CLOSTRIDIUM DIFFICILE INFECTION: RISK FACTORS, DIAGNOSIS AND CONTROL

The epidemiology of Clostridium difficile infections (CDI) has changed over the past decade. In addition to dramatic worldwide increases in incidence, new CDI populations are emerging. These populations include patients with community acquired infections with no previous antibiotic exposure, children, pregnant women and patients with IBD. Diagnosis of CDIs requires the identification of C. difficile toxin A or B in diarrheal stool. Current diagnostic tests, however, remains inadequate and an optimal diagnostic testing algorithm has not yet been defined. Metronidazole and vancomycin are currently first-line agents for CDI treatment. Vancomycine, however, has demonstrated superior efficacy and therefore is the preferred agent in patients with severe infections. As with many antibiotics, the incidence of treatment failure with metronidazole is increasing, thereby emphasizing the need to find alternative treatments. Disease recurrence continues to occur in 20-40% of patients and its treatment remains challenging. In patients who develop fulminant colitis from a CDI, early surgical consultation is essential. Intravenous immunoglobulin and tigecycline have been used in patients with severe refractory disease, however delaying surgery may be associated with worse outcomes. Due to the risk of horizontal transmission of C.difficile infection control measures are necessary. Animals may serve as reservoirs for humans. Ongoing research by human and veterinary scientist into, epidemiology, diagnosis, effective treatment protocols and prevention are essential.