Clostridium difficile - Associated diarrhea

Kaiser Permanente, Family Medicine Residency Program, Fontana, California 92335, USA.
American family physician (Impact Factor: 2.18). 04/2005; 71(5):921-8.
Source: PubMed


Clostridium difficile infection is responsible for approximately 3 million cases of diarrhea and colitis annually in the United States. The mortality rate is 1 to 2.5 percent. Early diagnosis and prompt aggressive treatment are critical in managing C. difficile-associated diarrhea. Major predisposing factors for symptomatic C. difficile colitis include antibiotic therapy; advanced age; multiple, severe underlying diseases; and a faulty immune response to C. difficile toxins. The most common confirmatory study is an enzyme immunoassay for C. difficile toxins A and B. The test is easy to perform, and results are available in two to four hours. Specificity of the assay is high (93 to 100 percent), but sensitivity ranges from 63 to 99 percent. In severe cases, flexible sigmoidoscopy can provide an immediate diagnosis. Treatment of C. difficile-associated diarrhea includes discontinuation of the precipitating antibiotic (if possible) and the administration of metronidazole or vancomycin. Preventive measures include the judicious use of antibiotics, thorough hand washing between patient contacts, use of precautions when handling an infected patient or items in the patient's immediate environment, proper disinfection of objects, education of staff members, and isolation of the patient.

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    • "C. difficile is a gram-positive, spore-forming bacillus that accounts for approximately 15-20% of antibiotic-related diarrhea.[7] It is shed in the feces and spread through the fecal-oral route. "
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    ABSTRACT: Clostridium difficile infection (CDI) is currently a leading cause of antibiotic and health care-related diarrhea. The incidence and the severity of CDI-related diarrhea have increased dramatically in the USA and Europe in the past few decades. The emergence of multidrug-resistant hypervirulent strains of C. difficile has led to an increase in mortality. Fecal microbiota transplantation (FMT) (also known as fecal bacteriotherapy) has been utilized sporadically since the 1950s; and currently, the interest in using FMT has grown again in the past few years for the treatment of CDI and other chronic gastrointestinal diseases. FMT has shown to be effective, cheap, and has very few side effects. It is believed to manipulate and restore the gut microbiota, and therefore enhances the growth of "healthy" bacteria that break the cycle of recurrent CDI. This article focus on the recent case reports on FMT, and general approach to patients undergoing this therapy. Data were obtained through a literature search via PubMed and Google.
    North American Journal of Medical Sciences 06/2013; 5(6):339-43. DOI:10.4103/1947-2714.114163
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    • "Endoscopy usually reveals the presence of adherent colonies, forming ulcers with inflammation of the mucus membrane and the presence of white–yellow plate features. Histological reports show that pseudomembranes contain neutrophils, fibrin, mucin and necrotic debris (Poutanen & Simor, 2004; Schroeder, 2005). In patients with a different form of colitis, such as that associated with Crohn's disease, typical pseudomembranes are not seen (Hookman & Barkin, 2009). "
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    ABSTRACT: Clostridium difficile-associated disease (CDAD) is caused by a spore-forming bacterium and can result in highly variable disease, ranging from mild diarrhoea to severe clinical manifestations. Infections are most commonly seen in hospital settings and are often associated with on-going antibiotic therapy. Incidences of CDAD have shown a sustained increase worldwide over the last ten years and a hypervirulent C. difficile strain, PCR ribotype 027/REA type BI/North American pulsed-field (NAP) type 1 (027/BI/NAP-1), has caused outbreaks in North America and Europe. In contrast, only a few reports of cases in Latin America have been published and the hypervirulent strain 027/BI/NAP-1 has, so far, only been reported in Costa Rica. The potential worldwide spread of this infection calls for epidemiological studies to characterize currently circulating strains and also highlights the need for increased awareness and vigilance among healthcare professionals in currently unaffected areas, such as Latin America. This review attempts to summarize reports of C. difficile infection worldwide, especially in Latin America, and aims to provide an introduction to the problems associated with this pathogen for those countries that might face outbreaks of epidemic strains of C. difficile for the first time in the near future.
    Journal of Medical Microbiology 11/2011; 61(Pt 2):169-79. DOI:10.1099/jmm.0.037077-0 · 2.25 Impact Factor
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    • "Broad-spectrum antibiotic use, such as aminopenicillins , clindamycin and cephalosporins have been highlighted as the most important risk factor for CDI (Schroeder 2005). Until recently, fluoroquinolones were rarely associated with CDI (Hookman and Barkin 2009; Rupnik et al. 2009) but, the emergence of the epidemic and more virulent C. difficile NAP1/ PCR ribotype 027 (NAP1/027) strain, which is strictly associated with the development of fluoroquinolone resistance (Huang et al. 2009a; Carman et al. 2009), changed this view and it has now emerged as one of the main causes of geographically dispersed outbreaks of CDI. "
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    ABSTRACT: Clostridium difficile is an important nosocomial enteric pathogen and is the etiological agent of pseudomembranous colites. Recently, the rates of C. difficile infection (CDI) have increased worldwide, but in Brazil few data about this situation and the incidence of clonal types of C. difficile exist. This study aimed to isolate and characterize C. difficile strains from samples obtained of a university hospital (HUCFF) in Rio de Janeiro city, Brazil. CDI was identified by ELISA in 27.1% of HUCFF-in-patients enrolled in the study, and the bacterium was recovered from eight of these fecal samples. All strains, except one, presented tcdA and tcdB genes and presented neither the cdtA and cdtB genes nor any significant deletions in the tcdC gene. All strains were sensitive to metronidazole, vancomycin and moxifloxacin, and resistant to clindamycin, ciprofloxacin and levofloxacin. PCR-ribotyping and PFGE revealed four different clonal types among the isolates. The Brazilian PCR-ribotype 133 accounted for 50% of strains isolated, and PCR-ribotype 233 strains were obtained from 25% of the in-patients. The prevalence and resurgence of the Brazilian PCR-ribotype 133 among the hospitalized patients of HUCFF was established, and cross-infection of different patients associated to the same PCR-ribotypes was detected. Our results emphasize the importance of the diagnosis and control of CDI in order to prevent the emergence of specific clones that can lead to C. difficile-associated outbreaks in Brazilian hospitals.
    Antonie van Leeuwenhoek 02/2011; 99(2):249-55. DOI:10.1007/s10482-010-9483-8 · 1.81 Impact Factor
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