Clostridioides difficile: diagnosis and treatments

Abstract

Clostridioides difficile (formerly Clostridium) is a major cause of healthcare associated diarrhea, and is increasingly present in the community. Historically, C difficile infection was considered easy to diagnose and treat. Over the past two decades, however, diagnostic techniques have changed in line with a greater understanding of the physiopathology of C difficile infection and the use of new therapeutic molecules. The evolution of diagnosis showed there was an important under- and misdiagnosis of C difficile infection, emphasizing the importance of algorithms recommended by European and North American infectious diseases societies to obtain a reliable diagnosis. Previously, metronidazole was considered the reference drug to treat C difficile infection, but more recently vancomycin and other newer drugs are shown to have higher cure rates. Recurrence of infection represents a key parameter in the evaluation of new drugs, and the challenge is to target the right population with the adapted therapeutic molecule. In multiple recurrences, fecal microbiota transplantation is recommended. New approaches, including antibodies, vaccines, and new molecules are already available or in the pipeline, but more data are needed to support the inclusion of these in practice guidelines. This review aims to provide a baseline for clinicians to understand and stratify their choice in the diagnosis and treatment of C difficile infection based on the most recent data available.

Gut Microbiota Characteristics in Mice with Antibiotic-Associated Diarrhea

“…As known to all, C. di cile and C. perfringens are highrisk infectious origins of AAD. The former can produce an enterotoxin (toxin A) and a cytotoxin (toxin B), which cause mucosal injury and colonic in ammation [7]. The later can produce potent protein toxins (αtoxin, β-toxin, ε-toxin, and -toxin), which cause many different histotoxic and enterotoxic diseases in humans and animals [37].…”

“…We observed more serious diarrhea in mice which received cephradine + gentamycin sulfate than in mice which received lincomycin hydrochloride + ampicillin sodium and ceftriaxone sodium + erythromycin lactobionate [3]. Numerous studies reported that the mechanisms for AAD mainly laid on the changes or dysbiosis of microbial composition and function induced by antibiotics [4][5][6][7]. Although recent studies were concentrated on C. di cile-associated diarrhea, it accounts for only 10% -25% of all AAD cases [7].…”

Updated Management Guidelines for Clostridioides difficile in Paediatrics

“…We can distinguish three kinds of CDIs: (1) healthcare facility-onset (HO) CDI; (2) community-onset, healthcare facility-associated (CO-HCFA) CDI and (3) community-associated (CA) CDI. Although C. difficile was defined as the major cause of healthcare-associated diarrhoea in adult patients for decades [33], the rate of community-acquired CDI has increased [34]. Healthcare-associated infections remain the most frequent in adults, whereas community-associated CDI is 3-fold more common than healthcare-associated CDI in children.…”

“…In a recent review about CDI in adults, Benoit Guery et al reported on effects of probiotics, used concurrently with antibiotics, towards preventing C. difficile diarrhoea [33]. A randomized, double-blinded phase 3 trial showed that Lactobacillus spp.…”

Akute und chronische Durchfallerkrankungen: Differenzialdiagnose und Therapie

“…Stunden gekennzeichnet, die Infektion erfolgt im Rahmen einer "Lebensmittelvergiftung". Bei rezidivierenden Verläufen kann durch einen fäkalen Mikrobiota-Transfer (FMT, "Stuhltransplantation") sehr wirksam eine Heilung erreicht werden [6]. Andere neue Therapieansätze basieren auf der Gabe nichtresorbierbarer Betalaktamase, um die antibiotikabedingte Betalaktamasehemmung im Darm zu antagonisieren und der Entstehung einer Dysbiose vorzubeugen.…”