Clostridium difficile Infection: Clinical Challenges and Management Strategies

Abstract

C lostridium difficile, an anaerobic, spore-forming, toxin-forming, gram-positive bacillus, has become the leading cause of health care-associated infectious diarrhea.1,2 The spectrum of C difficile infection (CDI) ranges from uncomplicated diarrhea to systemic toxic effects marked by sepsis and death.2 Fulminant cases, requiring colectomy, have a mortality rate up to 80%. 3 CDI is increasingly common and causes marked morbidity and mortality, prolonged hospital lengths of stay, and increased health care costs. Recent excess health care costs of hospital-onset CDI are estimated to be $5042 to $7179 per case, with a national annual estimate (limited to hospital-onset CDI) of $897 million to $1.3 billion. 4 The emergence of a hypervirulent epidemic strain and community-acquired disease in populations previously at low risk for CDI most likely will place an even greater burden on patients and the health care system.

Factors Favouring the Development of Clostridium Difficile Infection in Critically Ill Patients

“…Antibiotherapy alters normal gastrointestinal flora, facilitating the colonization and proliferation of CD. Clindamycin, fluoroquinolones, cephalosporins and β-lactam have been shown to be the antibiotics most often linked to CDI [1].…”

“…It is the leading cause of nosocomial diarrhoea in adults. It impacts considerably on the length of hospital stay (LOS) and medical costs [1,2]. The incidence and the mortality rate due to Clostridium difficile infection (CDI) have increased in the last two decades.…”

Evaluation of the novel artus C. difficile QS-RGQ, VanR QS-RGQ and MRSA/SA QS-RGQ assays for the laboratory diagnosis of Clostridium difficile infection (CDI), and for vancomycin-resistant enterococci (VRE) and methicillin-resistant Staphylococcus aureus (MRSA) screening

“…Clostridium difficile infection (CDI) is considered the most common cause of nosocomial infectious diarrhoea among adults in the developed world [5]. The infection is related to antibiotic use and is associated with the overgrowth of C. difficile and the production of toxins A and/or B.…”

Best Practices in Caring for Patients Infected With Clostridium difficile

“…1 Because current available tests for C difficile are accurate and reliable, there is no need for repeat testing and tests for cure should be discouraged. 7,8 Automatic, consecutive repeat testing for C difficile leads to false-positive results and does not improve patients' outcomes. 1 …”

“…3,7,8 • Treatment with metronidazole for initial or first-time CDI. Vancomycin should be reserved for more severe CDI and to prevent vancomycin resistance of enterococci.…”