Journal ArticleDOI
Narrative Review: The New Epidemic of Clostridium difficile–Associated Enteric Disease
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TLDR
Clostridium difficile is the most common identifiable bacterial cause of diarrhea in the United States and the most sensitive diagnostic test, but the enzyme immunoassay is now used by most laboratories because of ease of processing, cost, and speed of results.Abstract:
Antibiotic-associated diarrhea and colitis were well established soon after antibiotics became available. Early work implicated Staphylococcus aureus, but in 1978 Clostridium difficile became the established pathogen in the vast majority of cases. In the first 5 years (1978 through 1983), the most common cause was clindamycin, the standard diagnostic test was the cytotoxin assay, and standard management was to withdraw the implicated antibiotic and treat with oral vancomycin. Most patients responded well, but 25% relapsed when vancomycin was withdrawn. During the next 20 years (1983 through 2003), the most commonly implicated antibiotics were the cephalosporins, which reflected the rates of use; the enzyme immunoassay replaced the cytotoxin assay because of speed of results and technical ease of performance; and metronidazole replaced vancomycin as standard treatment, and principles of containment hospitals became infection control and antibiotic control. During the recent past (2003 to 2006), C. difficile has been more frequent, more severe, more refractory to standard therapy, and more likely to relapse. This pattern is widly distributed in the United States, Canada, and Europe and is now attributed to a new strain of C. difficile designated BI, NAP1, or ribotype 027 (which are synonymous terms). This strain appears more virulent, possibly because of production of large amounts of toxins, and fluoroquinolones are now major inducing agents along with cephalosporins, which presumably reflects newly acquired in vitro resistance and escalating rates of use. The recent experience does not change principles of management of the individual patient, but it does serve to emphasize the need for better diagnostics, early recognition, improved methods to manage severe disease and relapsing disease, and greater attention to infection control and antibiotic restraint.read more
Citations
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Antibiotic resistance—the need for global solutions
Ramanan Laxminarayan,Ramanan Laxminarayan,Ramanan Laxminarayan,Adriano Duse,Chand Wattal,Anita K. M. Zaidi,Heiman F. L. Wertheim,Nithima Sumpradit,Erika Vlieghe,Gabriel Levy Hara,Ian M. Gould,Herman Goossens,Christina Greko,Anthony D. So,Maryam Bigdeli,Goeran Tomson,Will Woodhouse,Eva Ombaka,Arturo Quizhpe Peralta,Farah Naz Qamar,Fatima Mir,Sam Kariuki,Zulfigar A. Bhutta,Anthony R.M. Coates,Richard Bergstrom,Gerard D. Wright,Eric D. Brown,Otto Cars +27 more
TL;DR: The global situation of antibiotic resistance, its major causes and consequences, and key areas in which action is urgently needed are described and identified.
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The Changing Epidemiology of Clostridium difficile Infections
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Hospital Epidemiology and Infection Control in Acute-Care Settings
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References
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Journal ArticleDOI
An epidemic, toxin gene-variant strain of Clostridium difficile.
L. Clifford McDonald,George Killgore,Angela Thompson,Robert C. Owens,Sophia Kazakova,Susan P. Sambol,Stuart Johnson,Dale N. Gerding +7 more
TL;DR: A previously uncommon strain of C. difficile with variations in toxin genes has become more resistant to fluoroquinolones and has emerged as a cause of geographically dispersed outbreaks of C.'s Difficile-associated disease.
Journal ArticleDOI
A predominantly clonal multi-institutional outbreak of Clostridium difficile-associated diarrhea with high morbidity and mortality.
Vivian G. Loo,Louise Poirier,Mark A. Miller,Matthew Oughton,Michael Libman,Sophie Michaud,Anne-Marie Bourgault,Tuyen Nguyen,Charles Frenette,Mirabelle Kelly,Anne Vibien,Paul Brassard,Susan Fenn,Ken Dewar,Thomas J. Hudson,Ruth Horn,Pierre René,Yury Monczak,Andre Dascal +18 more
TL;DR: A strain of C. difficile that was resistant to fluoroquinolones and had binary toxin and a partial deletion of the tcdC gene was responsible for this outbreak ofC.difficile-associated diarrhea.
Journal ArticleDOI
Toxin production by an emerging strain of Clostridium difficile associated with outbreaks of severe disease in North America and Europe
Michel Warny,Jacques Pépin,Aiqi Fang,George Killgore,Angela Thompson,Jon S. Brazier,Eric Frost,L. Clifford McDonald +7 more
TL;DR: The severity of C difficile-associated disease caused by NAP1/027 could result from hyperproduction of toxins A and B, and dissemination of this strain in North America and Europe could lead to important changes in the epidemiology of C diffusion disease.
Journal ArticleDOI
Nosocomial acquisition of Clostridium difficile infection
TL;DR: Nosocomial C. difficile infection, which was associated with diarrhea in about one third of cases, is frequently transmitted among hospitalized patients and that the organism is often present on the hands of hospital personnel caring for such patients.
Journal ArticleDOI
Antibiotic-associated pseudomembranous colitis due to toxin-producing clostridia.
TL;DR: Results suggest that toxin-producing clostridia are responsible for antibiotic-associated pseudomembranous colitis.