Recurrence of symptoms in Clostridium difficile infection—relapse or reinfection?

Wilcox, Mark H.; Fawley, Warren N.; Settle, Chris; Davidson, A. I.

doi:10.1016/s0195-6701(98)90062-7

Cited by 153 publications

(90 citation statements)

References 22 publications

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“…Delayed onset of new episodes (4-8 weeks later), reported in some studies, can be attributed to exposure to exogenous spores (reinfection) or overgrowth of indigenous C. difficile (asymptomatic carriage) before the normal colonic flora is re-established (Johnson et al, 1989;Kato et al, 1996;Nair et al, 1998;Wilcox et al, 1998). Previous work has shown the normal flora may be disrupted for up to 6 weeks after antibiotic use (Tedesco et al, 1985).…”

Section: Vancomycin Versus Metronidazolementioning

confidence: 97%

“…Most studies comparing strains from the original episode and subsequent episodes (or recurrent CDAD) have found that about half are relapses and half reinfections (Wilcox et al, 1998;Johnson et al, 1989;Barbut et al, 2000;Tang-Feldman et al, 2003). Relapses arise when vancomycin or metronidazole are discontinued and endogenous spores, which have not been destroyed by the antibiotics, germinate in the susceptible intestine.…”

Section: Standard Antibiotic Treatmentsmentioning

confidence: 99%

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Alternative treatments for Clostridium difficile disease: what really works?

McFarland

2005

Journal of Medical Microbiology

141

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Vancomycin and metronidazole have been used for treating Clostridium difficile-associated disease (CDAD) for the past 25 years, but approximately 20 % of patients develop recurrent disease. The increasing incidence of nosocomial outbreaks, cases of recurrent CDAD and other complications (toxic megacolon, ileus, sepsis) has fuelled the search for different types of treatments. As the understanding of the pathogenesis of this disease has matured, newer treatment strategies that take advantage of these mechanisms have been developed. This review will describe such treatments and examine the evidence for each strategy.

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Section: Vancomycin Versus Metronidazolementioning

confidence: 97%

Section: Standard Antibiotic Treatmentsmentioning

confidence: 99%

Alternative treatments for Clostridium difficile disease: what really works?

McFarland

2005

Journal of Medical Microbiology

141

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“…[49][50][51][52] Recurrent diarrhea is seen in 5%-40% of patients receiving treatment for C. difficile diarrhea. [53][54][55][56] Kyne and associates showed that independent risk factors for recurrent C. difficile diarrhea include age greater than 65 years, increased severity of underlying disease and exposure to additional antibiotics after treatment. 54 Controlling for these factors, they also showed that a low serum antibody response to toxin A during an initial episode of C. difficile diarrhea is associated with an increased risk of recurrence.…”

Section: Clinical Presentationmentioning

confidence: 99%

“…Up to almost half of recurrences have been shown to be caused by reinfection rather than by relapse, which suggests that reexposure to C. difficile from other patients or from the environment is a major source of recurrent symptoms. 55,56 In those with true relapse, however, recurrence of symptoms is most likely caused by the intraluminal persistence of C. difficile spores that germinate after antibiotic therapy is discontinued. 57 Relapse due to antibiotic resistance is not thought to be common, given the high intraluminal concentrations of antibiotics that can be achieved and the relatively rare occurrence of antimicrobial resistance in vitro.…”

Section: Clinical Presentationmentioning

confidence: 99%

Clostridium difficile-associated diarrhea in adults

Poutanen

Simor²

2004

Canadian Medical Association Journal

360

280

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CLOSTRIDIUM DIFFICILE is the most important cause of nosocomial diarrhea in adults. Illness may range from mild watery diarrhea to life-threatening colitis. An antecedent disruption of the normal colonic flora followed by exposure to a toxigenic strain of C. difficile are necessary first steps in the pathogenesis of disease. Diagnosis is based primarily on the detection of C. difficile toxin A or toxin B. First-line treatment is with oral metronidazole therapy. Treatment with oral vancomycin therapy should be reserved for patients who have contraindications or intolerance to metronidazole or who fail to respond to first-line therapy

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“…Target DNA was extracted from each bacterial strain as previously described [12]. To detect any mixed cultures of C. difficile, separate typing reactions were per-formed on DNA samples extracted from both single and multiple colonies.…”

Section: Dna Fingerprintingmentioning

confidence: 99%

Molecular epidemiology of endemic Clostridium difficile infection

Fawley

Wilcox

2001

Epidemiol. Infect.

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SUMMARYThis is the first study to provide a comprehensive insight into the molecular epidemiology of endemic Clostridium difficile and particularly that associated with a recently recognized epidemic strain. We DNA fingerprinted all C. difficile isolates from the stools of patients with symptomatic antibiotic-associated diarrhoea and from repeated samples of the inanimate ward environment on two elderly medicine hospital wards over a 22-month period. Notably, C. difficile was not recoverable from either ward immediately before opening, but was found on both wards within 1-3 weeks of opening, and the level of environmental contamination rose markedly during the first 6 months of the study period. C. difficile infection (CDI) incidence data correlated significantly with the prevalence of environmental C. difficile on ward B (r l 0n76, P 0n05) but not on ward A (r l 0n26, P 0n05). We found that RAPD and RS-PCR typing had similar discriminatory power, although, despite fingerprinting over 200 C. difficile isolates, we identified only six distinct types. Only two distinct C. difficile strains were identified as causing both patient infection and ward contamination. Attempts to determine whether infected patients or contaminated environments are the prime source for cross-infection by C. difficile had limited success, as over 90 % of C. difficile isolates were the UK epidemic clone. However, a non-epidemic strain caused a cluster of six cases of CDI, but was only isolated from the environment after the sixth patient became symptomatic. The initial absence of this strain from the environment implies patient-to-patient and\or staff-to-patient spread. In general, routine cleaning with detergent was unsuccessful at removing C. difficile from the environment. Understanding the epidemiology and virulence of prevalent strains is important if CDI is to be successfully controlled.

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Recurrence of symptoms in Clostridium difficile infection—relapse or reinfection?

Cited by 153 publications

References 22 publications

Alternative treatments for Clostridium difficile disease: what really works?

Alternative treatments for Clostridium difficile disease: what really works?

Clostridium difficile-associated diarrhea in adults

Molecular epidemiology of endemic Clostridium difficile infection

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