E Ofori1, D Ramai2, M Dhawan1, F Mustafa1, J Gasperino3, M Reddy1. 1. Division of Gastroenterology and Hepatology, The Brooklyn Hospital Center, Academic Affiliate of the Icahn School of Medicine at Mount Sinai, Clinical Affiliate of the Mount Sinai Hospital, Brooklyn, NY, USA. 2. Division of Gastroenterology and Hepatology, The Brooklyn Hospital Center, Academic Affiliate of the Icahn School of Medicine at Mount Sinai, Clinical Affiliate of the Mount Sinai Hospital, Brooklyn, NY, USA; School of Medicine, St. George's University, True Blue, Grenada, The West Indies. Electronic address: dramai@tbh.org. 3. Department of Medicine, The Brooklyn Hospital Center, Academic Affiliate of the Icahn School of Medicine at Mount Sinai, Clinical Affiliate of the Mount Sinai Hospital, Brooklyn, NY, USA.
Abstract
BACKGROUND: The epidemiological landscape of Clostridium difficile infection (CDI) has changed over the past 30 years. AIM: To review studies of CDI in the community setting. METHODS: Electronic databases including PubMed, MEDLINE, Embase, Google Scholar, Scopus, ClinicalTrials.gov and Cochrane Databases were searched for human studies performed between 2000 and 2017 that assessed the epidemiology, risk factors, ribotypes, hospital and intensive care unit (ICU) outcomes, and management of community-acquired CDI. In addition, references were searched manually to identify other relevant studies. FINDINGS: In total, 39 articles met the inclusion criteria. The incidence of community-acquired CDI has almost doubled in the past decade. Approximately half of all cases of CDI are attributed to community origin. Individuals who are younger, female, in the presence of infants, frequently use proton pump inhibitors or specific classes of antibiotics, or live near farms and livestock are at higher risk for community-acquired CDI. Additionally, approximately 40% of all community-acquired cases require hospitalization, where severity has been linked to hypervirulent ribotypes 027 and 078 with poor outcomes. Emerging data on treatment paradigms have led to the revision of clinical guidelines and two potential vaccines in phase three clinical trials. However, ribotype-specific responses to current treatment strategies are lacking. CONCLUSION: Community-acquired CDI represents a growing public health threat and burden on healthcare systems. A multi-disciplinary approach will be required to stem the tides.
BACKGROUND: The epidemiological landscape of Clostridium difficileinfection (CDI) has changed over the past 30 years. AIM: To review studies of CDI in the community setting. METHODS: Electronic databases including PubMed, MEDLINE, Embase, Google Scholar, Scopus, ClinicalTrials.gov and Cochrane Databases were searched for human studies performed between 2000 and 2017 that assessed the epidemiology, risk factors, ribotypes, hospital and intensive care unit (ICU) outcomes, and management of community-acquired CDI. In addition, references were searched manually to identify other relevant studies. FINDINGS: In total, 39 articles met the inclusion criteria. The incidence of community-acquired CDI has almost doubled in the past decade. Approximately half of all cases of CDI are attributed to community origin. Individuals who are younger, female, in the presence of infants, frequently use proton pump inhibitors or specific classes of antibiotics, or live near farms and livestock are at higher risk for community-acquired CDI. Additionally, approximately 40% of all community-acquired cases require hospitalization, where severity has been linked to hypervirulent ribotypes 027 and 078 with poor outcomes. Emerging data on treatment paradigms have led to the revision of clinical guidelines and two potential vaccines in phase three clinical trials. However, ribotype-specific responses to current treatment strategies are lacking. CONCLUSION: Community-acquired CDI represents a growing public health threat and burden on healthcare systems. A multi-disciplinary approach will be required to stem the tides.
Authors: Gayatri Vedantam; Joshua Kochanowsky; Jason Lindsey; Michael Mallozzi; Jennifer Lising Roxas; Chelsea Adamson; Farhan Anwar; Andrew Clark; Rachel Claus-Walker; Asad Mansoor; Rebecca McQuade; Ross Calvin Monasky; Shylaja Ramamurthy; Bryan Roxas; V K Viswanathan Journal: Front Microbiol Date: 2018-09-05 Impact factor: 6.064
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