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Geriatric Gastroenterology pp 1–19Cite as

Clostridium (Now Clostridioides) difficile-Associated Disease

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Abstract

Clostridium (Clostridioides) difficile is a spore-forming anaerobe bacterium that produces toxins causing mucosal inflammation of the colon resulting in diarrhea and/or colitis, usually in those with a disrupted normal colon microbiome. The Centers for Disease Control and Prevention classifies C. difficile infection (CDI) as an urgent public health threat. It disproportionately affects older adults in incidence, in morbidity and mortality, and in the likelihood of discharge to long-term care facilities. Initial episodes and recurrent CDI have increased due to epidemic hypervirulent strains with increased antibiotic resistance. Up to 7% of healthy adults are C. difficile carriers. Previously associated with antibiotic use and hospitalization, 40–60% of CDI now may be community-acquired. Diagnosis is based on clinical discernment substantiated by testing for the organism or its toxin in stools; current tests do not always reliably predict infection. Vancomycin or fidaxomicin is recommended for the initial infection and first recurrence. Metronidazole is only recommended in mild disease when preferred antibiotics are unavailable, because of increased resistance of the organism. Multiple guidelines recommend fecal microbiota transplant for recurrent disease not responding to standard antibiotics. Treatment of asymptomatic carriage is not recommended. Prevention includes antibiotic stewardship, handwashing, isolation, and sporicidal cleansing. Research is focused on prevention, restoration of C. difficile-resistant microbial communities, repletion of immune resistance, and improved therapies for active infection.

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Reference

  • Agrawal M, Aroniadis OC, Brandt LJ, Kelly C, Freeman S, Surawicz C, Broussard E, Stollman N, Giovanelli A, Smith B, Yen E, Trivedi A, Hubble L, Kao D, Borody T, Finlayson S, Ray A, Smith R. The long-term efficacy and safety of fecal microbiota transplant for recurrent, severe, and complicated Clostridium difficile infection in 146 elderly individuals. J Clin Gastroenterol. 2016;50(5):403–7.

    PubMed  Google Scholar 

  • Al Momani LA, Abughanimeh O, Boonpheng B, Gabriel JG, Young M. Fidaxomicin vs vancomycin for the treatment of a first episode of Clostridium Difficile infection: a meta-analysis and systematic review. Cureus. 2018;10(6):e2778.

    PubMed  PubMed Central  Google Scholar 

  • Allegretti JR, Kao D, Phelps E, Roach B, Smith J, Ganapini VC, Kassam Z, Xu H, Fischer M. Risk of Clostridium difficile infection with systemic antimicrobial therapy following successful fecal microbiota transplant: should we recommend anti-Clostridium difficile antibiotic prophylaxis? Dig Dis Sci. 2019;64:1668.

    Article  CAS  PubMed  Google Scholar 

  • Allen SJ, Wareham K, Bradley C, Harris W, Dhar A, Brown H, Foden A, Cheung WY, Gravenor MB, Plummer S, Phillips CJ, Mack D. A multicentre randomised controlled trial evaluating lactobacilli and bifidobacteria in the prevention of antibiotic-associated diarrhoea in older people admitted to hospital: the PLACIDE study protocol. BMC Infect Dis. 2012;12:108.

    Article  PubMed  PubMed Central  Google Scholar 

  • Al-Nassir WN, Sethi AK, Li Y, Pultz MJ, Riggs MM, Donskey CJ. Both oral metronidazole and oral vancomycin promote persistent overgrowth of vancomycin-resistant enterococci during treatment of Clostridium difficile-associated disease. Antimicrob Agents Chemother. 2008;52(7):2403–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Bakken JS. Staggered and tapered antibiotic withdrawal with administration of kefir for recurrent Clostridium difficile infection. Clin Infect Dis. 2014;59(6):858–61.

    Article  PubMed  Google Scholar 

  • Balsells E, Shi T, Leese C, Lyell I, Burrows J, Wiuff C, Campbell H, Kyaw MH, Nair H. Global burden of Clostridium difficile infections: a systematic review and meta-analysis. J Glob Health. 2019;9(1):010407.

    Article  PubMed  Google Scholar 

  • Barkin JA, Sussman DA, Fifadara N, Barkin JS. Clostridium difficile infection and patient-specific antimicrobial resistance testing reveals a high metronidazole resistance rate. Dig Dis Sci. 2017;62(4): 1035–42.

