title: Clostridium difficile: changing epidemiology and new treatment options.
abstract: OBJECTIVE
  The review summarizes changes in the epidemiology and treatment of Clostridium difficile-associated disease.
  
  
  RESULTS
  Recent outbreaks of Clostridrium difficile-associated diarrhoea with increased severity, high relapse rate and significant mortality, have been related to the emergence of a new, hypervirulent C. difficile strain in north America, Japan and Europe. Definitions have been proposed by the European Centre for Disease Prevention and Control to identify severe cases of Clostridrium difficile-associated diarrhoea and to differentiate community-acquired cases from nosocomial-acquired cases. The emerging strain is referred to as North American pulsed-field type 1 and polymerase chain reaction ribotype 027. The emerging strain has also been detected in calf diarrhoea and ground meat samples in Canada. Attempts to prevent outbreaks caused by type 027 should focus on controlling the overall use of antibiotics, and high-risk antibiotics such as cephalosporins, clindamycin and fluoroquinolones. Several new antibiotic and non-antibiotic alternatives have become available; there is currently no place for probiotic treatments. Patients who suffer multiple relapses of C. difficile-associated diarrhoea present a major therapeutic challenge.
  
  
  CONCLUSIONS
  The early recognition of Clostridrium difficile-associated diarrhoea caused by NAP1/027 is necessary to start rapid treatment, to prevent complications, and to prevent further spread of the bacterium.
authors.affiliation: Department of Medical Microbiology, Leiden University Medical Center, Leiden, the Netherlands. e.j.kuijper@lumc.nl
authors.forename: Ed J
authors.initials: EJ
authors.lastname: Kuijper
authors.forename: Jaap T
authors.initials: JT
authors.lastname: van Dissel
authors.forename: Mark H
authors.initials: MH
authors.lastname: Wilcox
mesh_terms: D000818:Animals; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects; D001428:Bacterial Vaccines / Q000276:immunology / Q000627:therapeutic use; D002417:Cattle; D002418:Cattle Diseases / Q000453:epidemiology; D016360:Clostridioides difficile / Q000187:drug effects / Q000472:pathogenicity; D003967:Diarrhea / Q000188:drug therapy* / Q000453:epidemiology* / Q000382:microbiology / Q000503:physiopathology; D004196:Disease Outbreaks; D004363:Drug Utilization; D004761:Enterocolitis, Pseudomembranous / Q000453:epidemiology* / Q000382:microbiology / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D021521:Ribotyping
chemical_list: D000900:Anti-Bacterial Agents; D001428:Bacterial Vaccines