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Clostridium difficile Diarrhea in the Elderly: Current Issues and Management Options

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Abstract

Clostridium difficile infection (CDI) is the most common cause of infectious diarrhea in healthcare settings. Along with antimicrobial exposure, advanced age has been shown to be a significant risk factor for the development and recurrence of, and mortality from, CDI. The substantial burden of CDI in the elderly may be related to frequent healthcare exposure, the necessity for more medications, altered intestinal microbiota, and complicated comorbidities. A diagnosis of CDI is based on evidence of toxin, or the C. difficile organism itself, in a stool sample in the presence of clinical signs and symptoms. Only symptomatic patients should be tested for CDI, and routine surveillance or repeat testing on asymptomatic patients as a test of cure is discouraged. Antibiotic discontinuation alone can improve or resolve CDI in some patients, and concomitant use of antibiotics is associated with decreased response to CDI treatment. Metronidazole, vancomycin, and fidaxomicin are the therapeutic agents currently available for CDI, with the selection of these agents being based on disease severity, history of recurrence, and cost. The recurrence rate after initial treatment is 20–30 %. The first recurrence can be treated with the same therapeutic agent and, for subsequent recurrences, vancomycin in a tapered and/or pulsed regimen is recommended. Fecal microbiota transplantation has shown remarkable effectiveness for recurrent anti-refractory CDI, although caution is advised in treating immunocompromised hosts and those with toxic megacolon. C. difficile can be transmitted directly and indirectly via contact with patients or their environment; therefore, isolation precautions should be initiated at the first suspicion of CDI. C. difficile spores can survive for a long time on environmental surfaces, and the patient’s room and all equipment used in the room should be disinfected. In order to manage CDI in the elderly, timely diagnosis, appropriate treatment based on severity of illness, and effective infection control are essential.

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References

  1. Guerrant RL, Hughes JM, Lima NL, Crane J. Diarrhea in developed and developing countries: magnitude, special settings, and etiologies. Rev Infect Dis. 1990;12(Suppl 1):S41–50.

    Article  PubMed  Google Scholar 

  2. To KB, Napolitano LM. Clostridium difficile infection: update on diagnosis, epidemiology, and treatment strategies. Surg Infect. 2014;15:490–502.

    Article  Google Scholar 

  3. Lo Vecchio A, Zacur GM. Clostridium difficile infection: an update on epidemiology, risk factors, and therapeutic options. Curr Opin Gastroenterol. 2012;28:1–9.

  4. Garey KW, Sethi S, Yadav Y, DuPont HL. Meta-analysis to assess risk factors for recurrent Clostridium difficile infection. J Hosp Infect. 2008;70:298–304.

    Article  CAS  PubMed  Google Scholar 

  5. Abou Chakra CN, Pepin J, Sirard S, Valiquette L. Risk factors for recurrence, complications and mortality in Clostridium difficile infection: a systematic review. PloS One. 2014;9:e98400.

  6. Bartlett JG, Chang TW, Gurwith M, Gorbach SL, Onderdonk AB. Antibiotic-associated pseudomembranous colitis due to toxin-producing clostridia. N Engl J Med. 1978;298:531–4.

    Article  CAS  PubMed  Google Scholar 

  7. Lessa FC, Gould CV, McDonald LC. Current status of Clostridium difficile infection epidemiology. Clin Infect Dis. 2012;55:S65–70.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  8. Labbé A-C, Poirier L, MacCannell D, Louie T, Savoie M, Béliveau C, et al. Clostridium difficile Infections in a Canadian tertiary care hospital before and during a regional epidemic associated with the BI/NAP1/027 strain. Antimicrob Agents Chemother. 2008;52:3180–7.

    Article  PubMed Central  PubMed  Google Scholar 

  9. Strausbaugh LJ, Sukumar SR, Joseph CL, High KP. Infectious disease outbreaks in nursing homes: an unappreciated hazard for frail elderly persons. Clin Infect Dis. 2003;36:870–6.

