Posted in Flagyl on April 21, 2015

A new review article on Clostridium difficile Infection covers the pathogenesis, epidemiology, diagnosis, and treatment of this nosocomial and potentially baleful infectious diarrhea, as well as the associated jeopard factors. New treatments include fecal microbiota transplantation on account of disease that is resistant to vancomycin.

Clostridium difficile is an anaerobic gram-positive, spore-forming, toxin-producing bacillus that is transmitted in the midst of humans through the fecal-oral route. C. difficile has emerged as a greater enteric pathogen with a worldwide disposal. In the United States, C. difficile is the most frequently reported nosocomial pathogen.

Clinical Pearls

– Who is at danger for C. difficile infection?

The ~ly important risk factor for C. difficile vitiation remains antibiotic use. Ampicillin, amoxicillin, cephalosporins, clindamycin, and fluoroquinolones are the antibiotics that are ~ly frequently associated with the disease, yet almost all antibiotics have been associated with infection. The risk of C. difficile corruption and the severity of infection greaten as age increases. In one study, the venture of contracting C. difficile during each outbreak was 10 times as complete among persons older than 65 years of date as among younger inpatients. The majorship of C. difficile infections are hospital-acquired, goal community-acquired infection has increased dramatically in the bygone time decade and may now account as being up to a third of recently made known cases. Other documented risk factors in opposition to infection include advanced age, inflammatory bowel infirmity, organ transplantation, chemotherapy, chronic kidney sickness, immunodeficiency, and exposure to an infant carrier or infected adult.

Table 1. Antibiotic Classes and Their Association through Clostridium difficile Infection.

– How is C. difficile vitiation diagnosed?

Stool culture for C. difficile requires anaerobic agri~ and is not widely available. Enzyme immunoassay used to exist the mainstay of testing for C. difficile virus, since it is rapid and easily performed. Recently, frequent hospital laboratories have adopted DNA-based tests that lay open toxigenic strains and provide higher sensitivity and specificity than does enzyme immunoassay.

Morning Report Questions

Q: What is the recommended manipulation for acute C. difficile infection?

A: Metronidazole and oral vancomycin have been the mainstays of management for C. difficile infection since the 1970s. For the treatment of severe disease, vancomycin is more usefully than metronidazole, but for mild-to-appease infection, the two antibiotics have been considered to subsist equivalent. However, a marked rise in clinical failure associated by metronidazole, especially in patients with the BI/NAP1/027 over-task, has been seen in the farther than decade. Previous studies were underpowered to evaluate differences between metronidazole and vancomycin in cases of nonsevere taint, but recent data suggest an overall nobility of vancomycin. In 2011, fidaxomicin, a poorly absorbed, bactericidal, macrocyclic antibiotic with smartness against specific anaerobic gram-positive bacteria, was approved ~ means of the Food and Drug Administration during the term of the treatment of C. difficile infection. In phase 3 clinical trials, the healing rate for acute infection was closely equivalent among patients receiving fidaxomicin and those receiving vancomycin (approximately 90% for each), but the jeopardy of recurrence was 15% among patients receiving  fidaxomicin, in the manner that compared with 25% among those receiving vancomycin. However, a reduced put in peril of recurrence was not seen among patients infected with BI/NAP1/027 strains, that were found in 38% of isolates. The markedly higher require to be paid of fidaxomicin has limited its use, despite its superiority to vancomycin in reducing the put to hazard of recurrence.

Q: How are renewed C. difficile infections treated?

A: Treatment of a rudimentary episode of recurrent infection with a rehearse course of either metronidazole or vancomycin in the place of 10 to 14 days is auspicious in approximately 50% of patients. Second and subsequent recurrences can be difficult to spiritual charge, primarily because of the persistence of spores in the bowel or environment and the being unable of the patient to mount some effective immune response to C. difficile toxins, more than to antibiotic resistance. Second recurrences have power to be treated with fidaxomicin or ~ dint of. a vancomycin regimen involving tapered and pulsed dosing. Recent facts suggest that fidaxomicin may be greater degree of effective than vancomycin at preventing further episodes of C. difficile after every initial recurrence. Fecal microbial transplantation, a procedure that was first reported in 1958, has newly emerged as an accepted, safe, and effective treatment for recurrent C. difficile taint.

Table 2. Treatment of Clostridium difficile Infection.

Tags: antibiotic, C-diff, C. difficile infections, Clostridium difficile, drug, NEJM, New England Journal of Medicine
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