    Article  CAS  PubMed  Google Scholar 

  • Barrett ML, Owens P. Clostridium Difficile hospitalizations, 2011–2015. Rockville: U.S. Agency for Healthcare Research and Quality; 2018.

    Google Scholar 

  • Bishop EJ, Tiruvoipati R, Metcalfe J, Marshall C, Botha J, Kelley PG. The outcome of patients with severe and severe-complicated Clostridium difficile infection treated with tigecycline combination therapy: a retrospective observational study. Intern Med J. 2018;48(6):651–60.

    Article  CAS  PubMed  Google Scholar 

  • Butler M, Bliss D, Drekonja D, Filice G, Rector T, MacDonald R, Wilt T. AHRQ comparative effectiveness reviews. In: Effectiveness of early diagnosis, prevention, and treatment of Clostridium difficile infection. Rockville: Agency for Healthcare Research and Quality (US); 2011.

    Google Scholar 

  • Cammarota G, Ianiro G, Tilg H, Rajilic-Stojanovic M, Kump P, Satokari R, Sokol H, Arkkila P, Pintus C, Hart A, Segal J, Aloi M, Masucci L, Molinaro A, Scaldaferri F, Gasbarrini G, Lopez-Sanroman A, Link A, de Groot P, de Vos WM, Hogenauer C, Malfertheiner P, Mattila E, Milosavljevic T, Nieuwdorp M, Sanguinetti M, Simren M, Gasbarrini A. European consensus conference on faecal microbiota transplantation in clinical practice. Gut. 2017;66(4):569–80.

    Article  PubMed  Google Scholar 

  • CDC. Antibiotic resistance threats in the United States, 2013. Cdc-pdf https://www.cdc.gov/drugresistance/pdf/ar-threats-2013-508

  • Chang JY, Antonopoulos DA, Kalra A, Tonelli A, Khalife WT, Schmidt TM, Young VB. Decreased diversity of the fecal microbiome in recurrent Clostridium difficile-associated diarrhea. J Infect Dis. 2008;197(3):435–8.

    Article  PubMed  Google Scholar 

  • Cheng YW, Fischer M. The present status of fecal microbiota transplantation and its value in the elderly. Curr Treat Options Gastroenterol. 2017;15(3):349–62.

    Article  PubMed  Google Scholar 

  • Chitnis AS, Holzbauer SM, Belflower RM, Winston LG, Bamberg WM, Lyons C, Farley MM, Dumyati GK, Wilson LE, Beldavs ZG, Dunn JR, Gould LH, MacCannell DR, Gerding DN, McDonald LC, Lessa FC. Epidemiology of community-associated Clostridium difficile infection, 2009 through 2011. JAMA Intern Med. 2013;173(14):1359–67.

    Article  PubMed  Google Scholar 

  • Collins J, Robinson C, Danhof H, Knetsch CW, van Leeuwen HC, Lawley TD, Auchtung JM, Britton RA. Dietary trehalose enhances virulence of epidemic Clostridium difficile. Nature. 2018;553(7688):291–4.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Culligan EP, Sleator RD. Advances in the microbiome: applications to Clostridium difficile infection. J Clin Med. 2016;5(9):83.

    Article  PubMed Central  CAS  Google Scholar 

  • Curry SR. Clostridium difficile. Clin Lab Med. 2017;37(2):341–69.

    Article  PubMed  Google Scholar 

  • Davido B, Leplay C, Bouchand F, Dinh A, Villart M, Le Quintrec JL, Teillet L, Salomon J, Michelon H. Oral Teicoplanin as an alternative first-line regimen in Clostridium difficile infection in elderly patients: a case series. Clin Drug Investig. 2017;37(7):699–703.

    Article  CAS  PubMed  Google Scholar 

  • Davies KA, Planche T, Wilcox MH. The predictive value of quantitative nucleic acid amplification detection of Clostridium difficile toxin gene for faecal sample toxin status and patient outcome. PLoS One. 2018;13(12):e0205941.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Davis MY, Zhang H, Brannan LE, Carman RJ, Boone JH. Rapid change of fecal microbiome and disappearance of Clostridium difficile in a colonized infant after transition from breast milk to cow milk. Microbiome. 2016;4(1):53.

    Article  PubMed  PubMed Central  Google Scholar 

  • Donskey CJ, Kundrapu S, Deshpande A. Colonization versus carriage of Clostridium difficile. Infect Dis Clin N Am. 2015;29(1):13–28.

