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Update on the changing epidemiology of Clostridium difficile-associated disease

Nature Clinical Practice Gastroenterology & Hepatology volume 5, pages 40–48 (2008)Cite this article

Abstract

In the past, Clostridium difficile-associated disease (CDAD) was thought of mainly as a nosocomial disease associated with the use of broad-spectrum antibiotics, but its epidemiology seems to be changing. Since 2002, outbreaks of severe CDAD associated with increased mortality and reduced effectiveness of treatment with metronidazole have focused attention on this challenging pathogen. A fluoroquinolone-resistant strain of C. difficile (BI/NAP1/027) has been predominantly associated with these outbreaks. Changes in the epidemiology of CDAD include the emergence of new at-risk populations and the increased incidence of the disease. Infection control programs and more effective treatments offer hope that future outbreaks of CDAD can be controlled.

Key Points

  • The incidence of health-care-associated C. difficile-associated disease (CDAD) is rising

  • Recent outbreaks of CDAD have been characterized by severe disease and increased mortality

  • Atypical hypervirulent BI/NAP1/027 is resistant to fluoroquinolones, produces more toxin and carries the gene encoding binary toxin

  • CDAD might be underdiagnosed if only one stool toxin assay is performed or if atypical at-risk patients are not assayed

  • Control of health-care-associated CDAD can involve a range of strategies

  • Vancomycin and metronidazole remain the mainstays of treatment for CDAD, but newer investigational therapies hold promise

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Figure 1: Suggested treatment algorithm for Clostridium difficile-associated disease (CDAD).
Figure 2: Treatment response rates (initial treatment failure and recurrences) before and after BI/NAP1/027 strain outbreaks.

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Acknowledgements

The views expressed in this article are those of the author and do not represent the views of the Department of Veterans Affairs.

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  1. VHA Puget Sound Health Care System, Department of Health Services R&D, S152, Metropolitan Park West, 1100 Olive Way #1400, Seattle, WA 98101, USA lynne.mcfarland@va.gov

Authors and Affiliations

  1. LV McFarland is a Research Health Science Specialist in the Department of Health Services Research and Development, and an affiliate Associate Professor at the Department of Medicinal Chemistry at the University of Washington, Puget Sound VA Health Care System, Seattle, WA, Seattle, WA, USA.,

    Lynne V McFarland

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The author is a speaker for Klaire Laboratory, a consultant and speaker for Laboratories Biocodex, and has received grant/research support from Massachusetts Biologic Laboratories.

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“Routes Amid The Chaos” Medical Abstract Series #184 by Lynne V McFarland, PhD (DOC 278 kb)

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McFarland, L. Update on the changing epidemiology of Clostridium difficile-associated disease. Nat Rev Gastroenterol Hepatol 5, 40–48 (2008). https://doi.org/10.1038/ncpgasthep1029

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