Materiały źródłowe

• #1 Epidemiology of Clostridium difficile-associated infections – PubMed

  https://pubmed.ncbi.nlm.nih.gov/11591202/

  Clostridium difficile is responsible for 15-25% of cases of antibiotic-associated diarrhea (AAD) and for virtually all cases of antibiotic-associated pseudomembranous colitis (PMC). This anaerobic bacterium has been identified as the leading cause of nosocomial infectious diarrhea in adults and can be responsible for large outbreaks. Nosocomial C. difficile infection results in an increased length of stay in hospital ranging from 8 to 21 days. Risk factors for C. difficile-associated diarrhea include antimicrobial therapy, older age (65 years), antineoplastic chemotherapy and length of hospital stay. Other interventions with high risk associations are enemas, nasogastric tubes, gastrointestinal surgery and antiperistaltic drugs. […] Prospective studies have shown that nosocomial transmission of C. difficile is frequent but often remains asymptomatic. Patients can be contaminated from environmental surfaces, shared instrumentation, hospital personnel hands and infected roommates. Once an outbreak starts, C. difficile may be spread rapidly throughout the hospital environment where spores may persist for months. Measures that are effective in reducing incidence of C. difficile infections and cross-infection include: (i) an accurate and rapid diagnosis, (ii) appropriate treatment, (iii) implementation of enteric precautions for symptomatic patients, (iv) reinforcement of hand-washing, (v) daily environmental disinfection, and (vi) a restrictive antibiotic policy. C. difficile is a common cause of infectious diarrhea and should be therefore systematically investigated in patients with nosocomial diarrhea.

• #2 Epidemiology of Clostridium difficile Infection

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4128635/

  There has been dramatic change in the epidemiology of Clostridium difficile infection (CDI) since the turn of the 21st Century noted by a marked increase in incidence and severity, occurring at a disproportionately higher frequency in older patients. […] Emerging risk factors and disease recurrence represent continued challenges in the management of CDI. […] Enhanced surveillance methods are needed to monitor the incidence, identify populations at risk, and characterize the molecular epidemiology of strains causing CDI. […] Data from the U.S. and Europe suggest the incidence of CDI may have reached a crescendo in recent years and is leveling off or slightly declining. […] The increased burden of CDI places a significant financial constraint on the healthcare system. […] The acute-care direct costs of CDI in the U.S. were estimated to be $4.8 billion in 2008.

• #3 Clostridioides (Clostridium) Difficile Colitis: Background, Etiology, Pathophysiology

  https://emedicine.medscape.com/article/186458-overview

  In the United States, CDI occurs primarily in hospitalized patients, causing as many as 3 million cases of diarrhea and colitis per year. Cancer patients are significantly affected by CDI healthcare-associated diarrhea. Diarrhea caused by C difficile is also linked to 14,000 American deaths annually. […] The incidence of reported CDI infection continues to increase. In the 1980s, McFarland et al reported that 7% of patients admitted to a hospital and 28% of patients who were hospitalized had positive cultures for the organism. By the 1990s, the incidence of C difficile in hospitalized patients had risen to 30-40 per 100,000 population, and by 2005, to 84 per 100,000 population. […] Indeed, in contrast to the incidence rates of other nosocomial infections, which declined from 2000 to 2009, the number of hospitalized patients with any CDI as a discharge diagnosis more than doubled in the same period, from approximately 139,000 to 336,600. Furthermore, the number of patients with a primary diagnosis of CDI more than tripled, from 33,000 to 111,000.

• #4 Pseudomembranous Colitis | Concise Medical Knowledge

  https://www.lecturio.com/concepts/pseudomembranous-colitis/

  Pseudomembranous colitis accounts for up to 3 million cases of diarrhea in the United States every year. Approximately 14,000 deaths in the US occur every year due to this condition. The majority of cases are hospital acquired. Up to 40% of cases of C. difficile colitis are community acquired. […] Recommendations for surveillance of Clostridium difficile-associated disease have been established.

• #5 Clostridioides difficile infection – Wikipedia

  https://en.wikipedia.org/wiki/Clostridioides_difficile_infection

  C. difficilediarrhea is estimated to occur in eight of 100,000 people each year. Among those who are admitted to hospital, it occurs in between four and eight people per 1,000. In 2011, it resulted in about half a million infections and 29,000 deaths in the United States. […] Due in part to the emergence of a fluoroquinolone-resistant strain, C. difficile-related deaths increased 400% between 2000 and 2007 in the United States. According to the CDC, „C. difficilehas become the most common microbial cause of healthcare-associated infections in U.S. hospitals and costs up to $4.8 billion each year in excess health care costs for acute care facilities alone.”