    Article  PubMed  Google Scholar 

  10. Chait M M. The new era of C. difficile-associated diarrhea. Ann Longterm Care. 2008;16.

  11. Karas JA, Bradshaw S, Mahmud W, Enoch DA. Mortality in hospitalized older adults associated with Clostridium difficile infection at a district hospital. Infect Dis Rep. 2010;2:e8. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3892575/. Accessed 30 Jun 2015.

  12. Kakwani R, Chakrabarti D, Khan R, Sinha A, Tawari G. Morbidity and mortality due to C. difficile infection in fracture neck of femur patients. J Bone Joint Surg Br. 2010;92-B:273.

  13. Finegold SM. Anaerobic infections and Clostridium difficile colitis emerging during antibacterial therapy. Scand J Infect Dis Suppl. 1986;49:160–4.

    CAS  PubMed  Google Scholar 

  14. Pierce PF, Wilson R, Silva J, Garagusi VF, Rifkin GD, Fekety R, et al. Antibiotic-associated pseudomembranous colitis: an epidemiologic investigation of a cluster of cases. J Infect Dis. 1982;145:269–74.

    Article  PubMed  Google Scholar 

  15. Beesley J, Eastham EJ, Jackson RH, Nelson R. Case report. Clindamycin associated pseudomembranous colitis. Acta Paediatr Scand. 1981;70:129–30.

    Article  CAS  PubMed  Google Scholar 

  16. Aronsson B, Möllby R, Nord CE. Clostridium difficile and antibiotic associated diarrhoea in Sweden. Scand J Infect Dis Suppl. 1982;35:53–8.

    CAS  PubMed  Google Scholar 

  17. Rocca JM, Pieterse AS, Rowland R, Hecker R, Rich GE. Clostridium difficile colitis. Aust N Z J Med. 1984;14:606–10.

    Article  CAS  PubMed  Google Scholar 

  18. Aronsson B, Möllby R, Nord CE. Diagnosis and epidemiology of Clostridium difficile enterocolitis in Sweden. J Antimicrob Chemother. 1984;14 Suppl D:85–95.

  19. Golledge CL, McKenzie T, Riley TV. Extended spectrum cephalosporins and Clostridium difficile. J Antimicrob Chemother. 1989;23:929–31.

    Article  CAS  PubMed  Google Scholar 

  20. Hyams JS, Feder H, Krause PJ, Frick J, McLaughlin JC, Furth T, et al. Occurrence of Clostridium difficile toxin-associated gastroenteritis following antibiotic therapy for otitis media in young children. Pediatr Infect Dis. 1984;3:433–6.

    Article  CAS  PubMed  Google Scholar 

  21. Gerding DN, Olson MM, Peterson LR, Teasley DG, Gebhard RL, Schwartz ML, et al. Clostridium difficile-associated diarrhea and colitis in adults. A prospective case-controlled epidemiologic study. Arch Intern Med. 1986;146:95–100.

    Article  CAS  PubMed  Google Scholar 

  22. Bohnen JM, Matlow AG, Cohen MM. Pseudomembranous colitis and wound infection following perioperative use of multiple antibiotics. Can J Surg J Can Chir. 1985;28:432–3.

    CAS  Google Scholar 

  23. McFarland LV, Mulligan ME, Kwok RY, Stamm WE. Nosocomial acquisition of Clostridium difficile infection. N Engl J Med. 1989;320:204–10.

    Article  CAS  PubMed  Google Scholar 

  24. Johnson S, Clabots CR, Linn FV, Olson MM, Peterson LR, Gerding DN. Nosocomial Clostridium difficile colonisation and disease. Lancet. 1990;336:97–100.

    Article  CAS  PubMed  Google Scholar 

  25. Eggertson L, Sibbald B. Hospitals battling outbreaks of C. difficile. CMAJ. 2004;171:19–21.

    Article  PubMed Central  PubMed  Google Scholar 

  26. Erban J. C. difficile: will lessons be learned? CMAJ. 2005;172:1161.

    Article  PubMed Central  PubMed  Google Scholar 

  27. Eggertson L. C. difficile: by the numbers. CMAJ. 2004;171:1331–2.

    Article  PubMed Central  PubMed  Google Scholar 

  28. Warny M, Pepin J, Fang A, Killgore G, Thompson A, Brazier J, et al. Toxin production by an emerging strain of Clostridium difficile associated with outbreaks of severe disease in North America and Europe. Lancet. 2005;366:1079–84.

