title: New advances in Clostridium difficile infection: changing epidemiology, diagnosis, treatment and control.
abstract: OBJECTIVE
  Clostridium difficile infection and Clostridium difficile-associated diarrhea (CDAD) are growing worldwide health threats. Recent studies have identified new host risk factors, diagnostic approaches and therapies of CDAD. The present review focuses on scientific papers published in the past 18 months in an attempt to provide the latest information on the topic.
  
  
  RESULTS
  We are seeing an increasing number of patients with Clostridium difficile infection developing their illness in the community, although many were recently discharged from a healthcare setting suggesting an acquisition of infection in the hospital environment. The use of gastric acid-altering drugs that facilitate intestinal transit of the bacteria, antibacterial drugs that deplete colonic flora and presence of inflammatory bowel disease are risk factors for CDAD. Fulminant CDAD is increasing, complicated by leukocytosis (peripheral white blood cell count >16,000/mm), hypoalbuminemia, renal failure and emergency colectomy, with overall rise in CDAD disease mortality rates. Although vancomycin is recommended for severe cases of CDAD, recurrence rates remain high. Control of Clostridium difficile infection in the hospital setting focuses on disinfection of the environment and antibiotic stewardship policies. Anti-Clostridium difficile vaccines are in development.
  
  
  CONCLUSIONS
  CDAD is an increasing health problem throughout the United States, Canada and Europe with rising mortality rate. Occurrence of CDAD outside of healthcare settings and in pediatric populations represents newly emerging problems. New treatments are needed.
authors: The University of Texas School of Public Health, Houston, Texas 77030, USA. Herbert.L.DuPont@uth.tmc.edu
authors: Herbert L
authors: HL
authors: DuPont
authors: Kevin
authors: K
authors: Garey
authors: Juan-Pablo
authors: JP
authors: Caeiro
authors: Zhi-Dong
authors: ZD
authors: Jiang
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016360:Clostridioides difficile / Q000472:pathogenicity*; D003015:Clostridium Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control; D003967:Diarrhea / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000382:microbiology; D004761:Enterocolitis, Pseudomembranous / Q000188:drug therapy* / Q000453:epidemiology / Q000401:mortality*; D006801:Humans
chemical_list: D000900:Anti-Bacterial Agents