What is the Recurrence Risk for Clostridium difficile Infection?

Discussion Clostridium difficile infection (CDI) is a common cause of nosocomial diarrhea. Clostridium difficile is an obligate, anaerobic, gram-positive bacillus that is spore-forming and toxin producing. It is resistant to acid, heat, antibiotics and many antiseptic agents. Spores are acquired from the environment or by oral-fecal route. Once in the colon, the bacteria attach and proliferate making vegetative forms. Two main toxins are produced which disrupt the colonic integrity. Toxin A (TcdA) is an endotoxin that disrupts the mucosal cells. Toxin B (TcdB) is a cytotoxin that is 1000x more potent than TcdA and causes apoptosis. An inflammatory reaction occurs along with cell death. There has been a significant increase in childhood CDI over the past 20 years. While this is mainly in the inpatient setting, community acquired CDI is also increasing, especially in patients without a history of antibiotic exposure who are young. The changing epidemiology is being attributed to the emergence of a more virulent strain called NAP1. Risks for CDI include young age, antibiotic therapy (of all types), potentially proton-pump inhibitor therapy, instrumentation with feeding tubes, prolonged hospitalization, viral gastroenteritis and underlying medical problems such as an immunodeficiency state (e.g. neoplasia, transplant, HIV) and cystic fibrosis. Potentially other diseases have also been linked in small series. Clinical manifestations include: Asymptomatic colonization Ve...
Source: PediatricEducation.org - Category: Pediatrics Authors: Tags: Uncategorized Source Type: news