Clostridium difficile infection: clinical, epidemiological and therapeutic aspects

Abstract

Clostridium difficile is a gram-positive spore-forming anaerobic enteropathogen. This bacillus is responsible for more than 95% of cases of pseudomembranous colitis and for 15 to 25% of cases of antibiotic-associated diarrhoea. C. difficile has emerged as the major cause of healthcare-associated diarrhoea. Risk factors for C. difficile infection (CDI) include age above 65 years, previous hospitalization, and recent antibiotic therapy (third-generation cephalosporins, amoxicillinclavulanate, clindamycin, and new fluoroquinolones). Serum immunity plays a key role in the development of CDI and relapses. Since 2003, a new hypervirulent strain (027/NAP1/BI) has emerged and spread rapidly worldwide. This epidemic strain is responsible for outbreaks with increased mortality and severity in North America and Europe. Recent American and European guidelines have been published for the treatment of CDI. Oral metronidazole (500 mg three times a day, for 10 days) is still the drug of choice for the initial episode of mild to moderate CDI. Vancomycin (125 mg four times a day, for 10 days) should be given orally (or per rectum if ileus is present) in case of severe CDI. There is no consensus for the treatment of multiple relapses; however, vancomycin therapy using a tapered and pulse regimen is the preferred next strategy. New developments including new drugs (fidaxomixin recently approved by the FDA) or passive or active immunization are currently evaluated.