Community-acquired Clostridium difficile-associated diarrhea, Montréal, 2005-2006: frequency estimates and their validity

Epidemiological Aspects of Clostridium Difficile Infection in the Southeast Region of Romania

Clostridium difficile infection (CDI) in Galati county is an very important public health problem, the number of cases per 100 outpatients being in the first 5, nationally. The percentage of community-associated infection in this county is higher than the national and european ones. We performed a prospective observational study on 720 patients admitted between 1.01.2017-31.12.2018 in the Clinical Hospital of Infectious Diseases „St. Cuv. Parascheva“ Galati and we analyzed comparative demographic data, risk factors, disease evolution and prognosis of a batch of 565 (78.47%) patients with healthcare facility associated infection, with a batch of 144 patients (20%) with community-associated infection. The identified type of Clostridium difficile was ribotype 027 in 93.61% of the toxigenic strains studied. The study showed that CDI predominantly affects women in urban areas. Patients with community source are younger, with less comorbidities, have episodes of illness with lower severity and better prognosis both in terms of CDI recurrence and post-CDI death. Patients with a nosocomial source are older, with multiple comorbidities, with greater exposure to antibiotic, proton pump inhibitor and recent abdominal surgery, have severe episodes of the disease and have a poorer prognosis than those with a community source.

Clostridium difficile infection: Updates in management

Clostridium difficile was first identified in 1978 as a diarrhea-causing bacterium in humans. In the last three decades, C. difficile infection (CDI) has reached an epidemic state, both in health care and community settings worldwide. There has been substantial progress in the field of CDI, including identification of novel risk factors, presence of CDI in individuals not considered at risk previously, and treatment options including new drugs, monoclonal antibodies, and fecal microbiota transplantation. This review discusses epidemiology, novel and traditional risk factors, and updates in management for CDI.

Epidemiology and Risk Factors for Community-Associated Clostridium difficile Infection: A Narrative Review

Clostridium difficile infection (CDI) was once considered a primarily nosocomial concern. Emerging evidence from the last 20 years has highlighted a drastic shift in the known epidemiology of CDI, with disease outside of hospitals apparently occurring more frequently and causing severe disease in populations that were thought to be at low risk. This narrative review summarises potential pathways for infection outside of the hospital environment and highlights likely routes of transmission. Further, evidence is presented on potential risk factors for development of disease. Understanding the epidemiology of CDI outside of hospitals is essential to the ability to prevent and control disease in vulnerable populations.

Clostridium difficile infection: management strategies for a difficult disease

Clostridium difficile was first described as a cause of diarrhea in 1978 and in the last three decades has reached an epidemic state with increasing incidence and severity in both healthcare and community settings. There also has been a rise in severe outcomes from C. difficile infection (CDI). There have been tremendous advancements in the field of CDI with the identification of newer risk factors, recognition of CDI in populations previously thought not at risk and development of better diagnostic modalities. Several treatment options are available for CDI apart from metronidazole and vancomycin, and include new drugs such as fidaxomicin and other options such as fecal microbiota transplantation. This review discusses the epidemiology, risk factors and outcomes from CDI, and focuses primarily on existing and evolving treatment modalities.

Underestimation of Clostridium difficile infection among clinicians: an international survey

The objective of this investigation was to document clinicians' awareness regarding the incidence and severity of Clostridium difficile-associated diarrhea (CDAD). An international electronic survey was conducted among corresponding authors of articles indexed by PubMed and published during the last 10 years in 'Core Clinical Journals'. A total of 1,163 clinicians answered (response rate 59%); most of the responses were submitted from North America (54.6%), Europe (32.2%), and Asia/Pacific (11.6%). Only 2.2% of the participants answered correctly all four questions, while 14.1% answered all questions incorrectly. Regarding each question, 10.8% of the participants correctly estimated current CDAD treatment failure or recurrence rates to be around 40%, 33.4% correctly estimated the ratio of antibiotic-associated colitis attributed to C. difficile to be around 60%, 72.7% correctly responded that almost all antibiotics are associated with CDAD, and 41.7% correctly responded that any patient is at risk for CDAD. Almost half (44.4%) of the respondents considered CDAD to be underestimated. Participants from North America scored higher than those from Europe or Asia/Pacific (p < 0.001). Participants considering CDAD to be overestimated (3.4%) had the lowest mean score of correct answers. Among a clinically diverse international sample of physicians with academic expertise, there was an inadequate level of awareness of the magnitude and clinical importance of CDAD.