[Epidemiology, risk factors and prevention of Clostridium difficile nosocomial infections].
Clostridium difficile is responsible for 10-25% of cases of antibiotic-associated diarrhea (AAD) and for virtually all cases of antibiotic-associated pseudo-membranous colitis (PMC). This anaerobic spore-forming bacterium has been identified as the leading cause of nosocomial infectious diarrhea in adults. Pathogenesis relies on a disruption of the normal bacterial flora of the colon, a colonization by C. difficile and the release of toxins A and B that cause mucosal damage and inflammation. Incidence of C. difficile intestinal disorders usually varies from one to 40 per thousand patient admissions. Risk factors for C. difficile-associated diarrhea include antimicrobial therapy, older age (> 65 years), antineoplastic chemotherapy, and length of hospital stay. Nosocomial transmission of C. difficile via oro-fecal route occurs in 3-30% of total patient admissions but it remains asymptomatic in more than 66% of cases. Persistent environmental contamination and carrying of the organism on the hands of hospital staff are common. Measures that are effective in reducing cross-infection consist of an accurate and rapid diagnosis, an appropriate treatment, an implementation of enteric precautions for symptomatic patients, a reinforcement of hand-washing and a daily environmental disinfection. C. difficile is a common cause of infectious diarrhea and should be therefore systematically investigated in patients with nosocomial diarrhea.
Unité d'hygiène et de lutte contre les infections nosocomiales (UHLNIN), hôpital Saint-Antoine, 184, rue du Faubourg Saint-Antoine, 75571 Paris, 12, France. frederic.barbut@sat.ap-hop-paris.fr
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D016360:Clostridioides difficile; D003015:Clostridium Infections / Q000453:epidemiology* / Q000517:prevention & control* / Q000635:transmission; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology* / Q000517:prevention & control; D003967:Diarrhea / Q000382:microbiology; D004761:Enterocolitis, Pseudomembranous / Q000453:epidemiology / Q000517:prevention & control / Q000635:transmission; D006761:Hospitals; D006801:Humans; D012307:Risk Factors