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Clostridioides difficile infection


Clostridioides difficile infection
Other namesC. difficile associated diarrhea (CDAD), Clostridium difficile infection, C. difficile colitis
Pathological specimen showing pseudomembranous colitis
SpecialtyInfectious disease
SymptomsDiarrhea, fever, nausea, abdominal pain[1]
ComplicationsPseudomembranous colitis, toxic megacolon, perforation of the colon, sepsis[1]
CausesClostridioides difficile spread by the fecal-oral route[2]
Risk factorsAntibiotics, proton pump inhibitors, hospitalization, other health problems, older age[1]
Diagnostic methodStool culture, testing for the bacteria's DNA or toxins[1]
PreventionHand washing, terminal room cleaning in hospital[2]
TreatmentMetronidazole, vancomycin, fidaxomicin, fecal microbiota transplantation[1][3]
Frequency453,000 (US 2011)[2][4]
Deaths29,000 (US)[2][4]

Clostridioides difficile infection[5] (CDI or C-diff), also known as Clostridium difficile infection, is a symptomatic infection due to the spore-forming bacterium Clostridioides difficile.[6] Symptoms include watery diarrhea, fever, nausea, and abdominal pain.[1] It makes up about 20% of cases of antibiotic-associated diarrhea.[1] Antibiotics can contribute to detrimental changes in gut microbiota; specifically, they decrease short-chain fatty acid absorption which results in osmotic, or watery, diarrhea.[7] Complications may include pseudomembranous colitis, toxic megacolon, perforation of the colon, and sepsis.[1]

Clostridioides difficile infection is spread by bacterial spores found within feces.[1] Surfaces may become contaminated with the spores with further spread occurring via the hands of healthcare workers.[1] Risk factors for infection include antibiotic or proton pump inhibitor use, hospitalization, hypoalbuminemia,[8] other health problems, and older age.[1] Diagnosis is by stool culture or testing for the bacteria's DNA or toxins.[1] If a person tests positive but has no symptoms, the condition is known as C. difficile colonization rather than an infection.[1]

Prevention efforts include terminal room cleaning in hospitals, limiting antibiotic use, and handwashing campaigns in hospitals.[2] Alcohol based hand sanitizer does not appear effective.[2] Discontinuation of antibiotics may result in resolution of symptoms within three days in about 20% of those infected.[1]

The antibiotics metronidazole, vancomycin, or fidaxomicin, will cure the infection.[1][3] Retesting after treatment, as long as the symptoms have resolved, is not recommended, as a person may often remain colonized.[1] Recurrences have been reported in up to 25% of people.[9] Some tentative evidence indicates fecal microbiota transplantation and probiotics may decrease the risk of recurrence.[2][10]

C. difficile infections occur in all areas of the world.[11] About 453,000 cases occurred in the United States in 2011, resulting in 29,000 deaths.[2][4] Global rates of disease increased between 2001 and 2016.[2][11] C. difficile infections occur more often in women than men.[2] The bacterium was discovered in 1935 and found to be disease-causing in 1978.[11] Attributable costs for Clostridioides difficile infection in hospitalized adults range from $4500 to $15,000.[12] In the United States, healthcare-associated infections increase the cost of care by US$1.5 billion each year.[13] Although C. difficile is a common healthcare-associated infection, at most 30% of infections are transmitted within hospitals.[14] The majority of infections are acquired outside of hospitals, where medications and a recent history of diarrheal illnesses (e.g. laxative abuse or food poisoning due to Salmonellosis) are thought to drive the risk of colonization.[15]

