Table of Contents Author Guidelines Submit a Manuscript
Scientifica
Volume 2014, Article ID 916826, 9 pages
http://dx.doi.org/10.1155/2014/916826
Review Article

Clostridium difficile Infection: Epidemiology, Pathogenesis, Risk Factors, and Therapeutic Options

1Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Science, Tehran, Iran
2Department of Pharmaceutical Biotechnology, Pasteur Institute of Iran (IPI), No. 358, 12th Farwardin Avenue, Jomhhoori Street, Tehran 1316943551, Iran
3Department of Pharmaceutical Biotechnology, Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran

Received 12 February 2014; Accepted 11 May 2014; Published 1 June 2014

Academic Editor: Joaquim Ruiz Blazquez

Copyright © 2014 Mehdi Goudarzi et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Linked References

  1. I. C. Hall and E. O'toole, “Intestinal flora in new-born infantswith a description of a new pathogenic anaerobe, Bacillus difficilis,” The American Journal of Diseases of Children, vol. 49, no. 2, pp. 390–402, 1935. View at Google Scholar
  2. E. J. Kuipers and C. M. Surawicz, “Clostridium difficile infection,” The Lancet, vol. 371, no. 9623, pp. 1486–1488, 2008. View at Publisher · View at Google Scholar · View at Scopus
  3. S. Hammarström, P. Perlmann, B. E. Gustafsson, and R. Lagercrantz, “Autoantibodies to colon in germfree rats monocontaminated with Clostridium difficile,” Journal of Experimental Medicine, vol. 129, no. 4, pp. 747–756, 1969. View at Google Scholar · View at Scopus
  4. F. J. Tedesco, “Clindamycin associated colitis. Review of the clinical spectrum of 47 cases,” The American Journal of Digestive Diseases, vol. 21, no. 1, pp. 26–32, 1976. View at Google Scholar · View at Scopus
  5. R. C. Owens Jr., C. J. Donskey, R. P. Gaynes, V. G. Loo, and C. A. Muto, “Antimicrobial-associated risk factors for Clostridium difficile infection,” Clinical Infectious Diseases, vol. 46, supplement 1, pp. S19–S31, 2008. View at Publisher · View at Google Scholar · View at Scopus
  6. M. Goudarzi, M. Alebouyeh, M. Azimirad, M. Zali, and M. Aslani, “Molecular typing of Clostridium difficile isolated from hospitalized patients by PCR ribotyping,” Pejouhesh, vol. 36, no. 2, pp. 68–75, 2013. View at Google Scholar
  7. A. C. Clements, R. J. S. Magalhães, A. J. Tatem, D. L. Paterson, and T. V. Riley, “Clostridium difficile PCR ribotype 027: assessing the risks of further worldwide spread,” The Lancet Infectious Diseases, vol. 10, no. 6, pp. 395–404, 2010. View at Publisher · View at Google Scholar · View at Scopus
  8. B. A. Miller, L. F. Chen, D. J. Sexton, and D. J. Anderson, “Comparison of the burdens of hospital-onset, healthcare facility-associated Clostridium difficile infection and of healthcare-associated infection due to methicillin-resistant Staphylococcus aureus in community hospitals,” Infection Control and Hospital Epidemiology, vol. 32, no. 4, pp. 387–390, 2011. View at Publisher · View at Google Scholar · View at Scopus
  9. R. Gilca, B. Hubert, E. Fortin, C. Gaulin, and M. Dionne, “Epidemiological Patterns and Hospital Characteristics Associated with Increased Incidence of Clostridium difficile Infection in Quebec, Canada, 1998–2006,” Infection Control and Hospital Epidemiology, vol. 31, no. 9, pp. 939–947, 2010. View at Publisher · View at Google Scholar · View at Scopus
  10. F. Barbut, G. Jones, and C. Eckert, “Epidemiology and control of Clostridium difficile infections in healthcare settings: an update,” Current Opinion in Infectious Diseases, vol. 24, no. 4, pp. 370–376, 2011. View at Publisher · View at Google Scholar · View at Scopus
  11. E. J. Kuijper, B. Coignard, P. Tüll et al., “Emergence of Clostridium difficile-associated disease in North America and Europe,” Clinical Microbiology and Infection, vol. 12, no. 12, pp. 2–18, 2006. View at Publisher · View at Google Scholar · View at Scopus
