Update on Clostridium difficile Infection

Caoilfhionn O'Donoghue; Lorraine Kyne

Disclosures

Curr Opin Gastroenterol. 2011;27(1):38-47. 

In This Article

Abstract and Introduction

Abstract

Purpose of review This review summarizes the most recent epidemiological data and advances in research into the pathogenesis, diagnosis and treatment of Clostridium difficile infection (CDI).
Recent findings The epidemiology of CDI has changed with the emergence of hypervirulent strains. CDI rates have increased in the community, in children and in patients with inflammatory bowel disease. Although the North American pulsed-field gel electrophoresis type 1, restriction endonuclease analysis group BI, PCR ribotype 027 (NAP1/BI/027) strain remains prevalent in North America, surveillance suggests that it is decreasing in Europe. A similar strain, PCR ribotype 078, is emerging which is associated with community-associated CDI and has been isolated in animals and food products. The Society for Healthcare Epidemiology of America and the Infectious Diseases Society of America have published new guidelines on the epidemiology, diagnosis, treatment, infection control and environmental management of C. difficile. Several novel therapies for CDI are at different stages of development. There have been promising trial results with fidaxomicin, a novel antibiotic for the treatment of CDI and monoclonal antibodies against toxins A and B, which have been shown to significantly reduce CDI recurrence rates.
Summary Major advances have been made in our understanding of the spread and pathogenesis of C. difficile and new treatment options are becoming available.

Introduction

During the past decade, rates of Clostridium difficile infection (CDI) increased worldwide. Morbidity and mortality rates increased associated with the emergence of hypervirulent strains such as North American pulsed-field gel electrophoresis type 1, restriction endonuclease analysis group BI, PCR ribotype 027 (NAP1/BI/027), also synonymous with toxinotype III. In this article we review the latest information on epidemiological trends, recent advances in diagnostics and the progress of effective treatment of this ubiquitous pathogen.

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