Friday, July 06, 2007
Clostridium difficile: changing epidemiology and new treatment options.
Clostridium difficile: changing epidemiology and new treatment options.
Curr Opin Infect Dis. 2007 Aug
Kuijper EJ, van Dissel JT, Wilcox MH.
aDepartment of Medical Microbiology, Leiden University Medical Center, Leiden, the Netherlands bInfectious Diseases, Leiden University Medical Center, Leiden, the Netherlands cDepartment of Medical Microbiology, Leeds Teaching Hospitals and University of Leeds, Leeds, UK.
PURPOSE OF REVIEW: The review summarizes changes in the epidemiology and treatment of Clostridium difficile-associated disease.
RECENT FINDINGS: Recent outbreaks of Clostridrium difficile-associated diarrhoea with increased severity, high relapse rate and significant mortality, have been related to the emergence of a new, hypervirulent C. difficile strain in north America, Japan and Europe. Definitions have been proposed by the European Centre for Disease Prevention and Control to identify severe cases of Clostridrium difficile-associated diarrhoea and to differentiate community-acquired cases from nosocomial-acquired cases. The emerging strain is referred to as North American pulsed-field type 1 and polymerase chain reaction ribotype 027. The emerging strain has also been detected in calf diarrhoea and ground meat samples in Canada.
Attempts to prevent outbreaks caused by type 027 should focus on controlling the overall use of antibiotics, and high-risk antibiotics such as cephalosporins, clindamycin and fluoroquinolones. Several new antibiotic and non-antibiotic alternatives have become available; there is currently no place for probiotic treatments. Patients who suffer multiple relapses of C. difficile-associated diarrhoea present a major therapeutic challenge.
SUMMARY: The early recognition of Clostridrium difficile-associated diarrhoea caused by NAP1/027 is necessary to start rapid treatment, to prevent complications, and to prevent further spread of the bacterium.
Lippincott, Williams & Wilkins
A portrait of the geographic dissemination of the Clostridium difficile North American pulsed-field type 1 strain and the epidemiology of C. difficile-associated disease in Québec.
Clin Infect Dis. 2007 * Full Text Article
Hubert B, Loo VG, Bourgault AM, Poirier L, Dascal A, Fortin E, Dionne M, Lorange M.
Institut National de Santé Publique du Québec, Québec, Canada. bruno.hubert@chu-bordeaux.fr
BACKGROUND: An increase in the incidence and severity of Clostridium difficile-associated disease in Québec and the United States has been associated with a hypervirulent strain referred to as North American pulsed-field type 1 (NAP1)/027.
METHODS: In 2005, a prospective study was conducted in 88 Québec hospitals, and 478 consecutive nosocomial isolates of C. difficile were obtained. The isolates were subjected to pulsed-field gel electrophoresis (PFGE) typing, antimicrobial susceptibility testing, and detection of binary toxin genes and tcdC gene deletion. Data on patient age and occurrence of complications were collected.
RESULTS: PFGE typing of 478 isolates of C. difficile yielded 61 PFGE profiles. Pulsovars A (57%), B (10%), and B1 (8%) were predominant. The PFGE profile of pulsovar A was identical to that of strain NAP1. It showed 67% relatedness with 15 other PFGE patterns, among which 11 had both binary toxin genes and a partial tcdC deletion but different antibiotic susceptibility profiles. Pulsovars B and B1 were identical to strain NAP2/ribotype 001. In hospitals showing a predominant clonal A or B-B1 PFGE pattern, incidence of C. difficile-associated disease was 2 and 1.3 times higher, respectively, than in hospitals without any predominant clonal PFGE pattern. Severe disease was twice as frequent among patients with strains possessing binary toxin genes and tcdC deletion than among patients with strains lacking these virulence factors.
CONCLUSIONS: This study helped to quantify the impact of strain NAP1 on the incidence and severity of C. difficile-associated disease in Québec in 2005. The identification of the geographic dissemination of this predominant strain may help to focus regional infection-control efforts.
University of Chicago Press * Full Text ArticleImplications of the changing face of Clostridium difficile disease for health care practitioners.
Am J Infect Control. 2007 May
McFarland LV, Beneda HW, Clarridge JE, Raugi GJ.
From the Department of Health Services Research and Development, Veterans Administration Puget Sound Health Care System, Seattle, WA 98101, USA. Lynne.McFarland@va.gov
Recent reported outbreaks of Clostridium difficile-associated disease in Canada have changed the profile of C difficile infections.
Historically, C difficile disease was thought of mainly as a nosocomial disease associated with broad-spectrum antibiotics, and the disease was usually not life threatening. The emergence of an epidemic strain, BI/NAP1/027, which produces a binary toxin in addition to the 2 classic C difficile toxins A and B and is resistant to some fluoroquinolones, was associated with large numbers of cases with high rates of mortality.
Recently, C difficile has been reported more frequently in nonhospital-based settings, such as community-acquired cases. The C difficile disease is also being reported in populations once considered of low risk (children and young healthy women). In addition, poor response to metronidazole treatment is increasing. Faced with an increasing incidence of C difficile infections and the changing profile of patients who become infected, this paper will reexamine the current concepts on the epidemiology and treatment of C difficile-associated disease, present new hypotheses for risk factors, examine the role of spores in the transmission of C difficile, and provide recommendations that may enhance infection control practices.
Elsevier
Labels: Clostridium difficile, community acquired, epidemiology, treatment
