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Clostridium difficile-Associated Disease

Changing Epidemiology and Implications for Management

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Abstract

Clostridium difficile-associated disease (CDAD) is increasingly being reported in many regions throughout the world. The reasons for this are unknown, are likely to be multifactorial, and are the subject of several current investigations. In addition to the upsurge in frequency of CDAD, an increased rate of relapse/recurrence, disease severity and refractoriness to traditional treatment have also been noted. Moreover, severe disease has been reported in non-traditional hosts (e.g. younger age, seemingly healthy, non-institutionalised individuals residing in the community, and some without apparent antimicrobial exposure). A previously uncommon and more virulent strain of C. difficile has been reported at the centre of multiple transcontinental outbreaks. The appearance of this more virulent strain, in association with certain environmental and antimicrobial exposure factors, may be combining to create the ‘perfect storm’. It is human nature to be reactive; however, the successful control of C. difficile will require healthcare systems (including administrators, and leadership within several departments such as environmental services, infection control, infectious diseases, gastroenterology, surgery, microbiology and nursing), clinicians, long-term care and rehabilitation facilities, and patients themselves to be proactive in a collaborative effort. Guidelines for the management of CDAD were last published over a decade ago, with the next iteration due in the fall (autumn) of 2007. Several newer therapies are under investigation but it is unclear whether they will be superior to current treatment options.

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Acknowledgements

I would like to express my deep gratitude to Drs Dale Gerding, Mark Wilcox and Tobi Karchmer for their input into the treatment algorithm used at our hospital.

No financial support was provided for the preparation of this manuscript. Dr Owens has acted as a consultant to Viropharma, Elan, Ortho McNeil, Schering Plough and Bayer.

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  1. Department of Clinical Pharmacy Services and Division of Infectious Diseases, Maine Medical Center, 22 Bramhall Street, Portland, Maine, 04102, USA

    Robert C. Owens Jr

  2. Department of Medicine, University of Vermont, College of Medicine, Burlington, Vermont, USA

    Robert C. Owens Jr

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Owens, R.C. Clostridium difficile-Associated Disease. Drugs 67, 487–502 (2007). https://doi.org/10.2165/00003495-200767040-00001

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