Clostridium difficile infections

Abstract

The incidence of Clostridium difficile infection (CDI) has increased significantly in the recent years. Actually, Clostridium (C.) difficile is an important nosocomial pathogen and the leading cause of antibiotic-associated diarrhea and colitis. In particular, elderly patients over 70 years are at risk. At the beginning, gram-positive spore-forming anaerobe C. difficile colonize the intestinal tract. Main risk factor for intestinal overgrowth of C. difficile is the use of broad-spectrum antibiotics as fluoroquinolones and β-lactams. Further risks are recurrent hospitalizations, use of acid suppressants, comorbidities and use of enteral feeding tubes. The pathogenesis of colitis it closely linked to the elaboration of toxin A and B. CDI can cause a wide range of disease, from mild diarrhea to fulminant colitis with complication such as toxic megacolon, bowel perforation, sepsis and death. Mortality increases with advanced age and can reach up to 30% in the elderly. Diagnosis is made by epidemiological links, typical clinical features and detection of clostridial toxins in stool specimens. For antimicrobial treatment two drugs are well established: metronidazole for mild to moderate disease, and vancomycin for advanced and severe disease. Fidaxomicin is a recently approved alternative antimicrobial. Additionally, supportive measures are required. Regarding high mortality and high relapse rates experimental approaches are continuously evaluated. Among them is fecotherapy the most promising option. Decisive measure to curb CDI are rational use of antimicrobials as well as an adequate and consistent hygiene management. For environmental disinfection sporocidal substances are recommended. The routinely used alcohol-based hand sanitizers are not sporocidal.