Medline ® Abstracts for References 4,80,81
of 'Clostridium difficile infection in adults: Clinical manifestations and diagnosis'
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).
Cohen SH, Gerding DN, Johnson S, Kelly CP, Loo VG, McDonald LC, Pepin J, Wilcox MH, Society for Healthcare Epidemiology of America, Infectious Diseases Society of America
Infect Control Hosp Epidemiol. 2010;31(5):431.
Since publication of the Society for Healthcare Epidemiology of America position paper on Clostridium difficile infection in 1995, significant changes have occurred in the epidemiology and treatment of this infection. C. difficile remains the most important cause of healthcare-associated diarrhea and is increasingly important as a community pathogen. A more virulent strain of C. difficile has been identified and has been responsible for more-severe cases of disease worldwide. Data reporting the decreased effectiveness of metronidazole in the treatment of severe disease have been published. Despite the increasing quantity of data available, areas of controversy still exist. This guideline updates recommendations regarding epidemiology, diagnosis, treatment, and infection control and environmental management.
Department of Internal Medicine, Division of Infectious and Immunologic Diseases, University of California Davis Medical Center, Sacramento, California, USA.
The challenges posed by reemerging Clostridium difficile infection.
Blossom DB, McDonald LC
Clin Infect Dis. 2007;45(2):222.
There have been recent, marked increases in the incidence and severity of Clostridium difficile-associated disease (CDAD). These may be attributable to the emergence of a hypervirulent strain of C. difficile that produces increased levels of toxins A and B, as well as an extra toxin known as "binary toxin." This previously uncommon strain has become epidemic, coincident with its development of increased resistance to fluoroquinolones, the use of which is increasingly associated with CDAD outbreaks. Although not necessarily related to this epidemic strain, unusually severe CDAD has been reported in populations that had previously been thought to be at low risk, including peripartum women and healthy persons living in the community. Challenges posed by the changing epidemiology of CDAD are compounded by current limitations in diagnostic testing, treatment, and infection control. Overcoming these challenges and limitations will require a concerted effort from a variety of sources, including an ongoing partnership between infectious disease clinicians and public health professionals.
Division of Healthcare Quality Promotion, National Center for Preparedness, Detection, and Control of Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
Evaluation of diagnostic tests for Clostridium difficile infection.
Swindells J, Brenwald N, Reading N, Oppenheim B
J Clin Microbiol. 2010;48(2):606. Epub 2009 Dec 23.
We evaluated toxigenic Clostridium difficile detection by a lateral flow assay for antigen and toxin, an enzyme immunoassay, and two commercial PCR methods. Compared to the cell cytotoxicity neutralization assay and toxigenic culture, both toxin detection methods lacked sensitivity. PCR following combined antigen and toxin detection provided the most useful diagnostic information.
Department of Microbiology, City Hospital, Dudley Road, Birmingham, United Kingdom.