Andrea Lo Vecchio1, George M Zacur. 1. Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Naples Federico II, Naples, Italy. andrelovecchio@gmail.com
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.
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.
Authors: Hisham Hussan; Emmanuel Ugbarugba; Michael T Bailey; Kyle Porter; Bradley Needleman; Sabrena Noria; Benjamin O'Donnell; Steven K Clinton Journal: Obes Surg Date: 2018-07 Impact factor: 4.129
Authors: M D Esteban-Vasallo; S Naval Pellicer; M F Domínguez-Berjón; M Cantero Caballero; Á Asensio; G Saravia; J Astray-Mochales Journal: Eur J Clin Microbiol Infect Dis Date: 2016-04-07 Impact factor: 3.267
Authors: Zsuzsanna Kurti; Barbara D Lovasz; Michael D Mandel; Zoltan Csima; Petra A Golovics; Bence D Csako; Anna Mohas; Lorant Gönczi; Krisztina B Gecse; Lajos S Kiss; Miklos Szathmari; Peter L Lakatos Journal: World J Gastroenterol Date: 2015-06-07 Impact factor: 5.742
Authors: A Lo Vecchio; L Lancella; C Tagliabue; C De Giacomo; S Garazzino; M Mainetti; L Cursi; E Borali; M V De Vita; E Boccuzzi; L Castellazzi; S Esposito; A Guarino Journal: Eur J Clin Microbiol Infect Dis Date: 2016-09-30 Impact factor: 3.267
Authors: Susana Fuentes; Els van Nood; Sebastian Tims; Ineke Heikamp-de Jong; Cajo J F ter Braak; Josbert J Keller; Erwin G Zoetendal; Willem M de Vos Journal: ISME J Date: 2014-02-27 Impact factor: 10.302