Clostridium Difficile Infection: Risk Factors, Diagnosis and Management

Opinion statement Clostridium difficile infection (CDI) is the leading cause of death due to gastrointestinal infections in the US and is the most common cause of nosocomial diarrhea. The emergence of a hypervirulent strain in the early 2000s has been associated with a dramatic increase in the numbe...

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Bibliographic Details
Published in:Current treatment options in gastroenterology 2015-03, Vol.13 (1), p.121-129
Main Author: Surawicz, Christina M.
Format: Article
Language:English
Subjects:
Colon (C Burke
Gastroenterology
Medicine
Medicine & Public Health
Section Editor
Topical Collection on Colon
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Summary:Opinion statement Clostridium difficile infection (CDI) is the leading cause of death due to gastrointestinal infections in the US and is the most common cause of nosocomial diarrhea. The emergence of a hypervirulent strain in the early 2000s has been associated with a dramatic increase in the number and severity of cases in the US, Canada, and several other countries. Most cases are related to antibiotic use, but sporadic cases occur in otherwise healthy individuals with no risk factors. Morbidity and mortality are highest in the elderly. Diagnosis is confirmed by detection of C. difficile toxin in the stools. Treatment should be stratified by severity of disease, with metronidazole use for mild disease cases and vancomycin for severe disease. Recurrent CDI occurs in 10-20 % of cases. A first recurrence can be treated with a ten-day regimen of metronidazole or vancomycin; a second recurrence is best treated by a pulsed regimen of vancomycin. In patients with multiple (three or more) recurrences, fecal microbiota transplant has a high rate of success. The most important methods of prevention are wise antibiotic policies, hand hygiene, isolation, and barrier methods in hospital and long-term care facilities (LCTF) settings.
ISSN:1092-8472
1534-309X
DOI:10.1007/s11938-014-0038-3