Update on Clostridium difficile associated disease

Current Opinion in Gastroenterology

Volumn 23, Issue 1, 2007, Pages 4-9

  Cloud, Jeffrey ^a   Kelly, Ciaran P ^b  

^a UNIVERSITY OF VIRGINIA HEALTH SYSTEM   (United States)

^b BETH ISRAEL DEACONESS MEDICAL CENTER   (United States)

Author keywords

Antibiotic; Bacterial strain; Colitis; Diarrhea; Quinolone

Indexed keywords

ANTIBIOTIC AGENT; BACTERIAL VACCINE; CEPHALOSPORIN DERIVATIVE; CIPROFLOXACIN; CLOSTRIDIUM DIFFICILE TOXIN A; CLOSTRIDIUM DIFFICILE TOXIN B; CULTURELLE; FLORASTOR; GATIFLOXACIN; HISTAMINE H2 RECEPTOR ANTAGONIST; IMMUNOGLOBULIN; INTERLEUKIN 8; LEVOFLOXACIN; MACROCYCLIC COMPOUND; METRONIDAZOLE; NITAZOXANIDE; OPT 80; PROBIOTIC AGENT; PROTON PUMP INHIBITOR; QUINOLINE DERIVED ANTIINFECTIVE AGENT; RAMOPLANIN; RESIN; RIFALAZIL; RIFAXIMIN; TOLEVAMER; VANCOMYCIN;

BACTERIAL INFECTION; BACTERIAL STRAIN; BACTERIUM IDENTIFICATION; BACTERIUM ISOLATE; CLINICAL TRIAL; CLOSTRIDIUM DIFFICILE; DIARRHEA; DISEASE ASSOCIATION; DRUG EFFECT; DRUG EFFICACY; DRUG TREATMENT FAILURE; FATALITY; HOSPITAL INFECTION; HUMAN; INFECTION RISK; MONOTHERAPY; NONHUMAN; PREVALENCE; REVIEW; RISK FACTOR;

CLOSTRIDIUM DIFFICILE; ENTEROCOLITIS, PSEUDOMEMBRANOUS; HUMANS; VIRULENCE;

EID: 33845304266     PISSN: 02671379     EISSN: None     Source Type: Journal    
DOI: 10.1097/MOG.0b013e32801184ac     Document Type: Review

References (42)

