Epidemiology, Diagnosis and Treatment of Clostridium Difficile Infection

Matteo Bassetti; Giovanni Villa; Davide Pecori; Alessandra Arzese; Mark Wilcox


Expert Rev Anti Infect Ther. 2012;10(12):1405-1423. 

In This Article

Expert Commentary & Five-year View

The rate of recurrence represents one the most challenging aspect on the management of CDI. In fact, after a successful first-line treatment with standard therapies, metronidazole or vancomycin, 20–30% of patients may experience a second event within 30 days from discontinuation, even though it usually occurs within the first 2 weeks. Identifying patients at higher risk of recurrence can result in more prompt recognition, diagnosis and treatment of recurrent CDI. Recurrence of CDI is one of the most important problems in the treatment of CDI. Recurrence appears to be related to a combination of different factors: failure to re-establish the colonic microflora, presence in the intestines of spores of C. difficile, suboptimal host immune response to the infecting organism and its toxins, therefore prevention of recurrent CDI is a substantial therapeutic challenge. Risk factors for recurrent episodes include: immunocompromisization, exposure to other antibacterial agents that disrupt the normal colonic microflora, previous episode of CDI, renal impairment, older age (≥65 years), severe underlying disease, prolonged hospitalization and ICU stay. Although metronidazole and vancomycin are effective in a first episode of CDI, therapy remains suboptimal, especially in recurrent cases.

New drugs, such as fidaxomicin has proven efficacy in CDI with a clinical cure rate comparable to vancomycin. Benefits in recurrence and sustained clinical cure rates for fidaxomicin versus vancomycin were seen in patients aged ≥65 years.