Clostridium difficile in Clinical Practice: Increasing Rates, More Virulent Organisms and New Therapies on the Horizon
Clostridium difficile-associated diarrhea has recently come under increasing scrutiny because of outbreaks of disease in eastern Canada in association with a hypervirulent ribotype 027 (NAP1) strain. Hospitals in the United States, the United Kingdom and Europe have been affected as well. Epidemiolo...
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| Main Author: | |
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| Format: | Article |
| Language: | English |
| Published: |
Wiley
2006-01-01
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| Series: | Canadian Journal of Infectious Diseases and Medical Microbiology |
| Online Access: | http://dx.doi.org/10.1155/2006/378702 |
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| Summary: | Clostridium difficile-associated diarrhea has recently come under
increasing scrutiny because of outbreaks of disease in eastern Canada
in association with a hypervirulent ribotype 027 (NAP1) strain.
Hospitals in the United States, the United Kingdom and Europe have
been affected as well. Epidemiological studies are underway to determine
the presence of the more virulent strain of C difficile in hospitals
across Canada. Because this strain is highly quinolone resistant, it is
suspected that overuse of that class of antimicrobial agent may be a
selection factor for this strain. Although C difficile-associated diarrhea
is usually considered a nosocomial infection, approximately one-quarter
of cases occur in the community. Recurrence following successful resolution
of diarrhea occurs in one in five patients treated with metronidazole
or vancomycin; relapse is more common in patients needing
retreatment. New therapies that may have equivalent or higher
response rates and lower recurrence rates are being investigated. It is
hoped that these new treatments will be a substantial improvement
over current therapies. In the interim, prudent antimicrobial use and
attention to infection control practices are the main preventive
strategies. Prompt testing for C difficile toxin in patients with diarrhea
after antibiotic exposure, discontinuation of unnecessary antibiotic
therapy and rapid initiation of treatment should minimize complications.
With the appearance of more toxigenic strains of C difficile,
careful monitoring of patients to detect suboptimal clinical response is
necessary. |
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| ISSN: | 1712-9532 |