Current Trends in the Epidemiology and Outcomes of Clostridium difficile Infection

Abstract

Clostridium difficile is the most frequently identified cause of nosocomial diarrhea and has been associated with epidemics of diarrhea in hospitals and long-term care facilities. The continued increase in C. difficile infection (CDI) suggests that it has surpassed other pathogens in causing healthcare-associated infections. The Centers for Disease Control and Prevention recently identified CDI as an "urgent threat" in its recent report on antibiotic resistance threats in the United States, highlighting the need for urgent and aggressive action to prevent this infection. The impact of antibiotics as a risk factor for new-onset CDI is well established; however, recognizing classes of antibiotics with the highest risks and reducing unnecessary antibiotic use are important strategies for prevention of CDI and subsequent recurrence. In addition, the recognition of the community as an important setting for onset of CDI presents a challenge and is an area for future research.

ProbioticSaccharomyces boulardiiCNCM I-745 prevents outbreak-associatedClostridium difficile-associated cecal inflammation in hamsters

“…The mainstream CDI regimen includes the use of metronidazole, vancomycin, and fidaxomicin (55). However, many C. difficileinfected patients may also suffer from recurrent infections (13), while the recent epidemics that also involve new epidemic outbreak-associated strains (29) pose a major medical problem and epidemiological concern. These challenges have been met with a broad range of preventive approaches against CDI, including the use of probiotics, most notably Saccharomyces boulardii (S.b) alone or in combination with established antibiotic treatment (23,24).…”

Epidemiology and Recurrence Rates of Clostridium difficile Infections in Germany: A Secondary Data Analysis

“…Clostridium difficile infection (CDI) is the most common cause of health-care-associated infectious diarrhea, affecting primarily elderly patients (>65 years) with comorbidities and exposure to antibiotics [1–5]. At least 7–17% of adult hospitalized patients are colonized by C. difficile , with higher rates observed in elderly long-term patients [4, 6].…”

“…At least 7–17% of adult hospitalized patients are colonized by C. difficile , with higher rates observed in elderly long-term patients [4, 6]. C. difficile is also responsible for diarrheal diseases in patients with no risk factors (community-acquired CDI) [1, 5, 7], and is associated with zoonotic transmission, particularly PCR-ribotype 078 [8, 9]. Highly virulent C. difficile strains have emerged since 2003 leading to a predominance of PCR-ribotype 027 in many hospitals of North America and Europe.…”

Clostridium difficile presence in Spanish and Belgian hospitals

“…In addition, in many hospitals the diagnosis strategy remains suboptimal and a proportion of infections may remain undiagnosed [8]. In the past decade, an increase in the incidence and severity of the infection has been reported in various healthcare settings among many countries [9]. This situation was attributed to the emergence of a new epidemic and hypervirulent C. difficile strain, identified as PCR-ribotype 027 (NAP1 or North American pulsed field type 1) [10].…”