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


The rate of recurrence represents perhaps 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 60 days from discontinuation, even though it usually occurs within the first 2 weeks.[79] A second cycle of treatment with metronidazole or vancomycin can be efficacious in this scenario, but 40–60% of patients have one or more relapses.

Clinical severity and unfavorable outcomes do not change significantly between primary events and recurrences.[80] Lack of restoration of enteric microbiota, persistence of C. difficile spores within the gut and deficient host immune response appear to all be related with the chance of recurrence. Some patients may even experience multiple recurrences, with the consequence of many courses of antibiotic therapies, which may be potentially toxic and very expensive. Hospitalized patients who are colonized by the bacteria or that experience acute or recurrent infection may represent a reservoir of infection for other patients who share the same environment.[81]