• #6

  https://link.springer.com/article/10.1007/s10151-013-1081-0

  This literature review looks at the epidemiology, clinical manifestations, diagnostics and current medical and surgical management of Clostridium difficile (C. difficile) infection. […] The occurrence of diarrhea and pseudomembranous colitis significantly increased, immediately following the introduction of widely available antibiotic treatments. […] The simple way in which the bacteria spread resulted in a significant increase in the number of infections, especially among hospitalized patients. […] In a retrospective Canadian study, diarrhea and pseudomembranous colitis were identified as occurring 4 times more frequently in the general population in 2003 than in 1991 and 10 times more frequently than in 1938. […] Nosocomial infections are characterized by a much more severe form of the disease than in the general population, and a higher incidence of C. difficile infection has been noted, especially since 2000.

• #7 Clostridium difficile: epidemiology, diagnostic and therapeutic possibilities—a systematic review | springermedizin.de

  https://www.springermedizin.de/clostridium-difficile-epidemiology-diagnostic-and-therapeutic-po/11089682

  The occurrence of diarrhea and pseudomembranous colitis significantly increased, immediately following the introduction of widely available antibiotic treatments. […] The occurrence of more and more resistant strains resulted in the rapid spread of the bacteria to different departments, particularly the surgical wards and intensive care units but also many other medical wards. […] In a retrospective Canadian study, diarrhea and pseudomembranous colitis were identified as occurring 4 times more frequently in the general population in 2003 than in 1991 and 10 times more frequently than in 1938. […] The same study noted a significant increase in the symptoms of infection among hospitalized patients from 3 to 12 per 1,000 patients (the difference between 1991 and 2003) and up to 43 per 1,000 patients in 2004.

• #8 Clostridioides (Clostridium) Difficile Colitis: Background, Etiology, Pathophysiology

  https://emedicine.medscape.com/article/186458-overview

  New CDI populations have emerged, and studies have challenged the notion that C difficile is primarily a hospital infection, as more cases are being seen in the community. These cases include patients with community-acquired infection and no previous antibiotic exposure, pregnant women, and patients with inflammatory bowel disease (IBD). […] A population-based study from Olmsted County, Minnesota, demonstrated that 41% of the cases of CDI were community acquired and that the incidence of both community- and hospital-acquired C difficile increased significantly from 1991 to 2005. […] The incidence of CDI, as well as deaths attributable to C difficile, has also risen in Europe and Canada. In Canada’s Estrie region of Quebec, the incidence quadrupled in 2003 to 92.2 cases per 100,000 population. In a survey of 97 hospitals across 34 European countries, the incidence of C difficile in hospitalized patients was 41 per 100,000 patient-days.

• #9 From the hospital to the home – the rise and rise of Clostridium difficile infection

  https://www.racgp.org.au/afp/2015/october/from-the-hospital-to-the-home-the-rise-and-rise-of

  Clostridium difficile infection (CDI) has emerged as a serious worldwide public health threat. […] The impact of C. difficile infection (CDI) on healthcare systems is a growing international concern. […] Recently, changes in the epidemiology of CDI have become apparent; not only has there been the emergence of new, highly virulent strains that are capable of causing severe outbreaks in healthcare facilities, but infections are now occurring in the community. […] Rates of community-associated (CA) CDI have increased. […] This change has been accompanied by the appearance of severe disease in groups of patients who would otherwise lack classical risk factors for CDI, including antibiotic exposure, recent hospitalisation and advanced age. […] All-cause mortality among CDI cases is high, and advanced age and infecting ribotype are associated with poorer outcomes.

• #10 From the hospital to the home – the rise and rise of Clostridium difficile infection

  https://www.racgp.org.au/afp/2015/october/from-the-hospital-to-the-home-the-rise-and-rise-of

  This group of patients is clearly an under-representation of all CA CDI cases, and detection in general practice is a key missing piece in the overall picture of CA CDI. […] Currently, these potential sources are of significant interest as identification of risk factors for infection may help in the early diagnosis and subsequent management of CDI. […] There are several potential reservoirs for CA CDI that need further investigation, including environmental, animal and human sources. […] There is an increasing incidence and severity of CA CDI, and evidence of disease in populations not traditionally considered at risk. […] This suggests that symptomatic patients presenting with no recent history of hospitalisation or antibiotic use should be investigated for potential CDI, in addition to being tested for other potential enteric pathogens.

