243 - Clostridioides difficile (Formerly Clostridium difficile) Infection

Abstract

Clostridioides difficile infection (CDI) is an acute diarrhea and colitis that is most often preceded by antimicrobial use and is caused by toxins of an anaerobic spore-forming bacterium, Clostridioides difficile (formerly Clostridium difficile). Patients are exposed to and ingest C. difficile spores in the health care setting. Disruption of the normal microbiota during antibiotic administration can lead to spore germination and vegetative outgrowth of C. difficile with toxin production, leading to clinical disease. Diagnosis of CDI is based on the presence of clinical symptoms coupled with a diagnostic test that detects the presence of either the C. difficile organism or its toxin genes, or detection of C. difficile toxin using an enzyme immunoassay or cell cytotoxin assay. Specific treatment of CDI consists of vancomycin or fidaxomicin orally. For mild-to-moderate disease metronidazole may also be used but is less effective. Recurrence of diarrhea following treatment occurs in 25% of patients and requires re-treatment. Patients with recurrent CDI may benefit from oral vancomycin in a taper and pulse dose, fidaxomicin, or the monoclonal antibody bezlotoxumab. Multiple CDI recurrences are effectively treated with a fecal microbiota transplant to restore the gut microbiota. Prevention in the health care environment is focused on preventing patient exposure to spores of C. difficile. It is exceedingly difficult to prevent spore exposure, so antimicrobial stewardship programs to reduce unnecessary antimicrobial use are extremely effective in limiting the number of susceptible patients. A number of new preventive approaches are undergoing clinical investigation, including vaccines to induce antibodies to toxins A and B, and biotherapeutics that are live bacterial organisms or spores of nontoxigenic C. difficile.