    Article  CAS  PubMed  Google Scholar 

  29. Pépin J, Saheb N, Coulombe M-A, Alary M-E, Corriveau M-P, Authier S, et al. Emergence of fluoroquinolones as the predominant risk factor for Clostridium difficile-associated diarrhea: a cohort study during an epidemic in Quebec. Clin Infect Dis. 2005;41:1254–60.

    Article  PubMed  Google Scholar 

  30. Joseph R, Demeyer D, Vanrenterghem D, van den Berg R, Kuijper E, Delmée M. First isolation of Clostridium difficile PCR ribotype 027, toxinotype III in Belgium. Euro Surveill. 2005;10(E051020):4.

    PubMed  Google Scholar 

  31. Kuijper EJ, van den Berg RJ, Debast S, Visser CE, Veenendaal D, Troelstra A, et al. Clostridium difficile ribotype 027, toxinotype III, the Netherlands. Emerg Infect Dis. 2006;12:827–30.

    Article  PubMed Central  PubMed  Google Scholar 

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

    Article  PubMed Central  PubMed  Google Scholar 

  33. Lim SK, Stuart RL, Mackin KE, Carter GP, Kotsanas D, Francis MJ, et al. Emergence of a ribotype 244 strain of Clostridium difficile associated with severe disease and related to the epidemic ribotype 027 strain. Clin Infect Dis. 2014;58:1723–30.

    Article  CAS  PubMed  Google Scholar 

  34. Bauer MP, Notermans DW, van Benthem BHB, Brazier JS, Wilcox MH, Rupnik M, et al. Clostridium difficile infection in Europe: a hospital-based survey. Lancet. 2011;377:63–73.

    Article  PubMed  Google Scholar 

  35. Wilcox MH, Shetty N, Fawley WN, Shemko M, Coen P, Birtles A, et al. Changing epidemiology of Clostridium difficile infection following the introduction of a national ribotyping-based surveillance scheme in England. Clin Infect Dis. 2012;55:1056–63.

    Article  CAS  PubMed  Google Scholar 

  36. See I, Mu Y, Cohen J, Beldavs ZG, Winston LG, Dumyati G, et al. NAP1 strain type predicts outcomes from Clostridium difficile infection. Clin Infect Dis. 2014;58:1394–400.

    Article  CAS  PubMed  Google Scholar 

  37. Petrella LA, Sambol SP, Cheknis A, Nagaro K, Kean Y, Sears PS, et al. Decreased cure and increased recurrence rates for Clostridium difficile infection caused by the epidemic C. difficile BI strain. Clin Infect Dis. 2012;55:351–7.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  38. Sirard S, Valiquette L, Fortier L-C. Lack of association between clinical outcome of Clostridium difficile infections, strain type, and virulence-associated phenotypes. J Clin Microbiol. 2011;49:4040–6.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  39. Centers for Disease Control and Prevention. QuickStats: rates of Clostridium difficile infection among hospitalized patients aged ≥65 years,* by Age Group—National Hospital Discharge Survey, United States, 1996–2009. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6034a7.htm?s_cid=mm6034a7_w. Accessed 16 Feb 2015.

  40. Lessa FC, Mu Y, Bamberg WM, Beldavs ZG, Dumyati GK, Dunn JR, et al. Burden of Clostridium difficile infection in the United States. N Engl J Med. 2015;372:825–34.

    Article  CAS  PubMed  Google Scholar 

  41. Campbell RJ, Giljahn L, Machesky K, Cibulskas-White K, Lane LM, Porter K, et al. Clostridium difficile infection in Ohio hospitals and nursing homes during 2006. Infect Control Hosp Epidemiol. 2009;30:526–33.

    Article  PubMed  Google Scholar 

  42. Kim JH, Toy D, Muder RR. Clostridium difficile infection in a long-term care facility: hospital-associated illness compared with long-term care-associated illness. Infect Control Hosp Epidemiol. 2011;32:656–60.

