Clostridioides difficile infection

Excerpt

Clostridioides difficile, formerly Clostridium difficile, is a gram-positive and spore-forming bacterium. This obligate anaerobic bacillus is recognized for its ability to produce toxins and is the leading cause of antibiotic-associated diarrhea worldwide. C difficile infections can range from an asymptomatic carrier to diarrhea, progressing to severe conditions such as pseudomembranous colitis and toxic megacolon with septic shock, often resulting in a high mortality rate. Although traditionally considered a primary healthcare-associated infection, an increasing incidence of community-acquired C difficile infections also exists. The emergence of a newer hypervirulent strain, the North American pulsed-field gel electrophoresis type 1 (NAP1), has been attributed to increased incidence and severity of C difficile infections over the last 2 decades.

C difficile can colonize the intestines of healthy people without causing infection and survive on surfaces in the hospital and soil for extended periods. Contaminated surfaces and medical equipment in healthcare facilities can become reservoirs for C difficile spores, potentially transmitting to patients if proper cleaning protocols are not routinely implemented. The most significant risk factor for C difficile infection is broad-spectrum antibiotics. Patients can be colonized with C difficile without symptoms, but antibiotic use disturbs the balance of gut flora, enabling C difficile overgrowth and infection. Additional risk factors for C difficile infection include proton pump inhibitors, advanced age, immunosuppression, underlying health conditions, prior C difficile infection, recent hospitalization, prolonged hospital stays, inadequate infection control, and suboptimal antibiotic stewardship in healthcare settings, facilitating C difficile transmission among patients.

While C difficile infection is primarily associated with healthcare settings, a growing recognition of community-acquired cases exists, particularly among younger and healthier individuals with minimal recent healthcare exposure. The emergence of genome sequencing has revealed that reservoirs for C difficile exist within healthcare systems, environment, food, soil, and animals, comprising a "One Health" continuum. Managing C difficile infections remains challenging due to its increasing global burden, emergence in community settings, complexities in handling severe and recurrent cases, and rising morbidity and mortality rates. Understanding the epidemiology of C difficile infection is crucial for implementing effective prevention and control measures in healthcare settings and the community. These strategies include prudent antibiotic use, hand hygiene practices, environmental cleaning, and early detection and management of cases.