  12. P. K. Kutty, C. W. Woods, A. C. Sena et al., “Risk factors for and estimated incidence of community-associated Clostridium difficile infection, North Carolina, USA,” Emerging Infectious Diseases, vol. 16, no. 2, pp. 198–204, 2010. View at Publisher · View at Google Scholar · View at Scopus
  13. J. L. Kuntz, M. Yang, J. Cavanaugh, A. F. Saftlas, and P. M. Polgreen, “Trends in Clostridium difficile infection among peripartum women,” Infection Control and Hospital Epidemiology, vol. 31, no. 5, pp. 532–534, 2010. View at Publisher · View at Google Scholar · View at Scopus
  14. R. A. Stabler, L. F. Dawson, L. T. H. Phua, and B. W. Wren, “Comparative analysis of BI/NAP1/027 hypervirulent strains reveals novel toxin B-encoding gene (tcdB) sequences,” Journal of Medical Microbiology, vol. 57, no. 6, pp. 771–775, 2008. View at Publisher · View at Google Scholar · View at Scopus
  15. A. K. Cheknis, S. P. Sambol, D. M. Davidson et al., “Distribution of Clostridium difficile strains from a North American, European and Australian trial of treatment for C. difficile infections: 2005–2007,” Anaerobe, vol. 15, no. 6, pp. 230–233, 2009. View at Publisher · View at Google Scholar · View at Scopus
  16. A. Indra, D. Schmid, S. Huhulescu et al., “Characterization of clinical Clostridium difficile isolates by PCR ribotyping and detection of toxin genes in Austria, 2006-2007,” Journal of Medical Microbiology, vol. 57, no. 6, pp. 702–708, 2008. View at Publisher · View at Google Scholar · View at Scopus
  17. D. A. Collins, P. M. Hawkey, and T. V. Riley, “Epidemiology of Clostridium difficile infection in Asia,” Antimicrobial Resistance and Infection Control, vol. 2, no. 1, article 21, 2013. View at Google Scholar
  18. J. Freeman, M. P. Bauer, S. D. Baines et al., “The changing epidemiology of Clostridium difficile infections,” Clinical Microbiology Reviews, vol. 23, no. 3, pp. 529–549, 2010. View at Publisher · View at Google Scholar · View at Scopus
  19. C. Vaishnavi, “Clinical spectrum & pathogenesis of Clostridium difficile associated diseases,” Indian Journal of Medical Research, vol. 131, no. 4, pp. 487–499, 2010. View at Google Scholar · View at Scopus
  20. S. A. Kuehne, S. T. Cartman, J. T. Heap, M. L. Kelly, A. Cockayne, and N. P. Minton, “The role of toxin A and toxin B in Clostridium difficile infection,” Nature, vol. 467, no. 7316, pp. 711–713, 2010. View at Publisher · View at Google Scholar · View at Scopus
  21. M. Goudarzi, H. Goudarzi, M. Alebouyeh et al., “Antimicrobial susceptibility of Clostridium difficile clinical isolates in Iran,” Iranian Red Crescent Medical Journal, vol. 15, no. 8, pp. 704–711, 2013. View at Google Scholar
  22. A. L. Vecchio and G. M. Zacur, “Clostridium difficile infection: an update on epidemiology, risk factors, and therapeutic options,” Current Opinion in Gastroenterology, vol. 28, no. 1, pp. 1–9, 2012. View at Publisher · View at Google Scholar · View at Scopus
  23. S. Johnson, “Recurrent Clostridium difficile infection: a review of risk factors, treatments, and outcomes,” Journal of Infection, vol. 58, no. 6, pp. 403–410, 2009. View at Publisher · View at Google Scholar · View at Scopus
  24. J. M. Wenisch, D. Schmid, H.-W. Kuo et al., “Hospital-acquired Clostridium difficile infection: determinants for severe disease,” European Journal of Clinical Microbiology and Infectious Diseases, vol. 31, no. 8, pp. 1923–1930, 2012. View at Publisher · View at Google Scholar · View at Scopus
  25. M. M. Riggs, A. K. Sethi, T. F. Zabarsky, E. C. Eckstein, R. L. P. Jump, and C. J. Donskey, “Asymptomatic carriers are a potential source for transmission of epidemic and nonepidemic Clostridium difficile strains among long-term care facility residents,” Clinical Infectious Diseases, vol. 45, no. 8, pp. 992–998, 2007. View at Publisher · View at Google Scholar · View at Scopus
  26. B. Elliott, B. J. Chang, C. L. Golledge, and T. V. Riley, “Clostridium difficile-associated diarrhoea,” Internal Medicine Journal, vol. 37, no. 8, pp. 561–568, 2007. View at Publisher · View at Google Scholar · View at Scopus