    Article  Google Scholar 

  • Dubberke ER, Burnham CA. Diagnosis of Clostridium difficile infection: treat the patient, not the test. JAMA Intern Med. 2015;175(11):1801–2.

    Article  PubMed  Google Scholar 

  • Duggal NA. Reversing the immune ageing clock: lifestyle modifications and pharmacological interventions. Biogerontology. 2018;19(6):481–96.

    Article  PubMed  PubMed Central  Google Scholar 

  • Elias R, Hartshorn K, Rahma O, Lin N, Snyder-Cappione JE. Aging, immune senescence, and immunotherapy: a comprehensive review. Semin Oncol. 2018;45(4): 187–200.

    Article  PubMed  Google Scholar 

  • Eze P, Balsells E, Kyaw MH, Nair H. Risk factors for Clostridium difficile infections – an overview of the evidence base and challenges in data synthesis. J Glob Health. 2017;7(1):010417.

    Article  PubMed  PubMed Central  Google Scholar 

  • Fang FC, Polage CR, Wilcox MH. Point-counterpoint: what is the optimal approach for detection of Clostridium difficile infection? J Clin Microbiol. 2017;55(3): 670–80.

    Article  PubMed  PubMed Central  Google Scholar 

  • Fashandi AZ, Wang PT, Hedrick TL, Friel CM, Hays RA, Hallowell PT. Recurrent Clostridium difficile infection after diverting loop ileostomy and colonic lavage: an unreported complication of the novel surgical therapy. Am Surg. 2017;83(8):e335–8.

    PubMed  Google Scholar 

  • Fischer M, Sipe BW, Rogers NA, Cook GK, Robb BW, Vuppalanchi R, Rex DK. Faecal microbiota transplantation plus selected use of vancomycin for severe-complicated Clostridium difficile infection: description of a protocol with high success rate. Aliment Pharmacol Ther. 2015;42(4):470–6.

    Article  CAS  PubMed  Google Scholar 

  • Fischer M, Sipe B, Cheng YW, Phelps E, Rogers N, Sagi S, Bohm M, Xu H, Kassam Z. Fecal microbiota transplant in severe and severe-complicated Clostridium difficile: a promising treatment approach. Gut Microbes. 2017;8(3):289–302.

    Article  CAS  PubMed  Google Scholar 

  • Friedman-Korn T, Livovsky DM, Maharshak N, Aviv Cohen N, Paz K, Bar-Gil Shitrit A, Goldin E, Koslowsky B. Fecal transplantation for treatment of Clostridium Difficile infection in elderly and debilitated patients. Dig Dis Sci. 2018;63(1):198–203.

    Article  PubMed  Google Scholar 

  • Fuentes S, van Nood E, Tims S, Heikamp-de Jong I, ter Braak CJ, Keller JJ, Zoetendal EG, de Vos WM. Reset of a critically disturbed microbial ecosystem: faecal transplant in recurrent Clostridium difficile infection. ISME J. 2014;8(8):1621–33.

    Article  PubMed  PubMed Central  Google Scholar 

  • Fujitani S, George WL, Murthy AR. Comparison of clinical severity score indices for Clostridium difficile infection. Infect Control Hosp Epidemiol. 2011;32(3):220–8.

    Article  PubMed  Google Scholar 

  • Gerding DN, Meyer T, Lee C, Cohen SH, Murthy UK, Poirier A, Van Schooneveld TC, Pardi DS, Ramos A, Barron MA, Chen H, Villano S. Administration of spores of nontoxigenic Clostridium difficile strain M3 for prevention of recurrent C. difficile infection: a randomized clinical trial. JAMA. 2015;313(17):1719–27.

    Article  PubMed  Google Scholar 

  • Gerding DN, Kelly CP, Rahav G, Lee C, Dubberke ER, Kumar PN, Yacyshyn B, Kao D, Eves K, Ellison MC, Hanson ME, Guris D, Dorr MB. Bezlotoxumab for prevention of recurrent Clostridium difficile infection in patients at increased risk for recurrence. Clin Infect Dis. 2018a;67(5):649–56.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Gerding DN, Sambol SP, Johnson S. Non-toxigenic Clostridioides (Formerly Clostridium) difficile for prevention of C. difficile infection: from bench to bedside Back to bench and Back to bedside. Front Microbiol. 2018b;9:1700.