• #11 The burden of CDI in the United States: a multifactorial challenge | BMC Infectious Diseases | Full Text

  https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-023-08096-0

  Clostridioides difficile infection (CDI) affects approximately 500,000 patients annually in the United States, of these around 30,000 will die. […] The Centers for Disease Control (CDC) identified CDI as an urgent threat, highlighting the need for immediate and aggressive action to prevent complications and recurrences of this infection. […] Despite some of the challenges of detecting C. difficile, the toxins produced, and the potential over-reporting based on PCR testing, CDI is associated with almost half a million infections and roughly 30,000 deaths annually in the US. […] The CDC reports that the incidence rate of healthcare-associated CDI (defined as those with onset in a healthcare facility or associated with recent admission to a healthcare facility) is 57.9 cases per 100,000 persons, which represents a sizeable decline in recent years.

• #12 The burden of CDI in the United States: a multifactorial challenge | BMC Infectious Diseases | Full Text

  https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-023-08096-0

  Community-associated CDI, on the other hand, is on the rise, almost doubling in the past decade with an incidence of 63.3 cases per 100,000 persons. […] The incidence of rCDI has increased significantly in recent years and this has been identified as a major public health challenge. […] Data indicate that in the US, recurrence accounts for 75,000 to 175,000 additional cases of CDI per year. […] The breadth of outcomes reported to be associated with CDI is shown in Fig. 1. […] The clinical burden of CDI and rCDI is extensive. […] Studies from four different sources reported 30-day CDI mortality rates ranging from 6 to 11%. […] Mortality rates associated with all-cause infections increase to 20-37% in the intensive care unit (ICU) setting where patients have more than triple the odds of mortality compared to their non-ICU counterparts.

• #13 From the hospital to the home – the rise and rise of Clostridium difficile infection

  https://www.racgp.org.au/afp/2015/october/from-the-hospital-to-the-home-the-rise-and-rise-of

  Definitions for CA and healthcare-associated (HA) CDI were published in 2007 in order to standardise surveillance. […] In Australia, there is mandatory reporting of hospital-identified (HI) CDI cases of CDI (HA and CA) that are identified within any part of the hospital system. […] Recently, surveillance data on HI CDI in Australia were aggregated for the first time. […] The annual incidence of HI CDI increased significantly from 3.25 for every 10,000 patient days (PD) in 2011 to 4.03 for every 10,000 PD in 2012. […] Trends were similar for HA and CA CDI, and a subgroup analysis determined that 26% of cases were CA CDI. […] Current prevalence estimates of CA CDI in WA are sourced from HI cases (ie those identified at an acute care facility, patients presenting to an outpatient appointment, or seen and/or admitted through the emergency department).

• #14 Pseudomembranous Colitis: Symptoms and Treatment | Doctor

  https://patient.info/doctor/pseudomembranous-colitis

  The incidence of primary and recurrent CDI has increased around the world, even after considerable efforts in the last decade. Increased risk of primary CDI is due in part to increasing age of populations and increasing numbers of residents in long-term care facilities. Antibiotic overuse and the emergence of resistance to commonly-used antibiotics such as vancomycin are contributory factors to recurrent infections. Increased recognition and reporting of infections may however account for some of this apparent increase. […] However, in the UK, counts and rates for CDI are falling across the NHS. In England, while rates remained substantial, they were seen to taper between 2009 and 2016 and have subsequently remained fairly stable. In 2009 NHS trusts in England reported 100.3 cases per 100,000 population. By 2017 this had decreased to 24 cases per 100,000. In 2022 there were 28 cases per 100,000 people.

• #15 Consensus on the prevention, diagnosis, and treatment of Clostridium difficile infection | Revista de Gastroenterología de México

  https://www.revistagastroenterologiamexico.org/en-consensus-on-prevention-diagnosis-treatment-articulo-S2255534X19300295

  In recent decades, an increase in the incidence of Clostridium difficile infection has been reported in numerous populations, including both hospital and community environments. […] Since the 1970s, CDI has been associated with antibiotic use and it is considered a nosocomial pathogen. CDI presents in up to 8% of hospitalized patients and is the most common cause of nosocomial diarrhea worldwide. […] Its incidence has increased dramatically since the year 2000. […] Its epidemiology has been modified in the last two decades due to outbreaks in confined settings of long-term care, such as nursing homes, as well as in the community. […] In Mexico, in a retrospective study conducted at 4 hospitals from 3 different cities, the authors reported that of the 487 cases of CDI included in the study, 43 (8.8%) were diagnosed in 2012 and 22 (4.5%) in 2013. There was an important increase in 2014, with 121 cases (24.8%) and in 2015, with 301 cases (61.8%).