1. Kyne L, Warny M, Qamar A, Kelly CP. Asymptomatic carriage of Clostridium difficile and serum levels of IgG antibody against toxin A. N Engl J Med 2000; 342:390-397.
2. Kyne L, Warny M, Qamar A, Kelly CP. Association between antibody response to toxin A and protection against recurrent Clostridium difficile diarrhoea. Lancet 2001; 357:189-193.
3. Pepin J, Valiquette L, Alary ME, et al. Clostridium difficile-associated diarrhea in a region of Quebec from 1991 to 2003: a changing pattern of disease severity. CMAJ 2004; 171:466-472.
4. Loo VG, Poirier L, Miller MA, et al. A predominantly clonal multiinstitutional outbreak of Clostridium difficile-associated diarrhea with high morbidity and mortality. N Engl J Med 2005; 353:2442-2449. This key article describes a large prospective case-control study during the Quebec outbreak which identified risk factors including fluoroquinolone use for the development of CDAD. The authors also performed strain typing and evaluated antibiotic susceptibility in a subgroup of their isolates.
5. Warny M, Pepin J, Fang A, et al. Toxin production by an emerging strain of Clostridium difficile associated with outbreaks of severe disease in North America and Europe. Lancet 2005; 366:1079-1084. This important paper quantitatively compared toxin production of NAP1/027 isolates from Quebec to historic C. difficile isolates. They found markedly increased toxin production by the NAP1/027 strain in vitro, providing a putative mechanism of increased pathogenicity of this epidemic strain.
6. Noren T. Outbreak from a high-toxin intruder: Clostridium difficile. Lancet 2005; 366:1053-1054. This short editorial provides background and explains the significance of the article by Warny et al. in the same issue of the Lancet.
7. McDonald LC, KillgoreGE, Thompson A, et al. An epidemic, toxin gene-variant strain of Clostridium difficile. N Engl J Med 2005; 353:2433-2441. The authors performed strain typing of isolates from a number of different institutions throughout the United States. This paper establishes that the NAP1/027 strain is not confined to Quebec but rather is already widespread in a number of US hospitals.
8. MacCannell DR, Louie TJ, Gregson DB, et al. Molecular analysis of Clostridium difficile PCR ribotype 027 isolates from Eastern and Western Canada. J Clin Microbiol 2006; 44:2147-2152.
9. Smith A. Outbreak of Clostridium difficile infection in an English hospital linked to hypertoxin-producing strains in Canada and the US. Euro Surveill 2005; 10:E050630.2.
10. Kuijper EJ, van den Berg RJ, Debast S, et al. Clostridium difficile ribotype 027, toxinotype III, the Netherlands. Emerg Infect Dis 2006; 12:827-830.
11. Joseph R, Demeyer D, Vanrenterghem D, et al. First isolation of Clostridium difficile PCR ribotype 027, toxinotype III in Belgium. Euro Surveill 2005; 10:E051020.4.
12. Savidge TC, Pan WH, Newman P, et al. Clostridium difficile toxin B is an inflammatory enterotoxin in human intestine. Gastroenterology 2003; 125:413-420.
13. Komatsu M, Kato H, Aihara M, et al. High frequency of antibiotic-associated diarrhea due to toxin A-negative, toxin B-positive Clostridium difficile in a hospital in Japan and risk factors for infection. Eur J Clin Microbiol Infect Dis 2003; 22:525-529.
14. van den Berg RJ, Claas EC, Oyib DH, et al. Characterization of toxin A-negative, toxin B-positive Clostridium difficile isolates from outbreaks in different countries by amplified fragment length polymorphism and PCR ribotyping. J Clin Microbiol 2004; 42:1035-1041.
15. Goncalves C, Decre D, Barbut F, et al. Prevalence and characterization of a binary toxin (actin-specific ADP-ribosyltransferase) from Clostridium difficile. J Clin Microbiol 2004; 42:1933-1939.
16. Barbut F, Decre D, Lalande V, et al. Clinical features of Clostridium difficile-associated diarrhoea due to binary toxin (actin-specific ADP-ribosyltransferase)-producing strains. J Med Microbiol 2005; 54:181-185. This retrospective case-control study examined differences in clinical features of CDAD caused by binary toxin producing strains compared to nonbinary toxin producing strains.
17. Geric B, Carman RJ, Rupnik M, et al. Binary toxin-producing, large clostridial toxin-negative Clostridium difficile strains are enterotoxic but do not cause disease in hamsters. J Infect Dis 2006; 193:1143-1150. This paper examines whether a strain of C. difficile that produces binary toxin but not toxins A or B is pathogenic in the hamster model.
18. McEllistrem MC, Carman RJ, Gerding DN, et al. A hospital outbreak of Clostridium difficile disease associated with isolates carrying binary toxin genes. Clin Infect Dis 2005; 40:265-272. This study looked at whether the presence of binary toxin is associated with more severe disease in an outbreak at a Pittsburgh hospital.
19. Severe Clostridium difficile-associated disease in populations previously at low risk-four states, 2005. MMWR Morb Mortal Wkly Rep 2005; 54:1201-1205. Prompted by several cases of severe CDAD in individuals considered to be at low risk, the CDC investigated cases reported in peripartum women and cases of community acquired CDAD. This is an alert to an important, possibly growing trend.
20. Dial S, Delaney JA, Barkun AN, Suissa S. Use of gastric acid-suppressive agents and the risk of community-acquired Clostridium difficile-associated disease. JAMA 2005; 294:2989-2995. This large population based case-control study examined gastric acid suppressive agents as a risk factor for the development of CDAD. Apart from the significance of its results, this study is also noteworthy for the number of non-nosocomially acquired cases included.
