Abstract
Clostridium difficile infection (CDI) continues to affect patients in hospitals and communities worldwide. The spectrum of clinical disease ranges from mild diarrhoea to toxic megacolon, colonic perforation and death. However, this bacterium might also be carried asymptomatically in the gut, potentially leading to 'silent' onward transmission. Modern technologies, such as whole-genome sequencing and multi-locus variable-number tandem-repeat analysis, are helping to track C. difficile transmission across health-care facilities, countries and continents, offering the potential to illuminate previously under-recognized sources of infection. These typing strategies have also demonstrated heterogeneity in terms of CDI incidence and strain types reflecting different stages of epidemic spread. However, comparison of CDI epidemiology, particularly between countries, is challenging due to wide-ranging approaches to sampling and testing. Diagnostic strategies for C. difficile are complicated both by the wide range of bacterial targets and tests available and the need to differentiate between toxin-producing and non-toxigenic strains. Multistep diagnostic algorithms have been recommended to improve sensitivity and specificity. In this Review, we describe the latest advances in the understanding of C. difficile epidemiology, transmission and diagnosis, and discuss the effect of these developments on the clinical management of CDI.
Highlights
Clostridium difficile is an anaerobic spore-forming Gram-positive bacillus which is able to colonise and proliferate in the human gut, especially following changes in the indigenous colonic microbiota after antibiotic use
8 Novel fingerprinting techniques, notably whole genome sequencing (WGS) and multi-locus variable-number tandem-repeat analysis (MLVA), have indicated that C. difficile can be acquired from a wide range of sources, 9 possibly including undiagnosed symptomatic cases, asymptomatic carriers, animals and food
We summarize the key advancements in Clostridium difficile infection (CDI) epidemiology, diagnosis and understanding of transmission
Summary
Clostridium difficile infection (CDI) continues to affect many patients in hospitals and communities worldwide. Modern technologies, such as whole genome sequencing, are helping to track C. difficile transmission across healthcare facilities, countries and continents. Comparison of CDI epidemiology between countries is challenging due to the varied approaches to sampling and diagnosis. In this Review, we describe recent advances in the understanding of C. difficile epidemiology, transmission and diagnosis and discuss the impact these developments have on clinical management of CDI. The optimal approach to sampling and testing for CDI remains a contentious issue. Multistep algorithms are recommended to improve diagnostic sensitivity and specificity
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