Clostridium difficile – a rising threat?

Abstract

Clostridium difficile infection (CDI) represents a serious problem in healthcare that continues to evolve, evidenced by increased incidence and greater morbidity and mortality. Asymptomatic patient can present with a broad spectrum of disease severity, ranging from mild, watery, self-limiting diarrhoea to life threatening fulminant pseudomembranous colitis, toxic megacolon, bowel perforation, septic shock, and death. Toxin testing is most important clinically, but is hampered by its lack of sensitivity. One potential strategy to overcome this problem is a two-step method that uses enzyme immunoassay detection of glutamatedehydrogenase as an initial screening and then uses a cell cytotoxicity assay ortoxigenic culture as the confirmatory test. It is important to stratify the severity of CDI by means of laboratory parameters that may indicate an increased risk of severe outcomes associated with CDI. The currently available treatments for CDI are insufficient to impede the increased spread and virulence of the infection, avoid recurrence or prevent infection in at-risk populations. Current efforts are focused on preservation of the gut microflora and optimization of the immune response to CDI and toxins. Promising therapies still need time to be adopted in routine management of CDI, due to feasibility, acceptability and economic concerns. Improved monitoring, judicious antibiotic use and universal implementation of prevention schemes are paramount to reducing disease incidence and recurrence.