Early Diagnosis, Prevention, and Treatment of Clostridium difficile: Update
Clostridium difficile is a gram-positive, anaerobic bacterium generally associated through ingestion. Various strains of the bacteria may produce disease generating toxins
and TedA and TedB, as well as the lesser understood binary toxin.
Our use of the term indicates this review’s focus is the presence of clinical disease rather than asymptomatic carriage of C. difficile CDI symptoms can range from mild diarrhea to severe cases including pseudomembranous colitis and toxic megacolon and death.
Estimated U.S. health care associated CDI incidence in 2011 was 95.3 per 100,000, or about
293,000 cases nationally. Incidence is higher among females, whites, and persons 65 years of
age or older. (1)
About one third to one half of health-care onset CDI cases begin in long term care,thus residents in these facilities are at high risk. Incidence rates may increase by four or five-fold during outbreaks.
Community associated CDI, where CDI occurs outside the institutional setting,
is also on the rise, though still generally lower than institution associated rates and may be in part due to increased surveillance. Estimated community associated CDI was 51.9 per 100,000, or 159,700 cases in 2011. (1)
Community-associated CDI complicates measuring the effectiveness of prevention within an institutional setting. 3 Additionally, the pathogenesis of CDI is complex and not
completely understood, and onset may occur as late as several months after hospitalization or antibiotic use
The estimated mortality rate for health -care associated CDI ranged from 2.4 to 8.9 deaths per
was 55.1 deaths per 100,000; (1)
CDI was the 17th leading cause of death in this age group (4)
Hypervirulent C. difficile strains have emerged since 2000 . These affect a wider population
adults, many of whom lack standard risk profiles such as previous hospitalization or antibiotic use.(5)
The hypervirulent strains account for 51 percent of CDI, compared to only 17 percent
of historical isolates. (6)
Time from symptom development to septic shock may be reduced in the hypervirulent strains, making quick diagnosis and proactive treatment regimens critical for positive outcomes.
To read more on TREATMENT, PREVENTION, KEY QUESTIONS ——
https://www.effectivehealthcare.ahrq.gov/ehc/products/604/2208/c-difficile-update-report-160329.pdf
Early Diagnosis, Prevention, and Treatment of Clostridium difficile: Update
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