Clostridium difficile infection: a review of the literature

Khan, Fahmi Yousef; Elzouki, Abdul-Naser

doi:10.1016/s1995-7645(14)60197-8

Cited by 39 publications

(37 citation statements)

References 67 publications

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“…Additionally, providing appropriate supportive care with rehydration and electrolyte replacement as needed, and avoiding the use of antiperistaltic agents which may contribute to the development of toxic megacolon [12,51]. Once the offending antibiotic is discontinued, spontaneous resolution of CDAD symptoms will be observed in most patients within 2-4 days [5,51]. Metronidazole (Flagyl) and oral vancomycin have been the main antimicrobial agents used in the treatment of CDI.…”

Section: Treatment Of C Difficile Clinical Cases With Antibioticsmentioning

confidence: 99%

Clostridium difficile: Infection, diagnosis and treatment with antimicrobial drugs : A review article

Shehabi

Badran

Abu-Khader

2015

int. arab. j antimicrob. agents

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Clostridium difficile infection (CDI) is increasing problem in healthcare, associated with high incidence, mortality, and costs in hospitalized patients. Dramatic increases in the incidence and severity of healthcare-associated C. difficile infection have occurred since the last decade, including elderly population, young adults, pregnant females, infants and children. C. difficile infections are mainly linked to the prolonged use of wide-spectrum antibiotics that disrupt the intestinal microbiota equilibrium. Toxigenic strains of C. difficile commonly produce two clostridial toxins, toxins A (TcdA) and B (TcdB), which are responsible for disease symptoms. Few strains of C. difficile may also produce another more powerful binary toxin associated with high fatality. The clinical manifestations of infection with toxin-producing strains of C. difficile range from symptomless carriage to mild or moderate watery-bloody diarrhea, and few percentage developed fulminant and sometimes fatal pseudomembranous colitis. Complications that have been associated with CDI include dehydration, electrolyte disturbances, toxic megacolon, bowel perforation, hypotension, renal failure, systemic inflammatory response syndrome, sepsis, and death. The most important step in treating CDI is immediately discontinuing use of offending antimicrobial drug. Both metronidazole and vancomycin are equally effective for the treatment of mild CDI, but vancomycin is superior for treating patients with severe C. difficile disease. Recently, fidaxomicin proved to be superior to other drugs in treatment of patients who are at high risk for CDI relapse.

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Section: Treatment Of C Difficile Clinical Cases With Antibioticsmentioning

confidence: 99%

Clostridium difficile: Infection, diagnosis and treatment with antimicrobial drugs : A review article

Shehabi

Badran

Abu-Khader

2015

int. arab. j antimicrob. agents

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“…Clostridium difficile ( C. difficile ) is a gram positive, spore-forming bacterium with sequelae ranging from mild diarrhea to life-threatening pseudomembranous colitis and even death [ 1 , 2 ]. Persons at increased risk for C. difficile infection (CDI) have advanced age, recent antibiotic exposure, proton pump inhibitor use, long length of stay in healthcare settings, serious underlying illness, or immunocompromised conditions [ 3 , 4 ].…”

Section: Introductionmentioning

confidence: 99%

Epidemiological and economic burden of Clostridium difficile in the United States: estimates from a modeling approach

et al. 2016

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BackgroundDespite a large increase in Clostridium difficile infection (CDI) severity, morbidity and mortality in the US since the early 2000s, CDI burden estimates have had limited generalizability and comparability due to widely varying clinical settings, populations, or study designs.MethodsA decision-analytic model incorporating key input parameters important in CDI epidemiology was developed to estimate the annual number of initial and recurrent CDI cases, attributable and all-cause deaths, economic burden in the general population, and specific number of high-risk patients in different healthcare settings and the community in the US. Economic burden was calculated adopting a societal perspective using a bottom-up approach that identified healthcare resources consumed in the management of CDI.ResultsAnnually, a total of 606,058 (439,237 initial and 166,821 recurrent) episodes of CDI were predicted in 2014: 34.3 % arose from community exposure. Over 44,500 CDI-attributable deaths in 2014 were estimated to occur. High-risk susceptible individuals representing 5 % of the total hospital population accounted for 23 % of hospitalized CDI patients. The economic cost of CDI was $5.4 billion ($4.7 billion (86.7 %) in healthcare settings; $725 million (13.3 %) in the community), mostly due to hospitalization.ConclusionsA modeling framework provides more comprehensive and detailed national-level estimates of CDI cases, recurrences, deaths and cost in different patient groups than currently available from separate individual studies. As new treatments for CDI are developed, this model can provide reliable estimates to better focus healthcare resources to those specific age-groups, risk-groups, and care settings in the US where they are most needed. (Trial Identifier ClinicaTrials.gov: NCT01241552)Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-016-1610-3) contains supplementary material, which is available to authorized users.

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“…However, in this decade, P. difficile and its toxins were related in fecal contents of human patients with pseudomembranous colitis [ 6 ] and the disease was reproduced in hamsters [ 7 ], confirming the importance of this microorganism as an enteropathogen. Today, this bacterium is known to be the cause of P. difficile infection (PDI), the main cause of nosocomial diarrhea in humans worldwide and a possible cause of diarrhea in general community [ 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

Complete genome sequence of Peptoclostridium difficile strain Z31

et al. 2016

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Background Peptoclostridium (Clostridium) difficile is a spore-forming bacterium responsible for nosocomial infections in humans. It is recognized as an important agent of diarrhea and colitis in several animal species and a possible zoonotic agent. Despite the known importance of P. difficile infection in humans and animals, no vaccine or other effective measure to control the disease is commercially available. A possible alternative treatment for P. difficile infection is the use of a nontoxigenic strain of P. difficile as a competitive exclusion agent. However, a thorough knowledge of this strain is necessary for this purpose. We selected P. difficile Z31, a nontoxigenic strain (PCR ribotype 009), for investigation because it prevents P. difficile infection in a hamster model.ResultsThe genome sequence of P. difficile Z31 is a circular chromosome of 4298,263 bp, with a 29.21 % GC content, encoding 4128 proteins, and containing 78 pseudogenes. This strain belongs to ST 3, clade 1, and has five phage regions in its genome. Genes responsible for resistance to tetracycline and erythromycin were detected and more importantly, Z31 also contains genes that promote spore production and stability, cell attachment, intestinal adherence, and biofilm formation.ConclusionIn this study, we present the first complete genome sequence of nontoxigenic P. difficile strain Z31. When the Z31 genome was compared with those of other isolates available in GenBank, including a draft genome of a nontoxigenic strain, several unique regions were evident. Z31 contains no toxin genes, but encodes several non-toxin virulence factors, which may favor host colonization.Electronic supplementary materialThe online version of this article (doi:10.1186/s13099-016-0095-3) contains supplementary material, which is available to authorized users.

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Clostridium difficile infection: a review of the literature

Cited by 39 publications

References 67 publications

Clostridium difficile: Infection, diagnosis and treatment with antimicrobial drugs : A review article

Clostridium difficile: Infection, diagnosis and treatment with antimicrobial drugs : A review article

Epidemiological and economic burden of Clostridium difficile in the United States: estimates from a modeling approach

Complete genome sequence of Peptoclostridium difficile strain Z31

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