    Article  PubMed  PubMed Central  Google Scholar 

  • Girotra M, Garg S, Anand R, Song Y, Dutta SK. Fecal microbiota transplantation for recurrent Clostridium difficile infection in the elderly: long-term outcomes and microbiota changes. Dig Dis Sci. 2016;61(10):3007–15.

    Article  PubMed  Google Scholar 

  • Goldstein EJ, Babakhani F, Citron DM. Antimicrobial activities of fidaxomicin. Clin Infect Dis. 2012;55(Suppl 2):S143–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Gonzales M, Pepin J, Frost EH, Carrier JC, Sirard S, Fortier LC, Valiquette L. Faecal pharmacokinetics of orally administered vancomycin in patients with suspected Clostridium difficile infection. BMC Infect Dis. 2010;10:363.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Guery B, Menichetti F, Anttila VJ, Adomakoh N, Aguado JM, Bisnauthsing K, Georgopali A, Goldenberg SD, Karas A, Kazeem G, Longshaw C, Palacios-Fabrega JA, Cornely OA, Vehreschild M. Extended-pulsed fidaxomicin versus vancomycin for Clostridium difficile infection in patients 60 years and older (EXTEND): a randomised, controlled, open-label, phase 3b/4 trial. Lancet Infect Dis. 2018;18(3):296–307.

    Article  CAS  PubMed  Google Scholar 

  • Hall BR, Leinicke JA, Armijo PR, Smith LM, Langenfeld SJ, Oleynikov D. No survival advantage exists for patients undergoing loop ileostomy for clostridium difficile colitis. Am J Surg. 2019;217(1):34–9.

    Article  PubMed  Google Scholar 

  • Hvas CL, Jorgensen SMD, Jorgensen SP, Storgaard M, Lemming L, Hansen MM, Erikstrup C, Dahlerup JF. Fecal microbiota transplantation is superior to Fidaxomicin for treatment of recurrent Clostridium difficile infection. Gastroenterology. 2019;156:1324.

    Article  PubMed  Google Scholar 

  • Ianiro G, Maida M, Burisch J, Simonelli C, Hold G, Ventimiglia M, Gasbarrini A, Cammarota G. Efficacy of different faecal microbiota transplantation protocols for Clostridium difficile infection: a systematic review and meta-analysis. United European Gastroenterol J. 2018;6(8):1232–44.

    Article  PubMed  PubMed Central  Google Scholar 

  • Isaac S, Scher JU, Djukovic A, Jimenez N, Littman DR, Abramson SB, Pamer EG, Ubeda C. Short- and long-term effects of oral vancomycin on the human intestinal microbiota. J Antimicrob Chemother. 2017;72(1): 128–36.

    Article  CAS  PubMed  Google Scholar 

  • Johnson S. Evidence-based approach to Clostridium difficile infection. Gastroenterol Hepatol (NY). 2017;13(4):238–41.

    Google Scholar 

  • Johnson S, Gerding DN. Treatment of recurrent Clostridium difficile infection. JAMA. 2019;321(5):512–3.

    Article  PubMed  Google Scholar 

  • Johnson S, Homann SR, Bettin KM, Quick JN, Clabots CR, Peterson LR, Gerding DN. Treatment of asymptomatic Clostridium difficile carriers (fecal excretors) with vancomycin or metronidazole. A randomized, placebo-controlled trial. Ann Intern Med. 1992;117(4):297–302.

    Article  CAS  PubMed  Google Scholar 

  • Johnson S, Louie TJ, Gerding DN, et al. Polymer Alternative for CDI Treatment (PACT) Investigators Vancomycin, metronidazole, or tolevamer for Clostridium difficile infection: results from two multinational, randomized, controlled trials. Clin Infect Dis. 2014;59:345–54.

    Article  CAS  PubMed  Google Scholar 

  • Johnston BC, Supina AL, Vohra S. Probiotics for pediatric antibiotic-associated diarrhea: a meta-analysis of randomized placebo-controlled trials. CMAJ. 2006;175(4):377–83.

    Article  PubMed  PubMed Central  Google Scholar 

  • Kao D, Roach B, Silva M, Beck P, Rioux K, Kaplan GG, Chang HJ, Coward S, Goodman KJ, Xu H, Madsen K, Mason A, Wong GK, Jovel J, Patterson J, Louie T. Effect of Oral capsule- vs colonoscopy-delivered fecal microbiota transplantation on recurrent Clostridium difficile infection: a randomized clinical trial. JAMA. 2017;318(20):1985–93.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Khanna S, Shin A, Kelly CP. Management of Clostridium difficile infection in inflammatory bowel disease: expert review from the clinical practice updates committee of the AGA Institute. Clin Gastroenterol Hepatol. 2017;15(2):166–74.

