Diagnosis and Management Clostridium difficile Infection.
Clin Gastroenterol Hepatol. 2013 Mar 28;
Authors: Dupont HL
C. difficile infection (CDI) is increasing in frequency and severity in and out of the hospital with a high probability of recurrences after treatment. The recent literature on CDI was reviewed using PubMed to include the recent publications dealing with diagnosis and therapy. Real Time PCR is a sensitive and useful diagnostic test for CDI but there are growing concerns of false positive tests if the rate of CDI is low in the patient population providing samples and or if the population being studied commonly includes people with C. difficile colonization. Recommended therapy of CDI includes oral metronidazole for milder cases of CDI and oral vancomycin or fidaxomicin for more severe cases each given for 10 days. Colectomy is being performed more frequently in patients with fulminant CDI. For treatment of first recurrences the drug used in the first bout can be used again and for second recurrences longer courses of vancomycin are often given in tapered dose or intermittently to allow gut flora reconstitution or other treatments including fidaxomicin may be used. Bacteriotherapy with fecal transplantation is playing an increasing role in therapy of recurrent cases. Metagenomic studies of patients with CDI during successful therapy are needed to determine how best to protect the flora from assaults from antibacterial drugs and to develop optimal therapeutic approaches. Immunotherapy and immunoprophylaxis offer opportunities to prevent CDI, to speed up recovery from CDI and to eliminate recurrent infection. Humanized monoclonal anti-toxin antibodies and active immunization with vaccines against C. difficile or its toxins are both in development and appear to be of potential value.
PMID: 23542332 [PubMed - as supplied by publisher]