Clostridium difficile infections in geriatric patients

Abstract

Clostridium difficile is the main cause of nosocomial antibiotic-associated diarrhea in adults in Europe and North America. Infections with C. difficile typically occur in elderly patients with comorbidities and prior antibiotic therapy. Other risk factors are proton pump inhibitors, which are taken by many elderly patients. The main virulence factors are toxinsA andB. The clinical spectrum ranges from asymptomatic colonization to severe disease with abdominal complications and sepsis. The current diagnostic gold standard is anaerobic culture but is impractical in routine use due to the long duration. Proven techniques involve glutamate dehydrogenase, toxinsA and B immunoassays and PCR. First infections and recurrences can be treated with 400-500mg metronidazole 3 times aday for 10days. Further recurrences, serious infections or patients with more than two positive predictors should be treated orally with 125mg vancomycin 4 times aday for at least 10days. Fidaxomicin, rifaximin, stool transplantation and monoclonal antibodies are promising alternative therapies.