  27. M. Kazanowski, S. Smolarek, F. Kinnarney, and Z. Grzebieniak, “Clostridium difficile: epidemiology, diagnostic and therapeutic possibilities—a systematic review,” Techniques in Coloproctology, pp. 1–10, 2013. View at Google Scholar
  28. C. Thomas, M. Stevenson, and T. Riley, “Antibiotics and hospital-acquired Clostridium difficile-associated diarrhoea: a systematic review,” Journal of Antimicrobial Chemotherapy, vol. 51, no. 6, pp. 1339–1350, 2003. View at Publisher · View at Google Scholar · View at Scopus
  29. S. D. Adams and D. W. Mercer, “Fulminant Clostridium difficile colitis,” Current Opinion in Critical Care, vol. 13, no. 4, pp. 450–455, 2007. View at Publisher · View at Google Scholar · View at Scopus
  30. R. M. Dallal, B. G. Harbrecht, A. J. Boujoukas et al., “Fulminant Clostridium difficile: an underappreciated and increasing cause of death and complications,” Annals of Surgery, vol. 235, no. 3, pp. 363–372, 2002. View at Publisher · View at Google Scholar · View at Scopus
  31. S. H. Cohen, D. N. Gerding, S. Johnson et al., “Clinical practice guidelines for Clostridium difficile infection in adults: 2010 update by the Society for Healthcare Epidemiology of America (SHEA) and the Infectious Diseases Society of America (IDSA),” Infection Control and Hospital Epidemiology, vol. 31, no. 5, pp. 431–455, 2010. View at Publisher · View at Google Scholar · View at Scopus
  32. K. C. Carroll, “Tests for the diagnosis of Clostridium difficile infection: the next generation,” Anaerobe, vol. 17, no. 4, pp. 170–174, 2011. View at Publisher · View at Google Scholar · View at Scopus
  33. Berg RJvd, Molecular Diagnosis and Genotyping of Clostridium difficile, Department of Medical Microbiology, Faculty of Medicine/Leiden University Medical Center (LUMC), Leiden University, 2007.
  34. J. Freeman and M. H. Wilcox, “The effects of storage conditions on viability of Clostridium difficile vegetative cells and spores and toxin activity in human faeces,” Journal of Clinical Pathology, vol. 56, no. 2, pp. 126–128, 2003. View at Publisher · View at Google Scholar · View at Scopus
  35. F. Barbut, N. Delmée, J. Brazier et al., “A European survey of diagnostic methods and testing protocols for Clostridium difficile,” Clinical Microbiology and Infection, vol. 9, no. 10, pp. 989–996, 2003. View at Publisher · View at Google Scholar · View at Scopus
  36. S. M. Novak-Weekley, E. M. Marlowe, J. M. Miller et al., “Clostridium difficile testing in the clinical laboratory by use of multiple testing algorithms,” Journal of Clinical Microbiology, vol. 48, no. 3, pp. 889–893, 2010. View at Publisher · View at Google Scholar · View at Scopus
  37. J. R. Ticehurst, D. Z. Aird, L. M. Dam, A. P. Borek, J. T. Hargrove, and K. C. Carroll, “Effective detection of toxigenic Clostridium difficile by a two-step algorithm including tests for antigen and cytotoxin,” Journal of Clinical Microbiology, vol. 44, no. 3, pp. 1145–1149, 2006. View at Publisher · View at Google Scholar · View at Scopus
  38. B. L. Boyanton Jr., P. Sural, C. R. Loomis et al., “Loop-mediated isothermal amplification compared to real-time PCR and enzyme immunoassay for toxigenic Clostridium difficile detection,” Journal of Clinical Microbiology, vol. 50, no. 3, pp. 640–645, 2012. View at Publisher · View at Google Scholar · View at Scopus
  39. L. Lemee, A. Dhalluin, S. Testelin et al., “Multiplex PCR targeting tpi (triose phosphate isomerase), tcdA (toxin A), and tcdB (toxin B) genes for toxigenic culture of Clostridium difficile,” Journal of Clinical Microbiology, vol. 42, no. 12, pp. 5710–5714, 2004. View at Publisher · View at Google Scholar · View at Scopus
  40. J. Brazier and S. Borriello, “Microbiology, epidemiology and diagnosis of Clostridium difficile infection,” in Clostridium difficile, vol. 250, pp. 1–33, Springer, Berlin, Germany, 2000. View at Google Scholar · View at Scopus