• #16 Consensus on the prevention, diagnosis, and treatment of Clostridium difficile infection | Revista de Gastroenterología de México

  https://www.revistagastroenterologiamexico.org/en-consensus-on-prevention-diagnosis-treatment-articulo-S2255534X19300295

  Recently, in a case-control study conducted at a tertiary care hospital center in Mexico City (2015 and 2016), Ochoa-Hein et al. reported that of the 329 cases observed within the study period, 155 (47.1%) were new hospital-acquired cases and 37 (11.2%) were community-acquired cases. […] The increase in more severe cases has been associated with a rise in more virulent strains (hypervirulent strains), such as the NAP1/BI/027 strain, which is the North American pulsed-field gel electrophoresis type 1 (NAP1), restriction endonuclease analysis group BI, and PCR ribotype 027. […] In Mexico, the prevalence of the NAP1/BI/027 strain varies from 28 to 91%. […] In a 2015 study on 22 patients, Camacho-Ortiz et al. demonstrated that 91% of the cases were positive for the NAP1/BI/027 strain. […] In another study, Morfn-Otero et al. examined the outbreaks of CDI at a tertiary care hospital over a 12-month period (n=288), and the NAP1/BI/027 strain was identified in 31 (39%) of the confirmed CDI cases, presenting more frequently in patients with a history of quinolone prescription (39.13 vs 10.4%, p=0.03) and relapses (19 vs 4%, p=0.03).

• #17 Epidemiology of Clostridium difficile Infection

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4128635/

  The findings of this population-based study demonstrate that a significant proportion of CDI cases occur in the community and generally involve younger, less ill patients. […] Recently the Centers for Disease Control and Prevention (CDC) launched an active, population-based surveillance for CDI through the Emerging Infections Program. […] Community-associated CDI cases were defined if a positive stool specimen was collected as an outpatient or within 3 days of an acute care admission in a patient without documentation of an overnight stay in a healthcare facility in the prior 12 weeks. […] The ribotype 027 strain was the most prevalent strain identified in the CA-CDI population. […] The increasing trend in morbidity and mortality has been noted since the start of the 21st Century eventually lead to the recognition of an emerging, previously rare strain, ribotype 027.

• #18 Epidemiology of Clostridium difficile Infection

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4128635/

  This epidemic strain has become endemic in many North American healthcare settings. […] It has been widely reported that the ribotype 027 strain is more virulent or hypervirulent compared to other pathogenic isolates of CDI. […] The need for standardized definitions and surveillance methods to detect outbreaks, assess disease trends, and facilitate comparison of CDI rates across healthcare institutions was recognized earlier this decade with the increased incidence and severity of CDI. […] National surveillance programs are vital to monitor the incidence, identify populations at risk, and characterize the molecular epidemiology of strains causing CDI.

• #19 Pseudomembranous colitis – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/pseudomembranous-colitis/symptoms-causes/syc-20351434

  Pseudomembranous colitis is sometimes called antibiotic-associated colitis or C. difficile colitis. […] C. difficile infections are more common in people over 65 years old. […] C. difficile spores are resistant to many common disinfectants and can be transmitted from the hands of health care professionals to patients. More and more often, C. difficile is being reported in people with no known risk factors, including people with no recent health care contact or use of antibiotics. This is called community-acquired C. difficile. […] An aggressive strain of C. difficile has emerged that produces far more toxins than other strains do. The new strain may be more resistant to certain medicines and has been reported in people who haven’t been in the hospital or taken antibiotics. […] Factors that may increase your risk of pseudomembranous colitis include: Taking antibiotics. Staying in the hospital or a nursing home. Increasing age, especially over 65 years. Having a weakened immune system. Having a colon disease, such as inflammatory bowel disease or colorectal cancer. Undergoing intestinal surgery. Receiving chemotherapy treatment for cancer. […] To help prevent the spread of C. difficile, hospitals and other health care facilities follow strict infection-control guidelines.

