Advertisement

Diagnosis and Management of Clostridium difficile Infection (CDI)

  • Paul C. JohnsonEmail author
  • Minh Le
  • Matthew D. Sims
  • Paul D. Bozyk
Chapter
  • 3 Downloads

Abstract

Infection due to Clostridium difficile is a prevalent cause of morbidity and mortality in the intensive care unit. Appropriate diagnosis and treatment of CDI remains challenging in the face of new methods of detection and emerging management strategies. We describe CDI symptoms, epidemiology, diagnosis, medical therapy, and surgical interventions for treatment. A review of upcoming modalities of therapy is additionally detailed.

Keywords

Clostridium difficile Infection CDI CDAD Diarrhea Treatment Diagnosis Megacolon Fecal transplant 

References

  1. 1.
    Hung YP, Lee JC, Lin HJ, Liu HC, Wu YH, Tsai PJ, et al. Clinical impact of Clostridium difficile colonization. J Microbiol Immunol Infect. 2014;48(3):241–8.CrossRefGoogle Scholar
  2. 2.
    Gupta A, Patel R, Baddour LM, Pardi DS, Khanna S. Extraintestinal Clostridium difficile infections: a single-center experience. Mayo Clin Proc. 2014;89(11):1525–36.CrossRefGoogle Scholar
  3. 3.
    Polage CR, Gyorke CE, Kennedy MA, Leslie JL, Chin DL, Wang S, et al. Overdiagnosis of Clostridium difficile infection in the molecular test era. JAMA Intern Med. 2015 Nov;175(11):1792–801.CrossRefGoogle Scholar
  4. 4.
    Planche TD, Davies KA, Coen PG, Finney JM, Monahan IM, Morris KA, et al. Differences in outcome according to Clostridium difficile testing method: a prospective multicentre diagnostic validation study of C difficile infection. Lancet Infect Dis. 2013;13(11):936–45.CrossRefGoogle Scholar
  5. 5.
    Wei SC, Wong JM, Hsueh PR, Shieh MJ, Wang TH, Luh KT, et al. Diagnostic role of endoscopy, stool culture, and toxin a in Clostridium difficile-associated disease. J Formos Med Assoc. 1997;96(11):879–83.PubMedGoogle Scholar
  6. 6.
    Lo Vecchio A, Zacur GM. Clostridium difficile infection: an update on epidemiology, risk factors, and therapeutic options. Curr Opin Gastroenterol. 2012;28(1):1–9.CrossRefGoogle Scholar
  7. 7.
    Pépin J, Valiquette L, Cossette B. Mortality attributable to nosocomial Clostridium difficile-associated disease during an epidemic caused by a hypervirulent strain in Quebec. CMAJ. 2005 Oct 25;173(9):1037–42.CrossRefGoogle Scholar
  8. 8.
    McDonald LC, Gerding DN, Johnson S, Bakken JS, Carroll KC, Coffin SE, et al. 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. 2018;66(7):e1–e48.CrossRefGoogle Scholar
  9. 9.
    Musher DM, Aslam S, Logan N, Nallacheru S, Bhaila I, Borchert F, et al. Relatively poor outcome after treatment of Clostridium difficile colitis with metronidazole. Clin Infect Dis. 2005;40(11):1586–90.CrossRefGoogle Scholar
  10. 10.
    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(5):440–7.CrossRefGoogle Scholar
  11. 11.
    Bakken JS. Staggered and tapered antibiotic withdrawal with administration of kefir for recurrent Clostridium difficile infection. Clin Infect Dis. 2014;59(6):858–61.CrossRefGoogle Scholar
  12. 12.
    Garey KW, Ghantoji SS, Shah DN, Habib M, Arora V, Jiang ZD, et al. A randomized, double-blind, placebo-controlled pilot study to assess the ability of rifaximin to prevent recurrent diarrhoea in patients with Clostridium difficile infection. J Antimicrob Chemother. 2011;66(12):2850–5.CrossRefGoogle Scholar
  13. 13.
    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 7–9CrossRefGoogle Scholar
  14. 14.
    Bhangu A, Nepogodiev D, Gupta A, Torrance A, Singh P. West Midlands Research Collaborative. Systematic review and meta-analysis of outcomes following emergency surgery for Clostridium difficile colitis. Br J Surg. 2012;99(11):1501–13.CrossRefGoogle Scholar
  15. 15.
    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(9):825–34.CrossRefGoogle Scholar
  16. 16.
    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(3):351–7.CrossRefGoogle Scholar
  17. 17.
    Loo VG. Environmental interventions to control Clostridium difficile. Infect Dis Clin N Am. 2015;29(1):83–91.CrossRefGoogle Scholar
  18. 18.
    Friedman ND, Pollard J, Stupart D, Knight DR, Khajehnoori M, Davey EK, et al. Prevalence of Clostridium difficile colonization among healthcare workers. BMC Infect Dis. 2013;13:459.CrossRefGoogle Scholar
  19. 19.
    Oughton MT, Loo VG, Dendukuri N, Fenn S, Libman MD. Hand hygiene with soap and water is superior to alcohol rub and antiseptic wipes for removal of Clostridium difficile. Infect Control Hosp Epidemiol. 2009;30(10):939–44.CrossRefGoogle Scholar
  20. 20.
    Mattila E, Uusitalo-Seppala R, Wuorela M, Lehtola L, Nurmi H, Ristikankare M, et al. Fecal transplantation, through colonoscopy, is effective therapy for recurrent Clostridium difficile infection. Gastroenterology. 2012;142(3):490–6.CrossRefGoogle Scholar
  21. 21.
    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(5):407–15.CrossRefGoogle Scholar
  22. 22.
    Tariq R, Pardi DS, Bartlett MG, Khanna S. Low cure rates in controlled trials of fecal microbiota transplantation for recurrent Clostridium difficile infection: a systematic review and meta-analysis. Clin Infect Dis. 2019;68(8):1351–8.CrossRefGoogle Scholar
  23. 23.
    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(17):1772–8.CrossRefGoogle Scholar
  24. 24.
    Goldenberg JZ, Yap C, Lytvyn L, Lo CK, Beardsley J, Mertz D, Johnston BC. Probiotics for the prevention of Clostridium difficile-associated diarrhea in adults and children. Cochrane Database Syst Rev. 2017;12:CD006095.PubMedGoogle Scholar
  25. 25.
    Mills JP, Rao K, Young VB. Probiotics for prevention of Clostridium difficile infection. Curr Opin Gastroenterol. 2018;34(1):3–10.CrossRefGoogle Scholar
  26. 26.
    Gerding DN, Meyer T, Lee C, Cohen SH, Murthy UK, Poirier A, et al. 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.CrossRefGoogle Scholar
  27. 27.
    Villano SA, Seiberling M, Tatarowicz W, Monnot-Chase E, Gerding DN. Evaluation of an oral suspension of VP20621, spores of nontoxigenic Clostridium difficile strain M3, in healthy subjects. Antimicrob Agents Chemother. 2012;56(10):5224–9.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Paul C. Johnson
    • 1
    Email author
  • Minh Le
    • 2
  • Matthew D. Sims
    • 1
  • Paul D. Bozyk
    • 2
  1. 1.Section of Infectious Diseases and International MedicineBeaumont HealthRoyal OakUSA
  2. 2.Section of Pulmonary, Critical Care, and Sleep MedicineBeaumont HealthRoyal OakUSA

Personalised recommendations