New advances in Clostridium difficile infection:: changing epidemiology, diagnosis, treatment and control

Purpose of review Clostridium difficile infection and Clostridium difficile-associated diarrhea (CDAD) are growing worldwide health threats. Recent studies have identified new host risk factors, diagnostic approaches and therapies of CDAD. The present review focuses on scientific papers published in the past 18 months in an attempt to provide the latest information on the topic. Recent findings We are seeing an increasing number of patients with Clostridium difficile infection developing their illness in the community, although many were recently discharged from a healthcare setting suggesting an acquisition of infection in the hospital environment. The use of gastric acid-altering drugs that facilitate intestinal transit of the bacteria, antibacterial drugs that deplete colonic flora and presence of inflammatory bowel disease are risk factors for CDAD. Fulminant CDAD is increasing, complicated by leukocytosis (peripheral white blood cell count > 16 000/mm(3)),hypoalbuminemia, renal failure and emergency colectomy, with overall rise in CDAD disease mortality rates. Although vancomycin is recommended for severe cases of CDAD, recurrence rates remain high. Control of Clostridium difficile infection in the hospital setting focuses on disinfection of the environment and antibiotic stewardship policies. Anti-Clostridium difficile vaccines are in development. Summary CDAD is an increasing health problem throughout the United States, Canada and Europe with rising mortality rate. Occurrence of CDAD outside of healthcare settings and in pediatric populations represents newly emerging problems. New treatments are needed.