    Article  PubMed  Google Scholar 

  • Kokai-Kun JF, Sarver JL, Carman RJ. Characterization of Clostridium difficile isolates collected during a phase 2b clinical study with SYN-004 (ribaxamase) for the prevention of C. difficile infection. Anaerobe. 2018;53:30.

    Article  PubMed  Google Scholar 

  • Kuijper EJ, Coignard B, Tull P. Emergence of Clostridium difficile-associated disease in North America and Europe. Clin Microbiol Infect. 2006;12(Suppl 6):2–18.

    Article  CAS  PubMed  Google Scholar 

  • Kundrapu S, Sunkesula V, Jury I, Deshpande A, Donskey CJ. A randomized trial of soap and water hand wash versus alcohol hand rub for removal of Clostridium difficile spores from hands of patients. Infect Control Hosp Epidemiol. 2014;35(2):204–6.

    Article  PubMed  Google Scholar 

  • Kyne L, Warny M, Qamar A, Kelly CP. Asymptomatic carriage of Clostridium difficile and serum levels of IgG antibody against toxin A. N Engl J Med. 2000;342(6): 390–7.

    Article  CAS  PubMed  Google Scholar 

  • Lawley TD, Clare S, Walker AW, Goulding D, Stabler RA, Croucher N, Mastroeni P, Scott P, Raisen C, Mottram L, Fairweather NF, Wren BW, Parkhill J, Dougan G. Antibiotic treatment of clostridium difficile carrier mice triggers a supershedder state, spore-mediated transmission, and severe disease in immunocompromised hosts. Infect Immun. 2009;77(9):3661–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Lee C, Louie TJ, Weiss K, Valiquette L, Gerson M, Arnott W, Gorbach SL. Fidaxomicin versus vancomycin in the treatment of Clostridium difficile infection: Canadian outcomes. Can J Infect Dis Med Microbiol. 2016;2016:8048757.

    Article  PubMed  PubMed Central  Google Scholar 

  • Lessa FC, Mu Y, Bamberg WM, Beldavs ZG, Dumyati GK, Dunn JR, Farley MM, Holzbauer SM, Meek JI, Phipps EC, Wilson LE, Winston LG, Cohen JA, Limbago BM, Fridkin SK, Gerding DN, McDonald LC. Burden of Clostridium difficile infection in the United States. N Engl J Med. 2015;372(9):825–34.

    Article  CAS  PubMed  Google Scholar 

  • Liang SY, Mackowiak PA. Infections in the elderly. Clin Geriatr Med. 2007;23(2):441–56, viii

    Article  PubMed  Google Scholar 

  • Louie TJ, Miller MA, Mullane KM, Weiss K, Lentnek A, Golan Y, Gorbach S, Sears P, Shue YK. Fidaxomicin versus vancomycin for Clostridium difficile infection. N Engl J Med. 2011;364(5):422–31.

    Article  CAS  PubMed  Google Scholar 

  • Ma GK, Brensinger CM, Wu Q, Lewis JD. Increasing incidence of multiply recurrent Clostridium difficile infection in the United States: a cohort study. Ann Intern Med. 2017;167(3):152–8.

    Article  PubMed  Google Scholar 

  • Madan R, Petri WA Jr. Immune responses to Clostridium difficile infection. Trends Mol Med. 2012;18(11): 658–66.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • McDonald LC, Owings M, Jernigan DB. Clostridium difficile infection in patients discharged from US short-stay hospitals, 1996–2003. Emerg Infect Dis. 2006;12(3):409–15.

    Article  PubMed  PubMed Central  Google Scholar 

  • McDonald JAK, Mullish BH, Pechlivanis A, Liu Z, Brignardello J, Kao D, Holmes E, Li JV, Clarke TB, Thursz MR, Marchesi JR. Inhibiting growth of Clostridioides difficile by restoring Valerate, produced by the intestinal microbiota. Gastroenterology. 2018a;155(5):1495–1507.e1415.

    Article  CAS  PubMed  Google Scholar 

  • McDonald LC, Gerding DN, Johnson S, Bakken JS, Carroll KC, Coffin SE, Dubberke ER, Garey KW, Gould CV, Kelly C, Loo V, Shaklee Sammons J, Sandora TJ, Wilcox MH. Clinical practice guidelines for Clostridium difficile infection in adults and children: 2017 update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA). Clin Infect Dis. 2018b;66(7):987–94.