  1. ^ a b c d e f g h i j k l m n o p "Frequently Asked Questions about Clostridium difficile for Healthcare Providers". CDC. 6 March 2012. Archived from the original on 2 September 2016. Retrieved 5 September 2016.
  2. ^ a b c d e f g h i j Butler M, Olson A, Drekonja D, Shaukat A, Schwehr N, Shippee N, et al. (March 2016). "Early Diagnosis, Prevention, and Treatment of Clostridium difficile: Update". AHRQ Comparative Effectiveness Reviews.: vi, 1. PMID 27148613.
  3. ^ a b Nelson RL, Suda KJ, Evans CT (March 2017). "Antibiotic treatment for Clostridium difficile-associated diarrhoea in adults". The Cochrane Database of Systematic Reviews. 2017 (3): CD004610. doi:10.1002/14651858.CD004610.pub5. PMC 6464548. PMID 28257555.
  4. ^ a b c Lessa FC, Mu Y, Bamberg WM, Beldavs ZG, Dumyati GK, Dunn JR, et al. (February 2015). "Burden of Clostridium difficile infection in the United States". The New England Journal of Medicine. 372 (9): 825–34. doi:10.1056/NEJMoa1408913. hdl:11603/29071. PMID 25714160. S2CID 20441835.
  5. ^ Taxonomy. Lawson et al (2016). NCBI. https://www.ncbi.nlm.nih.gov/Taxonomy/Browser/wwwtax.cgi?mode=Info&id=1496&lvl=3&lin=f&keep=1&srchmode=1&unlock
  6. ^ Di Bella S, Sanson G, Monticelli J, Zerbato V, Principe L, Giuffrè M, et al. (29 February 2024). "Clostridioides difficile infection: history, epidemiology, risk factors, prevention, clinical manifestations, treatment, and future options". Clinical Microbiology Reviews. doi:10.1128/cmr.00135-23. ISSN 0893-8512.
  7. ^ Mullish BH, Williams HR (June 2018). "Clostridium difficile infection and antibiotic-associated diarrhoea". Clinical Medicine. 18 (3): 237–241. doi:10.7861/clinmedicine.18-3-237. PMC 6334067. PMID 29858434.
  8. ^ di Masi A, Leboffe L, Polticelli F, Tonon F, Zennaro C, Caterino M, et al. (September 2018). "Human Serum Albumin Is an Essential Component of the Host Defense Mechanism Against Clostridium difficile Intoxication". The Journal of Infectious Diseases. 218 (9): 1424–1435. doi:10.1093/infdis/jiy338. PMID 29868851.
  9. ^ Long SS, Pickering LK, Prober CG (2012). Principles and Practice of Pediatric Infectious Diseases (4th ed.). Elsevier Health Sciences. p. 979. ISBN 978-1455739851. Archived from the original on 14 September 2016.
  10. ^ Li W (2019). Eat To Beat Disease. GrandCentral. pp. 44–45, 50–51.
  11. ^ a b c Lessa FC, Gould CV, McDonald LC (August 2012). "Current status of Clostridium difficile infection epidemiology". Clinical Infectious Diseases. 55 (Suppl 2): S65-70. doi:10.1093/cid/cis319. PMC 3388017. PMID 22752867.
  12. ^ Asensio A, Di Bella S, Lo Vecchio A, Grau S, Hart WM, Isidoro B, et al. (July 2015). "The impact of Clostridium difficile infection on resource use and costs in hospitals in Spain and Italy: a matched cohort study". International Journal of Infectious Diseases. 36: 31–38. doi:10.1016/j.ijid.2015.05.013. hdl:11368/2934734. PMID 26003403.
  13. ^ Leffler DA, Lamont JT (April 2015). "Clostridium difficile infection". The New England Journal of Medicine. 372 (16): 1539–1548. doi:10.1056/NEJMra1403772. PMID 25875259. S2CID 2536693.
  14. ^ Eyre DW, Cule ML, Wilson DJ, Griffiths D, Vaughan A, O'Connor L, et al. (September 2013). "Diverse sources of C. difficile infection identified on whole-genome sequencing". The New England Journal of Medicine. 369 (13): 1195–1205. doi:10.1056/NEJMoa1216064. PMC 3868928. PMID 24066741.
  15. ^ VanInsberghe D, Elsherbini JA, Varian B, Poutahidis T, Erdman S, Polz MF (April 2020). "Diarrhoeal events can trigger long-term Clostridium difficile colonization with recurrent blooms". Nature Microbiology. 5 (4): 642–650. doi:10.1038/s41564-020-0668-2. PMID 32042128. S2CID 211074075.

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