    Article  PubMed  Google Scholar 

  43. Mylotte JM, Russell S, Sackett B, Vallone M, Antalek M. Surveillance for Clostridium difficile infection in nursing homes. J Am Geriatr Soc. 2013;61:122–5.

    Article  PubMed  Google Scholar 

  44. Cohen SH, Gerding DN, Johnson S, Kelly CP, Loo VG, McDonald LC, et al. 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;31:431–55.

    Article  PubMed  Google Scholar 

  45. Fekety R, Silva J, Kauffman C, Buggy B, Deery HG. Treatment of antibiotic-associated Clostridium difficile colitis with oral vancomycin: comparison of two dosage regimens. Am J Med. 1989;86:15–9.

    Article  CAS  PubMed  Google Scholar 

  46. McFarland LV, Elmer GW, Surawicz CM. Breaking the cycle: treatment strategies for 163 cases of recurrent Clostridium difficile disease. Am J Gastroenterol. 2002;97:1769–75.

    Article  CAS  PubMed  Google Scholar 

  47. Gerding DN, Johnson S, Peterson LR, Mulligan ME, Silva J. Clostridium difficile-associated diarrhea and colitis. Infect Control Hosp Epidemiol. 1995;16:459–77.

    Article  CAS  PubMed  Google Scholar 

  48. Deshpande A, Pasupuleti V, Patel P, Ajani G, Hall G, Hu B, et al. Repeat stool testing to diagnose Clostridium difficile infection using enzyme immunoassay does not increase diagnostic yield. Clin Gastroenterol Hepatol. 2011;9(665–9):e1.

    PubMed  Google Scholar 

  49. Olson MM, Shanholtzer CJ, Lee JT, Gerding DN. Ten years of prospective Clostridium difficile-associated disease surveillance and treatment at the Minneapolis VA Medical Center, 1982–1991. Infect Control Hosp Epidemiol. 1994;15:371–81.

    Article  CAS  PubMed  Google Scholar 

  50. Mullane KM, Miller MA, Weiss K, Lentnek A, Golan Y, Sears PS, et al. Efficacy of fidaxomicin versus vancomycin as therapy for Clostridium difficile infection in individuals taking concomitant antibiotics for other concurrent infections. Clin Infect Dis. 2011;53:440–7.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  51. Cohen SH, Gerding DN, Johnson S, Kelly CP, Loo VG, McDonald LC, et al. 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;31:431–55.

    Article  PubMed  Google Scholar 

  52. Wilcox MH, Howe R. Diarrhoea caused by Clostridium difficile: response time for treatment with metronidazole and vancomycin. J Antimicrob Chemother. 1995;36:673–9.

    Article  CAS  PubMed  Google Scholar 

  53. Al-Nassir WN, Sethi AK, Nerandzic MM, Bobulsky GS, Jump RLP, Donskey CJ. Comparison of clinical and microbiological response to treatment of Clostridium difficile-associated disease with metronidazole and vancomycin. Clin Infect Dis. 2008;47:56–62.

    Article  PubMed  Google Scholar 

  54. Johnson S, Louie TJ, Gerding DN, Cornely OA, Chasan-Taber S, Fitts D, et al. 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 

  55. 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;45:302–7.

    Article  CAS  PubMed  Google Scholar 

  56. Louie TJ, Miller MA, Mullane KM, Weiss K, Lentnek A, Golan Y, et al. Fidaxomicin versus vancomycin for Clostridium difficile infection. N Engl J Med. 2011;364:422–31.

    Article  CAS  PubMed  Google Scholar 

  57. Ferrada P, Velopulos CG, Sultan S, Haut ER, Johnson E, Praba-Egge A, et al. Timing and type of surgical treatment of Clostridium difficile-associated disease: a practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg. 2014;76:1484–93.

    Article  PubMed  Google Scholar 

  58. Stewart DB, Hollenbeak CS, Wilson MZ. Is colectomy for fulminant Clostridium difficile colitis life saving? A systematic review. Colorectal Dis. 2013;15:798–804.

    Article  CAS  PubMed  Google Scholar 

  59. Klobuka AJ, Markelov A. Current status of surgical treatment for fulminant Clostridium difficile colitis. World J Gastrointest Surg. 2013;5:167–72.