  41. C. L. Knight and C. M. Surawicz, “Clostridium difficile Infection,” Medical Clinics of North America, vol. 94, no. 4, pp. 523–536, 2013. View at Publisher · View at Google Scholar · View at Scopus
  42. S. Khanna and D. S. Pardi, “Clostridium difficile infection: new insights into management,” in Mayo Clinic Proceedings, vol. 87, no. 11, pp. 1106–1117, Elsevier, New York, NY, USA, 2012. View at Publisher · View at Google Scholar · View at Scopus
  43. A. Apisarnthanarak, B. Razavi, and L. M. Mundy, “Adjunctive intracolonic vancomycin for severe Clostridium difficile colitis: case series and review of the literature,” Clinical Infectious Diseases, vol. 35, no. 6, pp. 690–696, 2002. View at Publisher · View at Google Scholar · View at Scopus
  44. L. V. McFarland, G. W. Elmer, and C. M. Surawicz, “Breaking the cycle: treatment strategies for 163 cases of recurrent Clostridium difficile disease,” The American Journal of Gastroenterology, vol. 97, no. 7, pp. 1769–1775, 2002. View at Publisher · View at Google Scholar · View at Scopus
  45. T. J. Louie, M. A. Miller, K. M. Mullane et al., “Fidaxomicin versus vancomycin for Clostridium difficile infection,” The New England Journal of Medicine, vol. 364, no. 5, pp. 422–431, 2011. View at Publisher · View at Google Scholar · View at Scopus
  46. J. S. Bakken, T. Borody, L. J. Brandt et al., “Treating Clostridium difficile infection with fecal microbiota transplantation,” Clinical Gastroenterology and Hepatology, vol. 9, no. 12, pp. 1044–1049, 2011. View at Publisher · View at Google Scholar · View at Scopus
  47. E. Gough, H. Shaikh, and A. R. Manges, “Systematic review of intestinal microbiota transplantation (fecal bacteriotherapy) for recurrent Clostridium difficile infection,” Clinical Infectious Diseases, vol. 53, no. 10, pp. 994–1002, 2011. View at Publisher · View at Google Scholar · View at Scopus
  48. S. O. Ali, J. P. Welch, and R. J. Dring, “Early surgical intervention for fulminant pseudomembranous colitis,” The American Surgeon, vol. 74, no. 1, pp. 20–26, 2008. View at Google Scholar · View at Scopus
  49. D. A. Burns and N. P. Minton, “Sporulation studies in Clostridium difficile,” Journal of Microbiological Methods, vol. 87, no. 2, pp. 133–138, 2011. View at Publisher · View at Google Scholar · View at Scopus
  50. U. Jabbar, J. Leischner, D. Kasper et al., “Effectiveness of alcohol-based hand rubs for removal of Clostridium difficile spores from hands,” Infection Control and Hospital Epidemiology, vol. 31, no. 6, pp. 565–570, 2010. View at Publisher · View at Google Scholar · View at Scopus
  51. D. J. Weber, W. A. Rutala, M. B. Miller, K. Huslage, and E. Sickbert-Bennett, “Role of hospital surfaces in the transmission of emerging health care-associated pathogens: norovirus, Clostridium difficile, and Acinetobacter species,” The American Journal of Infection Control, vol. 38, no. 5, pp. S25–S33, 2010. View at Publisher · View at Google Scholar · View at Scopus
  52. B. C. Johnston, S. S. Y. Ma, J. Z. Goldenberg et al., “Probiotics for the prevention of Clostridium difficile-associated diarrhea: a systematic review and meta-analysis,” Annals of Internal Medicine, vol. 157, no. 12, pp. 878–888, 2012. View at Google Scholar · View at Scopus
  53. L. V. McFarland, “Systematic review and meta-analysis of saccharomyces boulardii in adult patients,” World Journal of Gastroenterology, vol. 16, no. 18, pp. 2202–2222, 2010. View at Publisher · View at Google Scholar · View at Scopus
  54. S. Sougioultzis, L. Kyne, D. Drudy et al., “Clostridium difficile toxoid vaccine in recurrent C. difficile-associated diarrhea,” Gastroenterology, vol. 128, no. 3, pp. 764–770, 2005. View at Publisher · View at Google Scholar · View at Scopus
  55. D. F. Gardiner, T. Rosenberg, J. Zaharatos, D. Franco, and D. D. Ho, “A DNA vaccine targeting the receptor-binding domain of Clostridium difficile toxin A,” Vaccine, vol. 27, no. 27, pp. 3598–3604, 2009. View at Publisher · View at Google Scholar · View at Scopus