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Update on Clostridium difficile associated disease.

Jeffrey Cloud1, Ciaran P Kelly

  • 1Division of Gastroenterology and Hepatology, University of Virginia Health System, University of Virginia, Digestive Health Center of Excellence, Charlottesville, Virginia, USA.

Current Opinion in Gastroenterology
|November 30, 2006
PubMed
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A new Clostridium difficile strain (NAP1/027) is causing more severe disease and fatalities. This highly virulent, fluoroquinolone-resistant strain is spreading, necessitating new treatment and prevention strategies for Clostridium difficile associated disease.

Area of Science:

  • Infectious Diseases
  • Epidemiology
  • Microbiology

Background:

  • Clostridium difficile associated disease (CDAD) incidence and severity have recently increased.
  • This rise is a significant public health concern in healthcare settings and the community.

Purpose of the Study:

  • To report on recent epidemiological shifts in Clostridium difficile associated disease.
  • To identify factors contributing to the increased incidence and severity of CDAD.

Main Methods:

  • Review of recent epidemiological data on CDAD.
  • Strain typing of Clostridium difficile isolates.
  • Analysis of toxin production and antibiotic resistance patterns.

Main Results:

Related Experiment Videos

  • An epidemic in Quebec linked to a threefold increase in CDAD incidence and fatalities.
  • Identification of the NAP1/027 strain in 82% of isolates, producing significantly higher levels of toxins A and B.
  • Fluoroquinolone resistance of the NAP1/027 strain, potentially linked to nosocomial spread and increased community-acquired cases.
  • Emergence of community-acquired CDAD, sometimes without prior antibiotic exposure.

    • Conclusions:

    • The emergence of the highly virulent, fluoroquinolone-resistant NAP1/027 strain is a primary driver of increased CDAD incidence and severity.
    • Ongoing research into new treatments, including antibiotics, toxin binders, probiotics, and vaccines, is crucial.