    Article  PubMed Central  PubMed  Google Scholar 

  60. 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;254:423–7 (discussion 427–9).

  61. Garey KW, Sethi S, Yadav Y, DuPont HL. Meta-analysis to assess risk factors for recurrent Clostridium difficile infection. J Hosp Infect. 2008;70:298–304.

    Article  CAS  PubMed  Google Scholar 

  62. Vardakas KZ, Konstantelias AA, Loizidis G, Rafailidis PI, Falagas ME. Risk factors for development of Clostridium difficile infection due to BI/NAP1/027 strain: a meta-analysis. Int J Infect Dis. 2012;16:e768–73.

    Article  PubMed  Google Scholar 

  63. Kyne L, Warny M, Qamar A, Kelly CP. Association between antibody response to toxin A and protection against recurrent Clostridium difficile diarrhoea. Lancet. 2001;357:189–93.

    Article  CAS  PubMed  Google Scholar 

  64. Kelly CP. Can we identify patients at high risk of recurrent Clostridium difficile infection? Clin Microbiol Infect. 2012;18(Suppl 6):21–7.

    Article  PubMed  Google Scholar 

  65. Debast SB, Bauer MP, Kuijper EJ. European Society of Clinical Microbiology and Infectious Diseases, European Society of Clinical Microbiology and Infectious Diseases: update of the treatment guidance document for Clostridium difficile infection. Clin Microbiol Infect. 2014;20:1–26

  66. Gough E, Shaikh H, Manges AR. Systematic review of intestinal microbiota transplantation (fecal bacteriotherapy) for recurrent Clostridium difficile infection. Clin Infect Dis. 2011;53:994–1002.

    Article  PubMed  Google Scholar 

  67. Cammarota G, Ianiro G, Bibbò S, Gasbarrini A. Fecal microbiota transplantation: a new old kid on the block for the management of gut microbiota-related disease. J Clin Gastroenterol. 2014;48(Suppl 1):S80–4.

    Article  PubMed  Google Scholar 

  68. Youngster I, Russell GH, Pindar C, Ziv-Baran T, Sauk J, Hohmann EL. Oral, capsulized, frozen fecal microbiota transplantation for relapsing Clostridium difficile infection. JAMA. 2014;312:1772–8.

    Article  CAS  PubMed  Google Scholar 

  69. Van Nood E, Vrieze A, Nieuwdorp M, Fuentes S, Zoetendal EG, de Vos WM, et al. Duodenal infusion of donor feces for recurrent Clostridium difficile. N Engl J Med. 2013;368:407–15.

    Article  PubMed  Google Scholar 

  70. Youngster I, Sauk J, Pindar C, Wilson RG, Kaplan JL, Smith MB, et al. Fecal microbiota transplant for relapsing Clostridium difficile infection using a frozen inoculum from unrelated donors: a randomized, open-label, controlled pilot study. Clin Infect Dis. 2014;58:1515–22.

    Article  PubMed Central  PubMed  Google Scholar 

  71. Kelly CR, Ihunnah C, Fischer M, Khoruts A, Surawicz C, Afzali A, et al. Fecal microbiota transplant for treatment of Clostridium difficile infection in immunocompromised patients. Am J Gastroenterol. 2014;109:1065–71.

    Article  PubMed  Google Scholar 

  72. Thygesen JB, Glerup H, Tarp B. Saccharomyces boulardii fungemia caused by treatment with a probioticum. BMJ Case Rep. 2012;2012: pii:bcr0620114412.

  73. Muñoz P, Bouza E, Cuenca-Estrella M, Eiros JM, Pérez MJ, Sánchez-Somolinos M, et al. Saccharomyces cerevisiae Fungemia: an emerging infectious disease. Clin Infect Dis. 2005;40:1625–34.

    Article  PubMed  Google Scholar 

  74. Mehta A, Rangarajan S, Borate U. A cautionary tale for probiotic use in hematopoietic SCT patients—Lactobacillus acidophilus sepsis in a patient with mantle cell lymphoma undergoing hematopoietic SCT. Bone Marrow Transplant. 2013;48:461–2.