21. Wanahita A, Goldsmith EA, Marino BJ, Musher DM. Clostridium difficile infection in patients with unexplained leukocytosis. Am J Med 2003; 115:543-546.
22. Gerding DN. Clindamycin, cephalosporins, fluoroquinolones, and Clostridium difficile-associated diarrhea: this is an antimicrobial resistance problem. Clin Infect Dis 2004; 38:646-648.
23. Muto CA, Pokrywka M, Shutt K, et al. A large outbreak of Clostridium difficile-associated disease with an unexpected proportion of deaths and colectomies at a teaching hospital following increased fluoroquinolone use. Infect Control Hosp Epidemiol 2005; 26:273-280. Muto examines the risk of individual antibiotics towards the development of CDAD during an outbreak at a Pittsburgh hospital that occurred after a formulary change from ciprofloxacin to levofloxacin.
24. ••].
25. Gaynes R, Rimland D, Killum E, et al. Outbreak of Clostridium difficile infection in a long-term care facility: association with gatifloxacin use. Clin Infect Dis 2004; 38:640-645.
26. Dial S, Alrasadi K, Manoukian C, et al. Risk of Clostridium difficile diarrhea among hospital inpatients prescribed proton pump inhibitors: cohort and case-control studies. CMAJ 2004; 171:33-38.
27. Sanchez TH, Brooks JT, Sullivan PS, et al. Bacterial diarrhea in persons with HIV infection, United States, 1992-2002. Clin Infect Dis 2005; 41:1621-1627. This large cohort study looked at bacterial causes of diarrhea, including C. difficile, in patients with HIV.
28. Jiang ZD, DuPont HL, Garey K, et al. A common polymorphism in the interleukin 8 gene promoter is associated with Clostridium difficile diarrhea. Am J Gastroenterol 2006; 101:1112-1116. Jiang examines a report that a common IL-8 gene promotor polymorphism is associated with the development of CDAD, as it similarly is with traveller's diarrhea.
29. Morelli MS, Rouster SD, Giannella RA, Sherman KE. Clinical application of polymerase chain reaction to diagnose Clostridium difficile in hospitalized patients with diarrhea. Clin Gastroenterol Hepatol 2004; 2:669-674.
30. Boyce JM, Ligi C, Kohan C, et al. Lack of association between the increased incidence of Clostridium difficile-associated disease and the increasing use of alcohol-based hand rubs. Infect Control Hosp Epidemiol 2006; 27:479-483. Since most hospitals have been implementing alcohol based hand cleansing, Boyce et al. studied whether this has influenced the number of CDAD cases at their institution.
31. Pepin J, Alary ME, Valiquette L, et al. Increasing risk of relapse after treatment of Clostridium difficile colitis in Quebec, Canada. Clin Infect Dis 2005; 40:1591-1597. Pepin et al. examined treatment failures and recurrences of CDAD in the period before and during the CDAD epidemic in Quebec in those patients treated with metronidazole versus those treated with vancomycin.
32. Musher DM, Aslam S, Logan N, et al. Relatively poor outcome after treatment of Clostridium difficile colitis with metronidazole. Clin Infect Dis 2005; 40:1586-1590. This study reported on the failure rate of metronidazole in treating 207 patients with CDAD.
33. ••], this is an excellent editorial discussing whether metronidazole is still the treatment of choice for CDAD.
34. Aslam S, Hamill RJ, Musher DM. Treatment of Clostridium difficile-associated disease: old therapies and new strategies. Lancet Infect Dis 2005; 5:549-557. This is a solid and thorough review on the treatment of CDAD.
35. Maroo S, Lamont JT. Recurrent Clostridium difficile. Gastroenterology 2006; 130:1311-1316. This is an excellent review of the management of recurrent CDAD.
36. McFarland LV. Meta-analysis of probiotics for the prevention of antibiotic associated diarrhea and the treatment of Clostridium difficile disease. Am J Gastroenterol 2006; 101:812-822. McFarland provides a good, unbiased review of the various studies to determine which probiotic agents have proven efficacious in treating CDAD.
37. Lawrence SJ, Korzenik JR, Mundy LM. Probiotics for recurrent Clostridium difficile disease. J Med Microbiol 2005; 54:905-906. To McFarland's meta-analysis in the same issue, Lawrence adds the results of a placebo randomized pilot study using Lactobacillus rhamnosus as an adjunct to antibiotics in the treatment of 15 patients with CDAD.
38. McFarland LV. Alternative treatments for Clostridium difficile disease: what really works? J Med Microbiol 2005; 54:101-111. This reviews the data on a number of different antibiotics, probiotics, ion exchange resins, and immunotherapies in the treatment of CDAD.
39. Munoz P, Bouza E, Cuenca-Estrella M, et al. Saccharomyces cerevisiae fungemia: an emerging infectious disease. Clin Infect Dis 2005; 40:1625-1634. This paper describes a series of cases of fungemia with Saccharomyces cerevisiae after its use in the treatment of CDAD.
40. Wilcox MH. Descriptive study of intravenous immunoglobulin for the treatment of recurrent Clostridium difficile diarrhoea. J Antimicrob Chemother 2004; 53:882-884.
41. Giannasca PJ, Warny M. Active and passive immunization against Clostridium difficile diarrhea and colitis. Vaccine 2004; 22:848-856.
42. Sougioultzis S, Kyne L, Drudy D, et al. Clostridium difficile toxoid vaccine in recurrent C. difficile-associated diarrhea. Gastroenterology 2005; 128:764-770. This paper describes the successful use of a C. difficile toxoid vaccine in three individuals with recurrent CDAD.