Clostridium difficile-Associated Disease in the New Millennium

Abstract

Clostridium difficile and its various clinical manifestations, generally referred to as C. difficile-associated disease (CDAD), have been increasingly reported over the last few years. Greater frequency and severity of CDAD have been linked to a previously uncommon and more virulent strain of C. difficile, identified as BI/NAP1. This strain has now established itself in many parts of the world including North America and several countries in Europe. Clostridium difficile is a unique bacterium in many ways, from its ability to form subterminal spores, methods used for its clinical detection, to the fact that in vitro resistance to primary therapies has not been reported in clinical settings nor does it seem to be playing a role in treatment failures. In some respects, we seem to be in our infancy in our understanding of CDAD. In part, this is because certain strains of C. difficile have undergone rapid diversification; new virulence characteristics have been acquired, and new risk factors have been identified. Because CDAD is an unintended consequence of antimicrobial use, antimicrobial stewardship is vital to its prevention. The environment remains an important vector for the transmission of the organism; thus, hand washing and rigorous environmental cleaning are essential strategies to reduce the dissemination of C. difficile. Several newer therapies are under investigation, but it is unclear that they will be superior to current treatment options.