• #20 Clostridioides (Clostridium) Difficile Colitis: Background, Etiology, Pathophysiology

  https://emedicine.medscape.com/article/186458-overview

  The worldwide increased incidence of CDI has been attributed to a variety of risk factors, including more elderly patients in the population, treatment resistance to fluoroquinolones, and the emergence of a newly discovered, more virulent strain of C difficile (BI/NAP1/027). Additional risk factors toward increasing CDIs include the use of penicillins and clindamycin, as well as an increased use in the total number of antibiotics in the community. […] CDI is more common in elderly people, and old age may promote susceptibility to colonization and disease. Cross-infection by C difficile is common in neonatal units, but neonates do not seem to develop C difficile associated diarrhea. More recently, there have been specific populations affected by C difficile that were previously believed to be at low risk, such as young, healthy persons not exposed to a hospital environment or antimicrobial therapy and young women in a peripartum setting. […] A study by Nylund et al suggested an increase in CDI among hospitalized children, especially in those with medical conditions such as IBD and immunosuppression. Also at risk are individuals hospitalized with conditions that require antibiotic administration.

• #21 Pseudomembranous Colitis: Symptoms and Treatment | Doctor

  https://patient.info/doctor/pseudomembranous-colitis

  An American study found an incidence of 8.3 cases of hospital-associated CDI per 10 000 patient-days. […] Any antibiotic can increase the risk of CDI, including metronidazole and vancomycin, which are also used in the treatment of CDI. […] Disease has been reported following as little as one dose of antibiotic. […] Although the attributable risk has varied among studies, fluoroquinolones, macrolides, clindamycin, beta-lactam/beta-lactamase inhibitors and cephalosporins have been shown to pose a significant risk for the development of CDI. […] Antineoplastic agents and proton pump inhibitors have also been associated with CDI.

• #22 Consensus on the prevention, diagnosis, and treatment of Clostridium difficile infection | Revista de Gastroenterología de México

  https://www.revistagastroenterologiamexico.org/en-consensus-on-prevention-diagnosis-treatment-articulo-S2255534X19300295

  The association between proton pump inhibitors (PPIs) and CDI has been observed in recent years and prolonged gastric acid suppression is assumed to be the most important mechanism. […] The implementation of optimization and education programs on antibiotic use (antimicrobial stewardship), as well as in-hospital epidemiologic controls, environmental decontamination, and hand-washing are measures that have demonstrated a decrease in the incidence of CDI.

• #23 73. Clostridioides difficile Infection and Pseudomembranous Colitis | Healthcare-Associated Pathogens and Diseases | Table of Contents | APIC

  https://text.apic.org/toc/healthcare-associated-pathogens-and-diseases/clostridioides-difficile-infection-and-pseudomembranous-colitis

  Clostridioides difficile infection, including pseudomembranous colitis. In recent data show C. difficile rates in the U.S. have been decreasing since 2012. This is largely due to improvements in infection control practices, antimicrobial stewardship efforts, and diagnostic testing. Pseudomembranous colitis (PMC) is seen in about half of patients with symptomatic C. difficile infection and is characterized by formation of punctate pseudomembranes that can cover the entire colonic surface in severe cases. High-risk environments include acute care hospitals and long-term care facilities in which the use of antimicrobials is high, increasing the size of the susceptible population, and in which the environment is heavily contaminated by the spores of C. difficile, increasing the risk of patient contact with the organism. Good personal hand hygiene, gloving, barrier precautions, and thorough environmental cleaning to prevent transmission of the spores to the patient can accomplish prevention and control. C. difficile infection (CDI) can be most effectively prevented by reducing overall antimicrobial use and by limiting use of certain specific antimicrobials, such as clindamycin, third-generation cephalosporins, and fluoroquinolones. Implementation of a local antimicrobial stewardship program also encourages appropriate use of broader spectrum antimicrobials.

• #24 Pseudomembranous colitis: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/000259.htm

  Pseudomembranous colitis is uncommon in children, and rare in infants. It is most often seen in people who are in the hospital. However, it is becoming more common in people who take antibiotics and are not in a hospital. […] Risk factors include: Older age, Antibiotic use, Use of medicines that weaken the immune system (such as chemotherapy medicines), Recent surgery, History of pseudomembranous colitis, History of ulcerative colitis, Crohn disease, and inflammatory bowel disease (IBD). C difficile can happen in IBD patients even without taking antibiotics. […] The outlook is good in most cases, if there are no complications. However, up to 1 in 5 infections may return and need more treatment.

