the emergence of hyper-virulent strains, such as C. difficile BI/NAP1/ 027; 40 infection by this strain in patients between 60…”

Section: The Gut Microbiome: Composition Functionality and Evolutionmentioning

confidence: 99%

“…38 C. difficile spores are resistant to high temperatures, ultraviolet light and harsh chemicals, and can survive for long periods of time in hospitals and health care facilities, thus favoring its dissemination. 39,40 Furthermore, spores are also resistant to antibiotics and can persist in the GIT and potentially contribute to recurrent disease following treatment against the vegetative form. 39 C. difficile infection (CDI) is the most common cause of nosocomial diarrhea in the industrialized world.…”

Section: The Gut Microbiome: Composition Functionality and Evolutionmentioning

confidence: 99%

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Nutrition and the gut microbiome in the elderly

et al. 2016

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The gut microbiota is the assembly of microorganisms living in our intestine and their genomes are known as the microbiome. The correct composition and functionality of this microbiome is essential for maintaining a "healthy status." Aging is related to changes in the gut microbiota which are frequently associated with physiological modifications of the gastrointestinal tract, as well as, to changes in dietary patterns, together with a concomitant decline in cognitive and immune function, all together contributing to frailty. Therefore, nutritional strategies directed at restoring the microbiota in the elderly have to be addressed from a global perspective, considering not only the microbiota but also other extra-intestinal targets of action. The present review aims at summarizing the current knowledge on intestinal microbiota alterations and other functions impaired in the elderly and to analyze tools for implementing nutritional strategies, through the use of probiotics, prebiotics or specific nutrients in order to counterbalance such alterations.

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Section: The Gut Microbiome: Composition Functionality and Evolutionmentioning

confidence: 99%

Section: The Gut Microbiome: Composition Functionality and Evolutionmentioning

confidence: 99%

Section: The Gut Microbiome: Composition Functionality and Evolutionmentioning

confidence: 99%

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Nutrition and the gut microbiome in the elderly

et al. 2016

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“…Thus, the positive predictive value of detecting toxigenic C. difficile in routine diarrheal samples submitted to the laboratory is low and insufficient to diagnose CDI (1)(2)(3)7).…”

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confidence: 99%

Point-Counterpoint: What Is the Optimal Approach for Detection of Clostridium difficile Infection?

2017

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INTRODUCTION In 2010, we published an initial Point-Counterpoint on the laboratory diagnosis of Clostridium difficile infection (CDI). At that time, nucleic acid amplification tests (NAATs) were just becoming commercially available, and the idea of algorithmic approaches to CDI was being explored. Now, there are numerous NAATs in the marketplace, and based on recent proficiency test surveys, they have become the predominant method used for CDI diagnosis in the United States. At the same time, there is a body of literature that suggests that NAATs lack clinical specificity and thus inflate CDI rates. Hospital administrators are taking note of institutional CDI rates because they are publicly reported. They have become an important metric impacting hospital safety ratings and value-based purchasing; hospitals may have millions of dollars of reimbursement at risk. In this Point-Counterpoint using a frequently asked question approach, Ferric Fang of the University of Washington, who has been a consistent advocate for a NAAT-only approach for CDI diagnosis, will discuss the value of a NAAT-only approach, while Christopher Polage of the University of California Davis and Mark Wilcox of Leeds University, Leeds, United Kingdom, each of whom has recently written important articles on the value of toxin detection in the diagnosis, will discuss the impact of toxin detection in CDI diagnosis.

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“…Several diagnostic algorithms have been condensed into this figure 264 . Treatment options indicated here are based on reports by Leffler and Lamont 14 , and Debast et al 155 .…”

Section: Figure 8 Diagnosis and Treatment Options For Clostridium DImentioning

confidence: 99%

Clostridium difficile Infection

Wilcox¹,

Vehreschild²,

Nord³

2015

Annual Update in Intensive Care and Emergency Medicine

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Infection of the colon with the Gram-positive bacterium Clostridium difficile is potentially life threatening, especially in elderly people and in patients who have dysbiosis of the gut microbiota following antimicrobial drug exposure. C. difficile is the leading cause of health-care-associated infective diarrhoea. The life cycle of C. difficile is influenced by antimicrobial agents, the host immune system, and the host microbiota and its associated metabolites. The primary mediators of inflammation in C. difficile infection (CDI) are large clostridial toxins, toxin A (TcdA) and toxin B (TcdB), and, in some bacterial strains, the binary toxin CDT. The toxins trigger a complex cascade of host cellular responses to cause diarrhoea, inflammation and tissue necrosis -the major symptoms of CDI. The factors responsible for the epidemic of some C. difficile strains are poorly understood. Recurrent infections are common and can be debilitating. Toxin detection for diagnosis is important for accurate epidemiological study, and for optimal management and prevention strategies. Infections are commonly treated with specific antimicrobial agents, but faecal microbiota transplants have shown promise for recurrent infections. Future biotherapies for C. difficile infections are likely to involve defined combinations of key gut microbiota. Competing interests statement W.K.S. has performed research for Cubist. D.L. has performed research for Immuron and Adenium Biotech. D.B.L. has performed research for MedImmune and Merck. M.H.W. has received consulting fees from Abbott, Actelion Pharmaceuticals, Astellas, AstraZeneca, Bayer, Cerexa, Cubist, Durata, The European Tissue Symposium, The Medicines Company, MedImmune, Merck, Motif Biosciences, Nabriva, Optimer, Paratek, Pfizer, Roche, Sanofi Pasteur, Seres Therapeutics, Summit Pharmaceuticals, and Synthetic Biologics. M.H.W. has also received lecture fees from Abbott, Alere, Astellas, AstraZeneca, Pfizer and Hoffmann La Roche, and received grant support from Abbott, Actelion, Astellas, bioMérieux, Cubist, Da Volterra, The European Tissue Symposium, Merck and Summit Pharmaceuticals. E.J.K. has performed research for Cubist, Novartis and Qiagen, and has participated in advisory forums of Astellas, Optimer, Actelion, Pfizer, Sanofi Pasteur and Seres Therapeutics. These companies had no role in the writing of this Primer. HHS Public AccessAuthor manuscript Nat Rev Dis Primers. Author manuscript; available in PMC 2017 June 01. Published in final edited form as:Nat Rev Dis Primers. ; 2: 16020. doi:10.1038/nrdp.2016.20. Author Manuscript Author ManuscriptAuthor Manuscript Author ManuscriptClostridium difficile is a Gram-positive obligate anaerobic bacterium that was originally identified as part of the flora of healthy infants in 1935, described as an "actively motile, heavy-bodied rod with elongated subterminal or nearly terminal spores" (REF. 1) (FIG. 1). At that time, the strain was named Bacillus difficilis to reflect the difficulty experienced in isolating and culturing it. De...

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Clostridium difficile infection: epidemiology, diagnosis and understanding transmission

Abstract: This is a repository copy of Clostridium difficile infection: advances in epidemiology, diagnosis and transmission.

Cited by 274 publications

References 118 publications

Nutrition and the gut microbiome in the elderly

Nutrition and the gut microbiome in the elderly

Point-Counterpoint: What Is the Optimal Approach for Detection of Clostridium difficile Infection?

Clostridium difficile Infection

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