Recent advances in Clostridium difficile-associated disease

Abstract

The main purpose of this article is to review recent developments in the management of acute and recurrent Clostridium difficile-associated disease, with consideration of existing and new antibiotic and non-antibiotic agents for treatment. Details of the current developmental stage of new agents are provided and the role of surgery in the management of severe disease is discussed. Infection control measures considered comprise prudent use of antimicrobials, prevention of cross-infection and surveillance. Other topics that are covered include the recent emergence of an epidemic hypervirulent strain, pathogenesis, clinical presentation and approaches to rapid diagnosis and assessment of the colonic disease.

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

“…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 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.…”

“…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.…”

Therapeutic potential of egg yolk antibodies for treating Clostridium difficile infection

“…These studies have concentrated on novel toxin neutralizing agents, antibiotics which are more sparing of the normal GI microflora, and pre-or probiotic approaches (Aboudola et al, 2003;Giannasca & Warny, 2004;Kelly et al, 1996;Kink & Williams, 1998;McFarland, 2009;Merrigan et al, 2009;Monaghan et al, 2009).…”