• #25 Pseudomembranous Colitis Surgery: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/193031-overview

  The incidence of antibiotic-associated diarrhea ranges from 5% to 39%, depending on the antibiotic type. Pseudomembranous colitis complicates 10% of cases of antibiotic-associated diarrhea. C difficile is found in the stool of 15-25% of asymptomatic, antibiotic-treated, hospitalized adults. Similar numbers were found in debilitated patients and in patients who received one dose of prophylactic antibiotics before surgical procedure. […] C difficile colitis is the fourth most common nosocomial disease reported to the Centers for Disease Control and Prevention. C difficile is one of the most frequently isolated enteric pathogens, second only to Campylobacter jejuni. […] High-risk populations include elderly people, patients in the intensive care unit (ICU), people with uremia, people with burns, people undergoing abdominal surgery, women undergoing cesarean delivery, and patients with cancer. One suggestion is that these patients do not have greater susceptibility to the disease but are at heightened risk of nosocomial infection. C difficile can be transmitted nosocomially, via the hands of personnel or by contaminated objects. It can survive in spore form for as long as 5 months on hospital floors.

• #26 Asymptomatic Clostridium difficile colonization: epidemiology and clinical implications | BMC Infectious Diseases | Full Text

  https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-015-1258-4

  These features of asymptomatic C. difficile colonization are important to establish the contribution that asymptomatic C. difficile colonized patients make as potential vehicles of transmission of C. difficile in healthcare environments, particularly with the global spread of emergent hypervirulent toxigenic strains. […] Few studies have synthesized evidence on the role and importance of asymptomatic C. difficile colonization in the progression to symptomatic CDI, the transmission of infection, or the challenges to CDI control. […] The prevalence of asymptomatic C. difficile colonization among elderly residents ranged from 0 to 51 %, possibly because CDI is often endemic in units or institutions with elderly patients. […] The highest prevalence of asymptomatic C. difficile colonization has been reported in patients with cystic fibrosis (CF) and in spinal/brain injury rehabilitation.

• #27 Asymptomatic Clostridium difficile colonization: epidemiology and clinical implications | BMC Infectious Diseases | Full Text

  https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-015-1258-4

  The increased colonization rate among this group of patients is thought to result from the rehabilitation therapy where group activities and socialization are encouraged, facilitating transmission. […] The main modes of transmission are by the fecal-oral route and direct contact with contaminated surfaces and fomites, although transmission between healthy individuals who are asymptomatically colonized has also been reported. […] Spores from asymptomatically colonized patients are a potential source of CDI and may contribute to the transmission reservoir. […] The current CDI clinical practice guidelines from the Society of Healthcare Epidemiologists of America (SHEA) recommend maintaining contact precautions only until resolution of diarrhea. […] Asymptomatic C. difficile colonized patients in hospital have the potential to contaminate the environment and subsequently infect others; however the transmission potential is lower in asymptomatic C. difficile colonized patients than in those patients with active disease.

• #28 Fact Sheet – Clostridium difficile (C. difficile) – Canada.ca

  https://www.canada.ca/en/public-health/services/infectious-diseases/fact-sheet-clostridium-difficile-difficile.html

  C. difficile is the most frequent cause of infectious diarrhea in hospitals and long-term care facilities in Canada, as well as in other industrialized countries. […] The presence of C. difficile bacteria, together with a large number of patients receiving antibiotics in healthcare settings, can lead to frequent C. difficile outbreaks. […] The Public Health Agency of Canada publishes infection prevention and control guidelines as a resource for healthcare and public health professionals in provinces and territories. […] To better understand risk patterns and trends in Canada, C. difficile became a notifiable disease under national surveillance in 2009 through the Canadian Notifiable Disease Surveillance System. […] The Agency works closely with our provincial and territorial partners to monitor and control C. difficile infections across Canada.

• #29 Fact Sheet – Clostridium difficile (C. difficile) – Canada.ca

  https://www.canada.ca/en/public-health/services/infectious-diseases/fact-sheet-clostridium-difficile-difficile.html

  The Agency leads the Canadian Nosocomial Infection Surveillance Program (CNISP). […] As part of this program, participating hospitals report all cases of C. difficile infections. […] All these results are used to inform and improve surveillance activities and infection prevention and control guidance related to C. difficile across the country.

• #30

  https://www.gov.uk/government/collections/clostridium-difficile-guidance-data-and-analysis

  C. difficile is the biggest cause of infectious diarrhoea in hospitalised patients. […] UK Health Security Agency (UKHSA, formerly Public Health England) has carried out mandatory enhanced surveillance of C. difficile infection since April 2007 for NHS acute trusts; patient-level data of any C. difficile infections are reported monthly to UKHSA. […] Independent sector (IS) healthcare organisations providing regulated activities also undertake surveillance of C. difficile infection.