    Article  CAS  PubMed  Google Scholar 

  • McFarland LV. Epidemiology, risk factors and treatments for antibiotic-associated diarrhea. Dig Dis. 1998;16(5):292–307.

    Article  CAS  PubMed  Google Scholar 

  • McFarland LV. Systematic review and meta-analysis of Saccharomyces boulardii in adult patients. World J Gastroenterol. 2010;16(18):2202–22.

    Article  PubMed  PubMed Central  Google Scholar 

  • McFarland LV. Probiotics for the primary and secondary prevention of C. difficile infections: a meta-analysis and systematic review. Antibiotics (Basel). 2015;4(2): 160–78.

    Article  CAS  Google Scholar 

  • McFarland LV, Surawicz CM, Rubin M, Fekety R, Elmer GW, Greenberg RN. Recurrent Clostridium difficile disease: epidemiology and clinical characteristics. Infect Control Hosp Epidemiol. 1999;20(1):43–50.

    Article  CAS  PubMed  Google Scholar 

  • Minino AM, Xu J, Kochanek KD. Deaths: preliminary data for 2008 Hyattsville. Hyattsville: National Center for Health Statistics; 2010.

    Google Scholar 

  • Moayyedi P, Yuan Y, Baharith H, Ford AC. Faecal microbiota transplantation for Clostridium difficile-associated diarrhoea: a systematic review of randomised controlled trials. Med J Aust. 2017;207(4):166–72.

    Article  PubMed  Google Scholar 

  • Mullish BH, Quraishi MN, Segal JP, McCune VL, Baxter M, Marsden GL, Moore DJ, Colville A, Bhala N, Iqbal TH, Settle C, Kontkowski G, Hart AL, Hawkey PM, Goldenberg SD, Williams HRT. The use of faecal microbiota transplant as treatment for recurrent or refractory Clostridium difficile infection and other potential indications: joint British Society of Gastroenterology (BSG) and Healthcare Infection Society (HIS) guidelines. Gut. 2018;67(11):1920–41.

    Article  PubMed  Google Scholar 

  • Murphy MM, Patatanian E, Gales MA. Extended duration vancomycin in recurrent Clostridium difficile infection: a systematic review. Ther Adv Infect Dis. 2018;5(6): 111–9.

    CAS  PubMed  PubMed Central  Google Scholar 

  • Neal MD, Alverdy JC, Hall DE, Simmons RL, Zuckerbraun BS. Diverting loop ileostomy and colonic lavage: an alternative to total abdominal colectomy for the treatment of severe, complicated Clostridium difficile associated disease. Ann Surg. 2011;254(3):423–7; discussion 427-429

    Article  PubMed  Google Scholar 

  • Ofori E, Ramai D, Dhawan M, Mustafa F, Gasperino J, Reddy M. Community-acquired Clostridium difficile: epidemiology, ribotype, risk factors, hospital and intensive care unit outcomes, and current and emerging therapies. J Hosp Infect. 2018;99(4):436–42.

    Article  CAS  PubMed  Google Scholar 

  • Olesen M, Eriksson S, Bohr J, Jarnerot G, Tysk C. Microscopic colitis: a common diarrhoeal disease. An epidemiological study in Orebro, Sweden, 1993–1998. Gut. 2004;53(3):346–50.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Pepin J, Valiquette L, Gagnon S, Routhier S, Brazeau I. Outcomes of Clostridium difficile-associated disease treated with metronidazole or vancomycin before and after the emergence of NAP1/027. Am J Gastroenterol. 2007;102(12):2781–8.

    Article  PubMed  Google Scholar 

  • Pettit NN, DePestel DD, Fohl AL, Eyler R, Carver PL. Risk factors for systemic vancomycin exposure following administration of oral vancomycin for the treatment of Clostridium difficile infection. Pharmacotherapy. 2015;35(2):119–26.

    Article  CAS  PubMed  Google Scholar 

  • Polage CR, Chin DL, Leslie JL, Tang J, Cohen SH, Solnick JV. Outcomes in patients tested for Clostridium difficile toxins. Diagn Microbiol Infect Dis. 2012;74(4):369–73.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Quraishi MN, Widlak M, Bhala N, Moore D, Price M, Sharma N, Iqbal TH. Systematic review with meta-analysis: the efficacy of faecal microbiota transplantation for the treatment of recurrent and refractory Clostridium difficile infection. Aliment Pharmacol Ther. 2017;46(5):479–93.

