Clostridium Difficile--a Moving Target

Overview

Journal F1000 Med Rep

Specialty General Medicine

Date 2011 Jun 10

PMID 21654927

Citations 5

Authors

Glenn S Tillotson

Joni Tillotson

Affiliations

Soon will be listed here.

Abstract

Clostridium difficile has been recognized as a pathogen in humans for over 40 years, but in the past decade the incidence has increased and, more importantly, the clinical presentation and consequences have become more serious, with increased morbidity and mortality. The emergence of a new, more pathogenic strain, BI/NAP1/027, has driven these shifts. Treatment of this disease has been with two antibiotics, metronidazole and vancomycin, but increasing recurrence, not uncommon with C. difficile infections, has prompted research into several alternative therapies. These include a new class of antibiotic (fidaxomicin), a monoclonal antibody, a vaccine, and most recently a biotherapeutic (which, in this case, is a nontoxin-producing strain of C. difficile). The future management of C. difficile infection will probably require a combination of these approaches once we have the data from ongoing studies.

Citing Articles

Genome-Based Comparison of Clostridioides difficile: Average Amino Acid Identity Analysis of Core Genomes.

Cabal A, Jun S, Jenjaroenpun P, Wanchai V, Nookaew I, Wongsurawat T Microb Ecol. 2018; 76(3):801-813.

PMID: 29445826 PMC: 6132499. DOI: 10.1007/s00248-018-1155-7.

Adherence to and Outcomes Associated with a Clostridium difficile Guideline at a Large Teaching Institution.

Wieczorkiewicz S, Zatarski R Hosp Pharm. 2015; 50(1):42-50.

PMID: 25684800 PMC: 4321428. DOI: 10.1310/hpj5001-42.

Functional analysis of SleC from Clostridium difficile: an essential lytic transglycosylase involved in spore germination.

Gutelius D, Hokeness K, Logan S, Reid C Microbiology (Reading). 2013; 160(Pt 1):209-216.

PMID: 24140647 PMC: 3917228. DOI: 10.1099/mic.0.072454-0.

Equine hyperimmune serum protects mice against Clostridium difficile spore challenge.

Yan W, Shin K, Wang S, Xiang H, Divers T, McDonough S J Vet Sci. 2013; 15(2):249-58.

PMID: 24136208 PMC: 4087227. DOI: 10.4142/jvs.2014.15.2.249.

Protective efficacy induced by recombinant Clostridium difficile toxin fragments.

Leuzzi R, Spencer J, Buckley A, Brettoni C, Martinelli M, Tulli L Infect Immun. 2013; 81(8):2851-60.

PMID: 23716610 PMC: 3719595. DOI: 10.1128/IAI.01341-12.

References

Gerding D . Metronidazole for Clostridium difficile-associated disease: is it okay for Mom?. Clin Infect Dis. 2005; 40(11):1598-600. DOI: 10.1086/430317. View

Tam Dang T, de la Riva L, Fagan R, Storck E, Heal W, Janoir C . Chemical probes of surface layer biogenesis in Clostridium difficile. ACS Chem Biol. 2010; 5(3):279-85. DOI: 10.1021/cb9002859. View

Lyras D, OConnor J, Howarth P, Sambol S, Carter G, Phumoonna T . Toxin B is essential for virulence of Clostridium difficile. Nature. 2009; 458(7242):1176-9. PMC: 2679968. DOI: 10.1038/nature07822. View

Kuehne S, Cartman S, Heap J, Kelly M, Cockayne A, Minton N . The role of toxin A and toxin B in Clostridium difficile infection. Nature. 2010; 467(7316):711-3. DOI: 10.1038/nature09397. View

Pepin J, Valiquette L, Alary M, Villemure P, Pelletier A, Forget K . Clostridium difficile-associated diarrhea in a region of Quebec from 1991 to 2003: a changing pattern of disease severity. CMAJ. 2004; 171(5):466-72. PMC: 514643. DOI: 10.1503/cmaj.1041104. View