    Article  CAS  PubMed  Google Scholar 

  75. Johnston BC, Ma SSY, Goldenberg JZ, Thorlund K, Vandvik PO, Loeb M, et al. Probiotics for the prevention of Clostridium difficile-associated diarrhea systematic review and meta-analysis. Ann Intern Med. 2012;157:878–88.

    Article  PubMed  Google Scholar 

  76. Johnson S, Gerding DN, Olson MM, Weiler MD, Hughes RA, Clabots CR, et al. Prospective, controlled study of vinyl glove use to interrupt Clostridium difficile nosocomial transmission. Am J Med. 1990;88:137–40

  77. Lawrence SJ, Puzniak LA, Shadel BN, Gillespie KN, Kollef MH, Mundy LM. Clostridium difficile in the intensive care unit: epidemiology, costs, and colonization pressure. Infect Control Hosp Epidemiol. 2007;28:123–30.

    Article  PubMed  Google Scholar 

  78. Guide to preventing Clostridium difficile infections. Association for Professionals in Infection Control and Epidemiology; 2013;15–7.

  79. Siegel JD, Rhinehart E, Jackson M, Chiarello L, Health Care Infection Control Practices Advisory Committee. 2007 guideline for isolation precautions: preventing transmission of infectious agents in health care settings. Am J Infect Control. 2007;35:S65–164

  80. Sethi AK, Al-Nassir WN, Nerandzic MM, Bobulsky GS, Donskey CJ. Persistence of skin contamination and environmental shedding of Clostridium difficile during and after treatment of C. difficile infection. Infect Control Hosp Epidemiol. 2010;31:21–7.

    Article  PubMed  Google Scholar 

  81. Messina G, Ceriale E, Lenzi D, Burgassi S, Azzolini E, Manzi P. Environmental contaminants in hospital settings and progress in disinfecting techniques. Biomed Res Int. 2013;2013. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3830765/. Accessed 2 Feb 2015.

  82. Eckstein BC, Adams DA, Eckstein EC, Rao A, Sethi AK, Yadavalli GK, et al. Reduction of Clostridium difficile and vancomycin-resistant Enterococcus contamination of environmental surfaces after an intervention to improve cleaning methods. BMC Infect Dis. 2007;7:61.

    Article  PubMed Central  PubMed  Google Scholar 

  83. Nerandzic MM, Cadnum JL, Pultz MJ, Donskey CJ. Evaluation of an automated ultraviolet radiation device for decontamination of Clostridium difficile and other healthcare-associated pathogens in hospital rooms. BMC Infect Dis. 2010;10:197.

    Article  PubMed Central  PubMed  Google Scholar 

  84. Ghantoji SS, Stibich M, Stachowiak J, Cantu S, Adachi JA, Raad II, et al. Non-inferiority of pulsed xenon UV light versus bleach for reducing environmental Clostridium difficile contamination on high-touch surfaces in Clostridium difficile infection isolation rooms. J Med Microbiol. 2015;64:191–4.

    Article  PubMed  Google Scholar 

  85. Petersson LP, Albrecht U-V, Sedlacek L, Gemein S, Gebel J, Vonberg R-P. Portable UV light as an alternative for decontamination. Am J Infect Control. 2014;42:1334–6.

    Article  PubMed  Google Scholar 

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  1. Tufts Medical Center, 800 Washington Street, Boston, MA, 02111, USA

    Masako Mizusawa, Shira Doron & Sherwood Gorbach

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  1. Masako Mizusawa
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Correspondence to Masako Mizusawa.

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Sherwood Gorbach is a consultant for Seres Health, Cempra Pharmaceuticals, Medimmune and Cubist, and also serves as a member of the Scientific Advisory Board for Seres Health and Cempra Pharmaceuticals. He is a former employee of Cubist. Shira Doron serves on the speakers bureau for Merck and Cubist Pharmaceuticals, and is also a consultant and serves on the speakers bureau for Allergan. Masako Mizusawa has no conflicts of interest.

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Mizusawa, M., Doron, S. & Gorbach, S. Clostridium difficile Diarrhea in the Elderly: Current Issues and Management Options. Drugs Aging 32, 639–647 (2015). https://doi.org/10.1007/s40266-015-0289-2

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