    Article  CAS  PubMed  Google Scholar 

  • Rubin ZA, Martin EM, Allyn P. Primary prevention of Clostridium difficile-associated diarrhea: current controversies and future tools. Curr Infect Dis Rep. 2018;20(9):32.

    Article  PubMed  Google Scholar 

  • Secore S, Wang S, Doughtry J, Xie J, Miezeiewski M, Rustandi RR, Horton M, Xoconostle R, Wang B, Lancaster C, Kristopeit A, Wang SC, Christanti S, Vitelli S, Gentile MP, Goerke A, Skinner J, Strable E, Thiriot DS, Bodmer JL, Heinrichs JH. Development of a novel vaccine containing binary toxin for the prevention of Clostridium difficile disease with enhanced efficacy against NAP1 strains. PLoS One. 2017;12(1):e0170640.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  • Seekatz AM, Theriot CM, Rao K, Chang YM, Freeman AE, Kao JY, Young VB. Restoration of short chain fatty acid and bile acid metabolism following fecal microbiota transplantation in patients with recurrent Clostridium difficile infection. Anaerobe. 2018a;53:64.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Seekatz AM, Wolfrum E, DeWald CM, Putler RKB, Vendrov KC, Rao K, Young VB. Presence of multiple Clostridium difficile strains at primary infection is associated with development of recurrent disease. Anaerobe. 2018b;53:74–81.

    Article  PubMed  PubMed Central  Google Scholar 

  • Shannon-Lowe J, Matheson NJ, Cooke FJ, Aliyu SH. Prevention and medical management of Clostridium difficile infection. BMJ. 2010;340:c1296.

    Article  CAS  PubMed  Google Scholar 

  • Song HJ, Kim JY, Jung SA, Kim SE, Park HS, Jeong Y, Hong SP, Cheon JH, Kim WH, Kim HJ, Ye BD, Yang SK, Kim SW, Shin SJ, Kim HS, Sung JK, Kim EY. Effect of probiotic Lactobacillus (Lacidofil(R) cap) for the prevention of antibiotic-associated diarrhea: a prospective, randomized, double-blind, multicenter study. J Korean Med Sci. 2010;25(12): 1784–91.

    Article  PubMed  PubMed Central  Google Scholar 

  • Stuart RL, Marshall C, Harrington G, Sasko L, McLaws ML, Ferguson J. ASID/ACIPC position statement – infection control for patients with Clostridium difficile infection in healthcare facilities. Infect Dis Health. 2019;24(1):32–43.

    Article  PubMed  Google Scholar 

  • Suez J, Zmora N, Zilberman-Schapira G, Mor U, Dori-Bachash M, Bashiardes S, Zur M, Regev-Lehavi D, Ben-Zeev Brik R, Federici S, Horn M, Cohen Y, Moor AE, Zeevi D, Korem T, Kotler E, Harmelin A, Itzkovitz S, Maharshak N, Shibolet O, Pevsner-Fischer M, Shapiro H, Sharon I, Halpern Z, Segal E, Elinav E. Post-antibiotic gut mucosal microbiome reconstitution is impaired by probiotics and improved by autologous FMT. Cell. 2018;174(6):1406–1423.e1416.

    Article  CAS  PubMed  Google Scholar 

  • Surawicz CM, Brandt LJ, Binion DG, Ananthakrishnan AN, Curry SR, Gilligan PH, McFarland LV, Mellow M, Zuckerbraun BS. Guidelines for diagnosis, treatment, and prevention of Clostridium difficile infections. Am J Gastroenterol. 2013;108(4):478–98; quiz 499

    Article  CAS  PubMed  Google Scholar 

  • Tariq R, Weatherly RM, Kammer PP, Pardi DS, Khanna S. Experience and outcomes at a specialized Clostridium difficile clinical practice. Mayo Clin Proc Innov Qual Outcomes. 2017;1(1):49–56.

    Article  PubMed  PubMed Central  Google Scholar 

  • Tariq R, Law CCY, Khanna S, Murthy S, McCurdy JD. The impact of Clostridium difficile infection on mortality in patients with inflammatory bowel disease: a systematic review and meta-analysis. J Clin Gastroenterol. 2019;53(2):127–33.