• #31 Clinical Practice Guidelines for Clostridium difficile Infection in Adults and Children: 2017 Update by SHEA/IDSA

  https://www.idsociety.org/practice-guideline/clostridium-difficile/

  A panel of experts was convened by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA) to update the 2010 clinical practice guideline on Clostridium difficile infection (CDI) in adults. […] Clostridium difficile remains the most important cause of healthcare-associated diarrhea and has become the most commonly identified cause of healthcare-associated infection in adults in the United States. […] This guideline updates recommendations regarding epidemiology, diagnosis, treatment, infection prevention, and environmental management. […] To increase comparability between clinical settings, use available standardized case definitions for surveillance of (1) healthcare facility-onset (HO) CDI; (2) community-onset, healthcare facility-associated (CO-HCFA) CDI; and (3) community-associated (CA) CDI (good practice recommendation).

• #32 Clinical Practice Guidelines for Clostridium difficile Infection in Adults and Children: 2017 Update by SHEA/IDSA

  https://www.idsociety.org/practice-guideline/clostridium-difficile/

  At a minimum, conduct surveillance for HO-CDI in all inpatient healthcare facilities to detect elevated rates or outbreaks of CDI within the facility (weak recommendation, low quality of evidence). […] Express the rate of HO-CDI as the number of cases per 10000 patient-days. Express the CO-HCFA prevalence rate as the number of cases per 1000 patient admissions (good practice recommendation). […] Stratify data by patient location to target control measures when CDI incidence is above national and/or facility reduction goals or if an outbreak is noted (weak recommendation, low quality of evidence). […] Use the same standardized case definitions (HO, CO-HCFA, CA) and rate expression (cases per 10000 patient-days for HO, cases per 1000 patient admissions for CO-HCFA) in pediatric patients as for adults (good practice recommendation). […] Conduct surveillance for HO-CDI for inpatient pediatric facilities but do not include cases 2 years of age (weak recommendation, low quality of evidence). […] Consider surveillance for CA-CDI to detect trends in the community (weak recommendation, low quality of evidence).

• #33 Clostridium difficile: epidemiology, diagnostic and therapeutic possibilities—a systematic review | springermedizin.de

  https://www.springermedizin.de/clostridium-difficile-epidemiology-diagnostic-and-therapeutic-po/11089682

  Not only has the number of cases grown significantly over the years, but the severity has increased and the general condition of the patient has deteriorated. […] More and more patients, in addition to standard conservative treatment, require surgery. […] In another study, 10 % of patients were hospitalized in intensive care units and 2.5 % required an emergency colectomy. […] The mortality in this study reached 16 %. […] Similar statistics were observed in Europe and the USA, where in 1999-2007, C. difficile was the main contributor to death in patients with inflammatory bowel disease. […] Nosocomial infections are characterized by a much more severe form of the disease than in the general population, and a higher incidence of C. difficile infection has been noted, especially since 2000.

• #34 Consensus on the prevention, diagnosis, and treatment of Clostridium difficile infection | Revista de Gastroenterología de México

  https://www.revistagastroenterologiamexico.org/en-consensus-on-prevention-diagnosis-treatment-articulo-S2255534X19300295

  The clinical significance of the NAP1/BI/027 strain in the Mexican population is uncertain. […] The CDI spectrum is variable and ranges from mild diarrhea to severe complications, such as pseudomembranous colitis, toxic megacolon (fulminant colitis), sepsis, and death. […] Pseudomembranous colitis is considered a typical manifestation of CDI and presents in 40-60% of the cases. […] In that variety, diarrhea is generally profuse, with moderate-to-severe abdominal pain. […] In Mexico, Velarde-Ruiz Velasco et al. reported that pseudomembranous colitis had a certain tendency to present more frequently with the hypervirulent strain (47% vs. 28%), but those results showed no statistically significant difference (RR: 1.62, p=0.23). […] CDI should be suspected in a patient with diarrhea and a history of antibiotic use and/or immunosuppression, whose diarrhea is community-acquired, or presents after more than 48h of hospitalization, or within 8 weeks after hospital release.

• #35 Clostridioides difficile colitis | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/clostridioides-difficile-colitis?embed_domain=hackmd.io%252F%2540yIPUAFeCSL2JsU8smR5nJQ%252Fbnjhjgjghjghjgh&lang=us

  C. difficile infection is usually preceded by antibiotic use or chemotherapy and is therefore usually encountered in unwell, hospitalized patients with significant comorbidity. […] Untreated pseudomembranous colitis carries a high mortality from the sequelae of toxic megacolon and perforation.

• #36 The burden of CDI in the United States: a multifactorial challenge | BMC Infectious Diseases | Full Text

  https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-023-08096-0

  Significant health complications of CDI include sepsis, colectomy, megacolon, intestinal perforation, and renal failure. […] The cyclical nature of rCDI contributes to the significant burden with recurrence increasing the likelihood of hospitalization. […] CDI and rCDI are associated with a substantial economic burden that is driven by hospitalization costs.

