title: Biology of Clostridium difficile: implications for epidemiology and diagnosis.
abstract: Clostridium difficile is an anaerobic, spore-forming, gram-positive rod that causes a spectrum of antibiotic-associated colitis through the elaboration of two large clostridial toxins and other virulence factors. Since its discovery in 1978 as the agent responsible for pseudomembranous colitis, the organism has continued to evolve into an adaptable, aggressive, hypervirulent strain. Advances in molecular methods and improved animal models have facilitated an understanding of how this organism survives in the environment, adapts to the gastrointestinal tract of animals and humans, and accomplishes its unique pathogenesis. The advances in microbiology have been accompanied by some important clinical observations including increased rates of C. difficile infection, increased virulence, and multiple outbreaks. The major new risk is fluoroquinolone use; there is also an association with proton pump inhibitors and increased recognition of cases in outpatients, pediatric patients, and patients without recent antibiotic use. The combination of more aggressive strains with mobile genomes in a setting of an expanded pool of individuals at risk has refocused attention on and challenged assumptions regarding diagnostic gold standards. Future research is likely to build upon the advancements in phylogenetics to create novel strategies for diagnosis, treatment, and prevention.
authors.affiliation: Division of Medical Microbiology, The Johns Hopkins Medical Institutions, Baltimore, Maryland 21205, USA. Kcarrol7@jhmi.edu
authors.forename: Karen C
authors.initials: KC
authors.lastname: Carroll
authors.forename: John G
authors.initials: JG
authors.lastname: Bartlett
mesh_terms: D000818:Animals; D001427:Bacterial Toxins / Q000235:genetics / Q000378:metabolism; D016360:Clostridioides difficile / Q000235:genetics / Q000302:isolation & purification* / Q000502:physiology*; D003015:Clostridium Infections / Q000175:diagnosis* / Q000453:epidemiology / Q000382:microbiology*; D015964:Gene Expression Regulation, Bacterial; D006801:Humans; D037521:Virulence Factors / Q000235:genetics / Q000378:metabolism
chemical_list: D001427:Bacterial Toxins; D037521:Virulence Factors