Clostridium difficile infection: an update on epidemiology, risk factors, and therapeutic options
Abstract
PURPOSE OF REVIEW: The incidence and severity of Clostridium difficile infection (CDI) around the world has increased over the past 20 years due to the emergence of hypervirulent strains, increased use and misuse of antibiotics, and the increase of susceptible at-risk populations. Treatments currently available for CDI are inadequate to impede the increasing spread and virulence of the infection, avoid recurrence in chronic patients or prevent infection in at-risk populations. RECENT FINDINGS: New and promising evidence has been presented during the past year, focusing on two major points: preservation of gut microflora and optimization of immune response to CDI and toxins. SUMMARY: The review aims to summarize the most recent evidence available on the epidemiology, risk factors and treatment of CDI. New antibiotics with selected action on C. difficile and limited effect on microflora (fidaxomicin) and donor fecal transplantation seem to have a relevant efficacy in treating CDI and reducing its recurrence. The use of selected monoclonal antibodies directed against C. difficile toxins in addition to standard therapy is a new, promising approach for the treatment of recurrent cases. Vaccination could be an additional weapon against CDI. New robust data are needed before recommendations can be made to abandon current treatment based on vancomycin and metronidazole and move toward new frontiers.
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For moderate or severe C. difficile disease, particularly in oncologic patients, the first-line treatment is oral metronidazole (30 mg/kg/day); oral vancomycin is reserved for resistant strains.
“For moderate or severe disease, particularly in oncologic patients, the first-line treatment is oral metronidazole (30 mg/kg/day); oral vancomycin is reserved for resistant strains 37, 38.”
From Antibiotic treatment of acute gastroenteritis in children (2018) · cites this paper as [37]
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Guarino, A., Ashkenazi, S., Gendrel, D., Lo Vecchio, A., Shamir, R., & Szajewska, H. (2014) · Journal of Pediatric Gastroenterology and Nutrition · doi:10.1097/mpg.0000000000000375 · Cited by 935 · see citing works
Cammarota, G., Masucci, L., Ianiro, G., Bibbò, S., Dinoi, G., Costamagna, G., Sanguinetti, M., & Gasbarrini, A. (2015) · Alimentary Pharmacology & Therapeutics · doi:10.1111/apt.13144 · Cited by 558 · see citing works
Cammarota, G., Ianiro, G., & Gasbarrini, A. (2014) · Journal of Clinical Gastroenterology · doi:10.1097/mcg.0000000000000046 · Cited by 428 · see citing works
Sartelli, M., Di Bella, S., McFarland, L. V., Khanna, S., Furuya-Kanamori, L., Abuzeid, N., Abu-Zidan, F. M., Ansaloni, L., Augustin, G., Bala, M., et al. (2019) · World Journal of Emergency Surgery · doi:10.1186/s13017-019-0228-3 · Cited by 159 · see citing works
Antibiotic treatment of acute gastroenteritis in children
Bruzzese, E., Giannattasio, A., & Guarino, A. (2018) · F1000Research · doi:10.12688/f1000research.12328.1 · Cited by 122 · see citing works
Sekulovic, O., Ospina Bedoya, M., Fivian‐Hughes, A. S., Fairweather, N. F., & Fortier, L. (2015) · Molecular Microbiology · doi:10.1111/mmi.13121 · Cited by 63 · see citing works
Fecal microbiota transplantation for Clostridium difficile infection: benefits and barriers
Lo Vecchio, A., & Cohen, M. B. (2014) · Current Opinion in Gastroenterology · doi:10.1097/mog.0000000000000023 · Cited by 27 · see citing works
Self-citation
- Authors
- Lo Vecchio, A., & Zacur, G. M.
- Affiliations
- Cincinnati Children's Hospital Medical Center (US)
- Venue
- Current Opinion in Gastroenterology
- Published
- 2012-01
- Volume
- 28
- Issue
- 1
- Pages
- 1-9
- ISSN
- 0267-1379 (ISSN-L)
- OpenAlex
- W2318987907
- Cited by
- 183
- References
- 97
- Citations by year
- 2025: 1 · 2024: 2 · 2023: 3 · 2022: 4 · 2021: 7 · 2020: 6 · 2019: 17 · 2018: 16 · 2017: 17 · 2016: 20 · 2015: 29 · 2014: 20 · 2013: 28 · 2012: 12
- FWCI
- 2.40
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Current Opinion in Gastroenterology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Infectious Diseases › Clostridium difficile and Clostridium perfringens research
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Gut microbiota and health
- Health Sciences › Medicine › Epidemiology › Microscopic Colitis
- Keywords
- Clostridium difficile infection, hypervirulent strains, antibiotic misuse, fidaxomicin, fecal microbiota transplantation, monoclonal antibodies, recurrent infections, vancomycin, metronidazole, risk factors
- MeSH terms
- Anti-Bacterial Agents, Clostridium Infections, Enterocolitis, Pseudomembranous, Humans, Intestines, Risk Factors, United States, Incidence, Clostridioides difficile
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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