Merrigan M, Venugopal A, Mallozzi M, Roxas B, Viswanathan V, Johnson S . Human hypervirulent Clostridium difficile strains exhibit increased sporulation as well as robust toxin production. J Bacteriol. 2010; 192(19):4904-11. PMC: 2944552. DOI: 10.1128/JB.00445-10. View

McDonald L, Owings M, Jernigan D . Clostridium difficile infection in patients discharged from US short-stay hospitals, 1996-2003. Emerg Infect Dis. 2006; 12(3):409-15. PMC: 3291455. DOI: 10.3201/eid1205.051064. View

Lowy I, Molrine D, Leav B, Blair B, Baxter R, Gerding D . Treatment with monoclonal antibodies against Clostridium difficile toxins. N Engl J Med. 2010; 362(3):197-205. DOI: 10.1056/NEJMoa0907635. View

OBrien J, Lahue B, Caro J, Davidson D . The emerging infectious challenge of clostridium difficile-associated disease in Massachusetts hospitals: clinical and economic consequences. Infect Control Hosp Epidemiol. 2007; 28(11):1219-27. DOI: 10.1086/522676. View

10.

Cohen S, Gerding D, Johnson S, Kelly C, Loo V, McDonald L . Clinical practice guidelines for Clostridium difficile infection in adults: 2010 update by the society for healthcare epidemiology of America (SHEA) and the infectious diseases society of America (IDSA). Infect Control Hosp Epidemiol. 2010; 31(5):431-55. DOI: 10.1086/651706. View

11.

McDonald L, Killgore G, Thompson A, Owens Jr R, Kazakova S, Sambol S . An epidemic, toxin gene-variant strain of Clostridium difficile. N Engl J Med. 2005; 353(23):2433-41. DOI: 10.1056/NEJMoa051590. View

12.

Freeman J, Bauer M, Baines S, Corver J, Fawley W, Goorhuis B . The changing epidemiology of Clostridium difficile infections. Clin Microbiol Rev. 2010; 23(3):529-49. PMC: 2901659. DOI: 10.1128/CMR.00082-09. View

13.

Miller M, Bernard L, Thompson M, Grima D, Pepin J . Lack of increased colonization with vancomycin-resistant enterococci during preferential use of vancomycin for treatment during an outbreak of healthcare-associated Clostridium difficile infection. Infect Control Hosp Epidemiol. 2010; 31(7):710-5. DOI: 10.1086/653613. View

14.

Henrich T, Krakower D, Bitton A, Yokoe D . Clinical risk factors for severe Clostridium difficile-associated disease. Emerg Infect Dis. 2009; 15(3):415-22. PMC: 2681109. DOI: 10.3201/eid1503.080312. View

15.

Zilberberg M, Tillotson G, McDonald C . Clostridium difficile infections among hospitalized children, United States, 1997-2006. Emerg Infect Dis. 2010; 16(4):604-9. PMC: 3363321. DOI: 10.3201/eid1604.090680. View

16.

Zar F, Bakkanagari S, Moorthi K, Davis M . A comparison of vancomycin and metronidazole for the treatment of Clostridium difficile-associated diarrhea, stratified by disease severity. Clin Infect Dis. 2007; 45(3):302-7. DOI: 10.1086/519265. View

17.

Songer J . Clostridia as agents of zoonotic disease. Vet Microbiol. 2009; 140(3-4):399-404. DOI: 10.1016/j.vetmic.2009.07.003. View

18.

Clements A, Soares Magalhaes R, Tatem A, Paterson D, Riley T . Clostridium difficile PCR ribotype 027: assessing the risks of further worldwide spread. Lancet Infect Dis. 2010; 10(6):395-404. PMC: 7185771. DOI: 10.1016/S1473-3099(10)70080-3. View