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Related Experiment Videos

Clostridium difficile--Associated diarrhea: A review.

E Mylonakis1, E T Ryan, S B Calderwood

  • 1Division of Infectious Diseases, Gray-Jackson 504, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114, USA.

Archives of Internal Medicine
|March 17, 2001
PubMed
Summary
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Clostridium difficile infection, a common cause of diarrhea, is linked to antibiotic use. Metronidazole or vancomycin are effective treatments, but relapses occur, necessitating further management strategies.

Area of Science:

  • Infectious Diseases
  • Gastroenterology
  • Microbiology

Background:

  • Clostridium difficile infection (CDI) affects 300,000 to 3,000,000 individuals annually in the US.
  • Antibiotics like clindamycin, ampicillin, amoxicillin, and cephalosporins are frequently associated with CDI, though all antibiotics can predispose patients.
  • Clinical manifestations range from asymptomatic colonization to severe, life-threatening colitis.

Purpose of the Study:

  • To review the epidemiology, diagnosis, and management of Clostridium difficile infection.
  • To highlight the importance of prevention, accurate diagnostic testing, and effective treatment to reduce morbidity and mortality.

Main Methods:

  • Review of existing literature on Clostridium difficile infection.
  • Discussion of diagnostic methods including tissue culture assay for toxin B and enzyme-linked immunoassay.

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  • Evaluation of treatment options, primarily oral metronidazole and vancomycin hydrochloride.

    • Main Results:

    • Tissue culture assay for toxin B is sensitive and specific but time-consuming.
    • Enzyme-linked immunoassay offers a faster, less expensive alternative for toxin detection.
    • Oral metronidazole and vancomycin are equally effective for initial treatment (10-14 days), with metronidazole preferred due to cost and reduced selective pressure.
    • Approximately 15% of patients experience relapse and may require retreatment.

    Conclusions:

    • Effective management of CDI involves preventing its spread, utilizing appropriate diagnostic tests, and timely treatment.
    • Understanding the incomplete immunity, primarily mediated by serum IgG to toxin A, is crucial for managing recurrent infections.
    • Prompt and accurate interventions can significantly decrease the adverse outcomes associated with Clostridium difficile-associated diarrhea.