Current understanding and management of clostridioides difficile infection: an overview

Authors

  • Rama Paudel School of Biomedical Sciences, Trinity Medical Sciences University, Kingstown, St. Vincent and the Grenadines

DOI:

https://doi.org/10.18203/2320-6012.ijrms20232138

Keywords:

CDI, Pathogenesis, Clinical presentation, Diagnosis, Management

Abstract

Clostridiodes difficile infection (CDI) is a major cause of healthcare-associated infections worldwide, with a significant morbidity and mortality. The incidence of this infection has been increasing in recent years, particularly among elderly patients and those with comorbidities. The pathogenesis of CDI involves the disruption of the gut microbiota, followed by the production of toxins that lead to colonic inflammation and tissue damage. The clinical presentation varies from mild diarrhea to severe pseudomembranous colitis, toxic megacolon, and sepsis. The diagnosis of CDI is based on the presence of clinical symptoms, laboratory testing, and imaging studies. The treatment of CDI involves antimicrobial therapy, supportive care, and infection control measures. Recently, there have been significant developments in the management of CDI, including the use of fidaxomicin, fecal microbiota transplantation (FMT), and monoclonal antibodies. This manuscript reviews the epidemiology, pathogenesis, clinical presentation, diagnosis and updated guidelines for the management of CDI.

References

Magill SS, O'Leary E, Janelle SJ, Thompson DL, Dumyati G, Nadle J et al. Changes in Prevalence of Health Care-Associated Infections in U.S. Hospitals. N Engl J Med. 2018;379(18):1732-44.

Guh AY, Mu Y, Winston LG, Johnston H, Olson D, Farley MM, et al. Trends in U.S. burden of Clostridioides difficile infection and outcomes. N Engl J Med. 2020;382(14):1320-30.

McFarland LV. Epidemiology, risk factors and treatments for Clostridium difficile infection. Ther Adv Infect Dis. 2016;3(2-3):61-75.

Theriot CM, Young VB. Interactions between the gastrointestinal microbiome and Clostridium difficile. Annu Rev Microbiol. 2015;69:445-61.

Magill SS, Edwards JR, Bamberg W, Beldavs ZG, Dumyati G, Kainer MA et al. Multistate point-prevalence survey of health care-associated infections. N Engl J Med. 2014;370(13):1198-208.

Leffler DA, Lamont JT. Clostridium difficile Infection. N Engl J Med. 2015;372(6):1539-48.

Guh AY, Kutty PK. Clostridioides difficile Infection. Anna Internal Med. 2018;169(7):ITC49-64.

Brown KA, Khanafer N, Daneman N, Fisman DN. Meta-analysis of antibiotics and the risk of community-associated Clostridium difficile infection. Antimicrobial Agents Chemotherapy. 2013;57(5):2326-32.

Kuehne SA, Collery MM, Kelly ML, Cartman ST, Cockayne A, Minton NP. Importance of toxin A, toxin B, and CDT in virulence of an epidemic Clostridium difficile strain. J Infect Dis. 2014;209(1):83-6.

Martinez-Melendez A, Cruz-Lopez F, Morfin-Otero R, Maldonado-Garza HJ, Garza-Gonzalez E. An Update on Clostridioides difficile Binary Toxin. Toxins. 2022;14(5):305.

McDonald LC, Gerding DN, Johnson S, Bakken JS, Carroll KC, Coffin SE et al. Clinical practice guidelines for Clostridium difficile infection in adults and children: 2017 update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA). Clin Infect Dis. 2018;66(7):e1-48.

Lamont JT, Kelly CP, Bakken JS. Clostridioides difficile infection in adults: Clinical manifestations and diagnosis. UpToDate. 2021. Available at: https://www.uptodate.com/contents/clostridioides-difficile-infection-in-adults-clinical-manifestations-and-diagnosis. Accessed on May 16, 2023.

Song JH, Kim YS. Recurrent Clostridium difficile Infection: Risk Factors, Treatment, and Prevention. Gut Liver. 2019;13(1):16-24.

Crobach MJT, Planche T, Eckert C, Barbut F, Terveer EM, Dekkers OM et al. European Society of Clinical Microbiology and Infectious Diseases: update of the diagnostic guidance document for Clostridium difficile infection. Clin Microbiol Infect. 2016;22(4):S63-81.

Polage CR, Gyorke CE, Kennedy MA, Leslie JL, Chin DL, Wang S et al. Overdiagnosis of Clostridium difficile infection in the molecular test era. JAMA Intern Med. 2015;175(11):1792-801.

Surawicz CM, Brandt LJ, Binion DG, Ananthakrishnan AN, Curry SR, Gilligan PH et al. Guidelines for diagnosis, treatment, and prevention of Clostridium difficile infections. Am J Gastroenterol. 2013;108(4):478-98.

Salen P, Stankewicz HA. Pseudomembranous Colitis. Stat Pearls. Available at: https://www.ncbi.nlm.nih.gov/books/NBK470319/#:~:text=Colonoscopies%20of%20patients%20with%20pseudomembranous,surface%20of%20the%20colonic%20mucosa. Accessed on May 16, 2023

Zar FA, Bakkanagari SR, Moorthi KM, Davis MB. A comparison of vancomycin and metronidazole for the treatment of Clostridium difficile-associated diarrhea, stratified by disease severity. Clin Infect Dis. 2007;45:302-7.

Oldfield EC IV, Oldfield EC III, Johnson DA. Clinical update for the diagnosis and treatment of Clostridium difficile infection. World J Gastrointest Pharmacol Ther. 2014;5(1):1-26.

Cornely OA, Crook DW, Esposito R, Poirier A, Somero MS, Weiss K et al. Fidaxomicin versus vancomycin for infection with Clostridium difficile in Europe, Canada, and the USA: a double-blind, non-inferiority, randomised controlled trial. Lancet Infect Dis. 2012;12(4):281-9.

Dubberke ER, Carling P, Carrico R, Donskey CJ, Loo VG, McDonald LC et al. Strategies to prevent Clostridium difficile infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol. 2014;35(2):S48-65.

Anderson DJ, Chen LF, Weber DJ, Moehring RW, Lewis SS, Triplett PF et al. Enhanced terminal room disinfection and acquisition and infection caused by multidrug-resistant organisms and Clostridium difficile (the Benefits of Enhanced Terminal Room Disinfection study): a cluster-randomised, multicentre, crossover study. Lancet. 2017;389(10071):805-14.

Cammarota G, Ianiro G, Tilg H, Rajilic-Stojanovic M, Kump P, Satokari R et al. European consensus conference on faecal microbiota transplantation in clinical practice. Gut. 2017;66(4):569-80.

Wilcox MH, Gerding DN, Poxton IR, Kelly C, Nathan R, Birch T et al. Bezlotoxumab for prevention of recurrent Clostridium difficile infection. N Engl J Med. 2017;376(4):305-17.

Downloads

Published

2023-06-30

How to Cite

Paudel, R. (2023). Current understanding and management of clostridioides difficile infection: an overview. International Journal of Research in Medical Sciences, 11(7), 2745–2749. https://doi.org/10.18203/2320-6012.ijrms20232138

Issue

Section

Review Articles