Clostridium difficile Infection: an update on treatment and prevention

Czech version

Authors: Roman Stebel; Lenka Vojtilová; Petr Husa
Authors‘ workplace: Klinika infekčních chorob LF MU a FN Brno, pracoviště Bohunice
Published in: Vnitř Lék 2020; 66(2): 58-62
Category:

Overview

Disruption of the colonic microflora is one of the most significant adverse effects of antibiotic (ATB) therapy. Excessive multiplication of toxigenic Clostridioides difficile strains is responsible for about 20 % of cases of post-antibiotic diarrhoea. The global trend of Clostridium colitis incidence, severity, mortality and in particular therapeutic failure keeps rising. At the Department of Infectious Diseases we work on long-term monitoring of the most important colitis-associated risk factors and evaluation of individual therapeutic and preventive procedures (selective ATB therapy, faecal bacteriotherapy). A diligent analysis of risk factors and knowledge of pathogenesis are a prerequisite to practical implementation of effective and rational precautions to curb spreading of this illness. In the future, we anticipate increased use of fecal microbiota transplant, improvements in faecal transplant administration, wider use of probiotics and selective ATBs and further introduction of passive and active immunization into practice.

Keywords:

Clostridioides difficile – fecal microbiota transplant – fidaxomicin – intestinal dysbiosis – passive immunotherapy – probiotics

Sources

1. Al -Jashaami LS, Dupont HL. Management of Clostridium difficile Infection. Gastroenterol Hepatol 2016; 12: 609–616.

2. Mills JP, Rao K, Young VB. Probiotics for prevention of Clostridium difficile infection. Curr Opin Gastroenterol 2018; 34: 3–10.

3. Napolitano LM, Edmiston CE. Clostridium difficile disease: Diagnosis, pathogenesis, and treatment update. Surgery 2017; 162: 325–348.

4. Yacyshyn B. Pathophysiology of Clostridium difficile -Associated Diarrhea. Gastroenterol Hepatol 2016; 12: 558–560.

5. McDonald LC, Gerding DN, Johnson S et al. Clinical Practice Guidelines for Clostridium difficile Infection in Adults and Children. Clin Infect Dis 2018; 66: 1–48.

6. Ooijevaar RE, Van Beurden YH, Terveer EM et al. Update of treatment algorithms for Clostridium difficile infection. Clin Microbiol Infect 2018; 24: 452–462.

7. Beneš J, Husa P, Nyč O et al. Doporučený postup diagnostiky a léčby kolitidy vyvolané Clostridium difficile. Postgraduální gastroenterologie & hepatologie 2015; 1: 304-313.

8. Pate K, Reece J, Smyre A A. Multifaceted Approach to the Prevention of Clostridioides (Clostridium) Difficile. Clin Nurse Spec 2019; 33: 75–81.

9. Shen NT, Maw A, Tmanova LL et al. Timely Use of Probiotics in Hospitalized Adults Prevents Clostridium difficile Infection: A Systematic Review With Meta -Regression Analysis. Gastroenterology 2017; 152: 1889–1900.

10. Hota SS, Sales V, Tomlinson G et al. Oral Vancomycin Followed by Fecal Transplantation Versus Tapering Oral Vancomycin Treatment for Recurrent Clostridium difficile Infection. Clin Infect Dis 2016; 64: 265–271.

11. Li YT, Cai HF, Wang ZH et al. Systematic review with meta -analysis: long -term outcomes of faecal microbiota transplantation for Clostridium difficile infection. Aliment Pharmacol Ther 2016; 43: 445–457.

12. Cammarota G, Ianiro G, Gasbarrini A Fecal microbiota transplantation for the treatment of Clostridium difficile infection: a systematic review. J Clin Gastroenterol 2014; 48: 693–702.

13. Weingarden AR, Chen C, Zhang N et al. Ursodeoxycholic Acid Inhibits Clostridium difficile Spore Germination and Vegetative Growth, and Prevents the Recurrence of Ileal Pouchitis Associated With the Infection. J Clin Gastroenterol 2016; 50: 624–630.

14. Wilcox MH, Gerding DN, Poxton IR et al. Bezlotoxumab for Prevention of Recurrent Clostridium difficile Infection. N Engl J Med 2017; 376: 305–317.