    Article  PubMed  Google Scholar 

  • Thorpe CM, Kane AV, Chang J, Tai A, Vickers RJ, Snydman DR. Enhanced preservation of the human intestinal microbiota by ridinilazole, a novel Clostridium difficile-targeting antibacterial, compared to vancomycin. PLoS One. 2018;13(8):e0199810.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  • Ticinesi A, Lauretani F, Milani C, Nouvenne A, Tana C, Del Rio D, Maggio M, Ventura M, Meschi T. Aging gut microbiota at the cross-road between nutrition, physical frailty, and sarcopenia: is there a gut-muscle Axis? Nutrients. 2017;9(12):12–32

    Article  PubMed Central  CAS  Google Scholar 

  • van Opstal E, Kolling GL, Moore JH 2nd, Coquery CM, Wade NS, Loo WM, Bolick DT, Shin JH, Erickson LD, Warren CA. Vancomycin treatment alters humoral immunity and intestinal microbiota in an aged mouse model of Clostridium difficile infection. J Infect Dis. 2016;214(1):130–9.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  • Vrieze A, Out C, Fuentes S, Jonker L, Reuling I, Kootte RS, van Nood E, Holleman F, Knaapen M, Romijn JA, Soeters MR, Blaak EE, Dallinga-Thie GM, Reijnders D, Ackermans MT, Serlie MJ, Knop FK, Holst JJ, van der Ley C, Kema IP, Zoetendal EG, de Vos WM, Hoekstra JB, Stroes ES, Groen AK, Nieuwdorp M. Impact of oral vancomycin on gut microbiota, bile acid metabolism, and insulin sensitivity. J Hepatol. 2014;60(4):824–31.

    Article  CAS  PubMed  Google Scholar 

  • Wadhwa A, Al Nahhas MF, Dierkhising RA, Patel R, Kashyap P, Pardi DS, Khanna S, Grover M. High risk of post-infectious irritable bowel syndrome in patients with Clostridium difficile infection. Aliment Pharmacol Ther. 2016;44(6):576–82.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Weingarden AR, Chen C, Bobr A, Yao D, Lu Y, Nelson VM, Sadowsky MJ, Khoruts A. Microbiota transplantation restores normal fecal bile acid composition in recurrent Clostridium difficile infection. Am J Physiol Gastrointest Liver Physiol. 2014;306(4):G310–9.

    Article  CAS  PubMed  Google Scholar 

  • Weingarden A, Gonzalez A, Vazquez-Baeza Y, Weiss S, Humphry G, Berg-Lyons D, Knights D, Unno T, Bobr A, Kang J, Khoruts A, Knight R, Sadowsky MJ. Dynamic changes in short- and long-term bacterial composition following fecal microbiota transplantation for recurrent Clostridium difficile infection. Microbiome. 2015;3:10.

    Article  PubMed  PubMed Central  Google Scholar 

  • Wilcox MH, Gerding DN, Poxton IR, Kelly C, Nathan R, Birch T, Cornely OA, Rahav G, Bouza E, Lee C, Jenkin G, Jensen W, Kim YS, Yoshida J, Gabryelski L, Pedley A, Eves K, Tipping R, Guris D, Kartsonis N, Dorr MB. Bezlotoxumab for prevention of recurrent Clostridium difficile infection. N Engl J Med. 2017;376(4):305–17.

    Article  CAS  PubMed  Google Scholar 

  • Zar FA, Bakkanagari SR, Moorthi KM, Davis MB. 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.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Division of Gastroenterology, University of Virginia, Charlottesville, VA, USA

    R. Ann Hays

  2. Division of Gastroenterology, University of Washington, Seattle, WA, USA

    Christina Surawicz

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  1. R. Ann Hays
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  2. Christina Surawicz
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Correspondence to R. Ann Hays .

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Editors and Affiliations

  1. Saint Peter's Healthcare System, New Brunswick, NJ, USA

    C. S. Pitchumoni

  2. Albert Einstein College of Medicine, Montefiore Medical Center, Wakefield Campus, Bronx, NY, USA

    T.S. Dharmarajan

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Hays, R.A., Surawicz, C. (2020). Clostridium (Now Clostridioides) difficile-Associated Disease. In: Pitchumoni, C., Dharmarajan, T. (eds) Geriatric Gastroenterology. Springer, Cham. https://doi.org/10.1007/978-3-319-90761-1_71-1

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  • DOI: https://doi.org/10.1007/978-3-319-90761-1_71-1

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