From the Guidelines
Clostridioides difficile (C. Diff) infection is a significant cause of morbidity and mortality, particularly in adults, and its treatment strategies should be based on disease severity and recurrence risk. According to a systematic review published in JAMA in 2015 1, C. difficile remains an important cause of morbidity and mortality, and treatment strategies should be based on disease severity and recurrence risk. Key aspects of C. Diff infection include:
- Risk factors: recent antibiotic exposure, hospitalization, advanced age, immunosuppression, and proton pump inhibitor use
- Clinical presentation: ranges from mild diarrhea to severe colitis with complications like toxic megacolon
- Diagnosis: requires detection of C. diff toxins in stool, with PCR being most sensitive
- Treatment: depends on severity, with options including oral vancomycin, fidaxomicin, and fecal microbiota transplantation for recurrent cases
- Prevention: focuses on contact precautions, hand hygiene with soap and water, and antimicrobial stewardship The pathophysiology of C. Diff infection involves the disruption of normal gut microbiota, allowing C. Diff overgrowth and the production of toxins A and B that cause colonic inflammation. In terms of treatment, fecal microbiota transplantation is associated with symptom resolution in recurrent CDI, and its role may be expanded in the future 1. Overall, C. Diff infection is a serious condition that requires prompt diagnosis and treatment to reduce morbidity and mortality, and to improve quality of life.
From the Research
Definition and Overview of Clostridioides difficile (C. Diff) Infection
- Clostridioides difficile infection (CDI) is a serious diarrheal illness associated with substantial morbidity and mortality 2
- CDI recurs in nearly one-third of patients who develop an initial infection, and recurrent CDI (RCDI) is associated with considerable morbidity, mortality, and cost 3
- The infection is caused by the bacterium Clostridioides difficile, which can lead to life-threatening diarrhea and refractory recurrence 4
Treatment and Management of C. Diff Infection
- The preferred medications for treating CDI are oral vancomycin or fidaxomicin, with fidaxomicin being slightly more efficacious than vancomycin 3, 2
- For patients who experience recurrence after the first episode, vancomycin taper pulse or fidaxomicin can be used, and intravenous bezlotoxumab is available to prevent recurrences 5, 6
- Fecal microbiota transplantation and live biotherapeutics are also available for the prevention of recurrent CDI 5, 4
Current Research and Developments
- Researchers are investigating new therapeutic antibacterial drugs, preventive medications against recurrence, primary prevention strategies, and other anti-CDI medications in the preclinical stage 4
- Recent guidelines recommend fidaxomicin and vancomycin as first-line drugs to treat CDI, bezlotoxumab to prevent recurrence, and faecal microbiota transplantation for rescue treatment 4