Clinical and Epidemiological Aspects of Clostridium difficile

Abstract 

Clostridium difficile-associated disease (CDAD) has increased in frequency and severity throughout North America and Europe over the last 5 years, largely due to the emergence of the NAP1 epidemic strain. This transformation of a formerly mild disease into one that can cause severe morbidity and mortality within a few days has challenged our entire approach to this serious infection. Institutions require accurate and rapid diagnostics for early detection of cases and possible outbreaks in order to initiate specific therapy and implement effective infection control. The optimal hand hygiene techniques, barrier methods and environmental cleaning practices that would diminish transmission remain uncertain. Clinicians need reliable research that can pinpoint the most important factors determining severity of disease and relapse. Epidemiologic and molecular analyses are vital in order to understand the local and international transmission of this disease, as well as its recent change in pathogenicity. As well, further examination of this infection is crucial in order to find effective prophylactic maneuvers and optimal therapies. This review discusses the changing epidemiology of CDAD across North America and internationally, as well as the common diagnostic methods and molecular typing tools for this pathogen. Finally, the current evidence supporting conventional, novel, and non-antimicrobial preventative and therapeutic options is examined.