The Ecology and Pathobiology of Clostridium difficile Infections: An Interdisciplinary Challenge

Abstract

Summary Clostridium difficile is a well recognized pathogen of humans and animals. Although C. difficile was first identified over 70 years ago, much remains unknown in regards to the primary source of human acquisition and its pathobiology. These deficits in our knowledge have been intensified by dramatic increases in both the frequency and severity of disease in humans over the last decade. The changes in C. difficile epidemiology might be due to the emergence of a hypervirulent stain of C. difficile, aging of the population, altered risk of developing infection with newer medications, and/or increased exposure to C. difficile outside of hospitals. In recent years there have been numerous reports documenting C. difficile contamination of various foods, and reports of similarities between strains that infect animals and strains that infect humans as well. The purposes of this review are to highlight the many challenges to diagnosing, treating, and preventing C. difficile infection in humans, and to stress that collaboration between human and veterinary researchers is needed to control this pathogen.

Fecal specimens for Clostridium difficile Diagnostic Testing are Stable for up to 72 hours at 4°C

“…Although GD antigen is stable at RT, our data demonstrated that Toxin A/B antigen detection deteriorates to 70% when stool samples were stored aerobically at RT for 72 hours. This supports Dubberke et al [6] caution that toxin deteriorates when stool is held at room temperature. Furthermore, our data clarifies the timeframe within which transport at RT will cause deterioration.…”

“…It has become one of the most common hospitalacquired-infections (HAIs) and causes significant patient morbidity and mortality, especially in elderly patients [2,4,5,7]. Discrepancies in C. difficile detection rates using nucleic acid amplification tests (NAAT) and antigen, culture and cytopathic effect (CPE) tests have been reported [2,6,8,9]. Indeed Leslie et al [8] reported that this may primarily be due to differences in the load of organisms in stool (very low load in asymptomatic carriage) and suggested that determining the viable count for C. difficile may be needed to differentiate between asymptomatic colonization versus true disease.…”

“…Disease caused by Clostridium difficile may be community onset or hospital onset [1][2][3][4][5][6]. It has become one of the most common hospitalacquired-infections (HAIs) and causes significant patient morbidity and mortality, especially in elderly patients [2,4,5,7].…”

Isolation and characterization of Clostridium difficile from shellfish and marine environments

“…Recently, C. difficile infections have also been reported in pigs, calves, dogs, ostriches, equines, and other animal sources (Dubberke et al 2011;Freeman et al 2010), while Miller et al (2010) reported the isolation of C. difficile in fecal samples of sea otters (Enhydra lutris nereis) along the California coast. C. difficile has also been isolated from meat products in North America (Rodriguet-Palacios et al 2007;Songer et al 2009;Weese et al 2010) and Europe (Jobstl et al 2010;Martirani von Abercron et al 2009).…”

The Potential of Probiotics to Prevent Clostridium difficile Infection

“…Although disease severity varies, CDD can be severe and complicated by toxic megacolon, intestinal perforation, and death. 1,2 The 3 main risk factors for CDD, age greater than 65 years, admission to hospital, and exposure to antibiotics, have been recognized for many years. 1,2 A prospective study of adults (age >18 years) admitted to hospitals in Canada reported that increasing age, exposure to antibiotics, treatment with proton pump inhibitors (PPIs), and prior recent hospital admission predicted CDD.…”