Epidemiology of Clostridium difficile-associated infections

Abstract

Clostridium difficile is responsible for 15-25% of cases of antibiotic-associated diarrhea (AAD) and for virtually all cases of antibiotic-associated pseudomembranous colitis (PMC). This anaerobic bacterium has been identified as the leading cause of nosocomial infectious diarrhea in adults and can be responsible for large outbreaks. Nosocomial C. difficile infection results in an increased length of stay in hospital ranging from 8 to 21 days. Risk factors for C. difficile-associated diarrhea include antimicrobial therapy, older age (>65 years), antineoplastic chemotherapy and length of hospital stay. Other interventions with high risk associations are enemas, nasogastric tubes, gastrointestinal surgery and antiperistaltic drugs. Prospective studies have shown that nosocomial transmission of C. difficile is frequent but often remains asymptomatic. Patients can be contaminated from environmental surfaces, shared instrumentation, hospital personnel hands and infected roommates. Once an outbreak starts, C. difficile may be spread rapidly throughout the hospital environment where spores may persist for months. Measures that are effective in reducing incidence of C. difficile infections and cross-infection include: (i) an accurate and rapid diagnosis, (ii) appropriate treatment, (iii) implementation of enteric precautions for symptomatic patients, (iv) reinforcement of hand-washing, (v) daily environmental disinfection, and (vi) a restrictive antibiotic policy. C. difficile is a common cause of infectious diarrhea and should be therefore systematically investigated in patients with nosocomial diarrhea.

Prevalent PCR ribotypes of clinical and environmental strains of Clostridium difficile isolated from intensive-therapy unit patients in Kuwait

“…Person-to-person transmission on hospital wards, especially geriatric wards, as well as environmental contamination and carriage on the hands of hospital workers have been documented (Kim et al, 1981; MalamouLadas et al, 1983;Savage & Alford, 1983;McFarland et al, 1989). Transmission occurs mainly via the faecal oral route and direct contact with contaminated surfaces (Barbut & Petit, 2001). …”

The Clinical Potential of Linex Forte® in Systemic Antibiotic Therapy

“…difficile, составляет 10-25% всех случаев ААД. Ее проявления варьируются от изнуритель-ной диареи до токсического мегаколона, требующего хирургического вмешательства, до смерти [21]. Метаанализ 22 клинических исследований выявил у детей, подверг-шихся воздействию антибиотиков, частоту возникновения CD-ААД, которая колебалась от 4,3 до 80%, со средней частотой 22% [22].…”

Bovine antibody-enriched whey to aid in the prevention of a relapse of Clostridium difficile-associated diarrhoea: preclinical and preliminary clinical data

“…Underlying disease, old age, a long hospital stay and prior antimicrobial therapy, notably with broad-spectrum antibiotics such as cephalosporins, are factors that disrupt the endogenous bowel flora and increase the rate of acquisition of C. difficile. As a result, individual cases of C. difficile-associated pseudomembranous colitis and hospital-associated outbreaks of diarrhoea occur (Kelly et al, 1994;McFarland et al, 1989;Stoddart & Wilcox, 2001;Barbut & Petit, 2001;Bignardi, 1998). With an estimated half a million cases occurring annually in the United States, the infection adds significant costs to patient care (Stoddart & Wilcox, 2001;Spencer, 1998;Wilcox et al, 1996).…”

“…difficile-associated diarrhoea (CDAD) relapses in about 10-20 % of cases (Kelly et al, 1994;Stoddart & Wilcox, 2001;Barbut & Petit, 2001). Such patients are not only prone to further relapse, but also create a reservoir from which the bacterium may spread to susceptible individuals (Stoddart & Wilcox, 2001;Barbut & Petit, 2001). Treatment of CDAD consists of the discontinuation of implicated antibiotics in an effort to restore normal bowel flora (McNulty et al, 1997), and all but mild cases receive specific therapy with metronidazole and/or vancomycin.…”