• #37 A Case Report of Pseudomembranous Colitis Resulting from Clostridium difficile Infection Successfully Treated with Fidaxomicin | Cardoso | Journal of Medical Cases

  https://www.journalmc.org/index.php/JMC/article/view/2632/1988

  Pseudomembranous colitis (PMC) is a serious condition caused by Clostridium difficile, often arising after antibiotic therapy in the healthcare setting. […] Currently, C. difficile is the leading cause of nosocomial diarrhea in industrialized countries, and the incidence of CDI is increasing in Europe. […] The main risk factor for the development of CDI is exposure to antibacterial therapy, classically broad-spectrum agents, which are able to disrupt colonic microflora. […] According to the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) guidelines, recurrence is the major challenge in the treatment of CDI, with up to 25% of patients with CDI suffering a recurrence of infection within 30 days after treatment with metronidazole or vancomycin and 45-65% of these patients present subsequent recurrences.

• #38

  https://link.springer.com/article/10.1007/s10151-013-1081-0

  This is the most well-known form of C. difficile infection. […] It is essential to initiate the appropriate medical treatment for patients with pseudomembranous colitis due to the potential toxic effects of the infection. […] Relapses occur in about 10-25 % of cured patients. […] The optimal time for surgery is within 48 h of initiating conservative treatment without seeing a response, the development of multiple organ failure or a bowel perforation. […] The number of subtotal colectomies performed continues to escalate due to the presence of hypervirulent strains of C. difficile.

• #39 Pseudomembranous colitis: Symptoms, treatment, and more

  https://www.medicalnewstoday.com/articles/pseudomembranous-colitis

  In 20% of cases, pseudomembranous colitis can return following treatment. […] Sometimes it is not possible to prevent pseudomembranous colitis. However, if it results from a C. difficile infection, people can help prevent the condition by practicing good hand hygiene. […] The condition has various causes. However, it often results from a C. difficile infection. Treatment focuses on resolving the underlying cause, which may require antibiotics.

• #40 Clostridioides difficile Infection: Update on Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2020/0201/p168.html

  Pseudomembranous colitis is characterized by a wide range of symptoms, from mild or moderate diarrhea to severe disease with pseudomembranous colitis, colonic ileus, toxic megacolon, sepsis, or death. […] The rate of C. difficile infections increased from 13 to 14.2 cases per 1,000 adults between 2011 and 2015; it is now the most commonly reported nosocomial pathogen in the United States. […] A recent retrospective cohort study of adults with C. difficile infection in the Veterans Health Administration found that 60% of cases were diagnosed after more than two days of hospitalization; these were classified as health care facility-acquired infections. […] The risk of C. difficile infection associated with hospitalization is attributed to colonization rates of 20% to 40% in hospitalized adults compared with 2% to 3% in healthy adults. […] Infection control requires a robust surveillance system to detect increased infection rates or outbreaks of C. difficile infection; in addition, key preventive strategies include use of contact precautions, good hand hygiene, environmental cleaning and disinfection, and patient bathing.

• #41 C. diff: Facts for Clinicians | C. diff | CDC

  https://www.cdc.gov/c-diff/hcp/clinical-overview/index.html

  Clostridioides difficile (C. diff) is a common cause of antibiotic-associated diarrhea (AAD). It accounts for 15 to 25% of all events of AAD. […] CDC works with federal and public health partners to reduce C. diff infections. CDC also discovers, implements and evaluates innovative ways to improve healthcare quality and patient safety. […] EPA-registered disinfectants with a sporicidal claim have been successful in environmental surface disinfection of patient-care areas where surveillance and epidemiology indicate ongoing transmission of C. diff.

• #42 Pseudomembranous colitis – UF Health

  https://ufhealth.org/conditions-and-treatments/pseudomembranous-colitis

  Pseudomembranous colitis is uncommon in children, and rare in infants. It is most often seen in people who are in the hospital. However, it is becoming more common in people who take antibiotics and are not in a hospital. […] Risk factors include: Older age, Antibiotic use, Use of medicines that weaken the immune system (such as chemotherapy medicines), Recent surgery, History of pseudomembranous colitis, History of ulcerative colitis and Crohn disease. […] People who have had pseudomembranous colitis should tell their providers before taking antibiotics again. It is also very important to wash hands well to prevent passing the germ to other people. Alcohol sanitizers do not always work on C difficile.

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