REVIEW ARTICLE – Clostridium difficile Infection

April 16, 2015 at 8:32 am

N Engl J of Medic April 16, 2015 V.372 N.16 P.1539-1548

D.A. Leffler and J.T. Lamont

From the Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston.

Address reprint requests to Dr. Leffler at Beth Israel Deaconess Medical Center, 330 Brookline Ave., Boston, MA 02215, or at dleffler@bidmc.harvard.edu.

Clostridium difficile is an anaerobic gram-positive, spore-forming, toxin-producing bacillus that is transmitted among humans through the fecal–oral route.

The relationship between the bacillus and humans was once thought to be commensal, but C. difficile has emerged as a major enteric pathogen with worldwide distribution.

In the United States, C. difficile is the most frequently reported nosocomial pathogen. A surveillance study in 2011 identified 453,000 cases of C. difficile infection and 29,000 deaths associated with C. difficile infection; approximately a quarter of those infections were community-acquired.

Nosocomial C. difficile infection more than quadruples the cost of hospitalizations, increasing annual expenditures by approximately $1.5 billion in the United States.

In this article, we review the changing epidemiology of this infection, discuss risk factors and preventive strategies, outline current recommendations for treatment, and highlight developing strategies for disease control…..

PDF

http://www.nejm.org/doi/pdf/10.1056/NEJMra1403772

 

N Engl J of Medic April 16, 2015 V.372 N.16 P.1566-1568

CLINICAL IMPLICATIONS OF BASIC RESEARCH

Toward a True Bacteriotherapy for Clostridium difficile Infection

Rupnik

From the National Laboratory for Health, Environment and Food and the Faculty of Medicine, University of Maribor, Maribor, and the Center of Excellence for Integrated Approaches in Chemistry and Biology of Proteins, Ljubljana — all in Slovenia.

Clostridium difficile is one of the most commonly reported pathogens in nosocomial infections in the United States and the European Union.

It is associated with a disturbance in gut microbiota; symptoms range from mild diarrhea to colitis and pseudomembranous colitis or gut perforation.

Although most cases of infection are treated with antibiotics (e.g., metronidazole, vancomycin, and fidaxomicin), a subgroup of patients who have had multiple relapses are treated through the restoration of gut microbiota.

In this approach, fecal matter from a healthy donor is suspended in solution and introduced into the gut of the patient.

This procedure has multiple descriptions, including fecal transplantation, fecal replacement, fecal microbiota transplantation, and the more aesthetically pleasing bacteriotherapy…..

PDF

http://www.nejm.org/doi/pdf/10.1056/NEJMcibr1500270

 

Entry filed under: Antimicrobianos, Bacterias, Epidemiología, Health Care-Associated Infections, Infecciones gastrointestinales, Infecciones nosocomiales, Metodos diagnosticos, REVIEWS, Update. Tags: .

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