title: Clostridium difficile:  novel insights on an incessantly challenging disease.
abstract: OBJECTIVE
  This review comprises recent insights on epidemiology, risk factors, diagnostic approaches, pathophysiologic mechanisms, novel treatment options and prevention strategies of Clostridium difficile infection (CDI).
  
  
  RESULTS
  Incidence of Clostridium difficile continues to rise and hypervirulent subtypes such as polymerase chain reaction (PCR) ribotype 027 and 078 have emerged worldwide. Children and postpartum women are increasingly recognized as being at risk for development of CDI and community-associated infection is no longer rare. PCR technology may replace complicated two-step test algorithms in the future, because it is rapid, sensitive and specific. Pathophysiological studies have provided evidence that either one of the two exotoxins A and B is important in conferring virulence - the role of binary toxin requires further investigation. Proton pump inhibitors are now established as important risk factors for acquiring, complicating CDI, and developing recurrences. Fidaxomycin, monoclonal antibodies and intestinal microbiota transplantation are promising new treatment options, especially regarding prevention of recurrent disease. Future prevention strategies involve vaccination and novel insights on reservoirs for ongoing transmission, including the food chain.
  
  
  CONCLUSIONS
  Important advances in research on CDI include novel diagnostic approaches, better understanding of the underlying pathophysiological mechanisms of disease and the development of new approaches to treatment.
authors.affiliation: Department of Healthcare Epidemiology and Infection Prevention, The Johns Hopkins Health System, Baltimore, Maryland 21287, USA. stschudi@jhsph.edu
authors.forename: Sarah
authors.initials: S
authors.lastname: Tschudin-Sutter
authors.forename: Andreas F
authors.initials: AF
authors.lastname: Widmer
authors.forename: Trish M
authors.initials: TM
authors.lastname: Perl
mesh_terms: D000818:Animals; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016360:Clostridioides difficile / Q000472:pathogenicity; D004761:Enterocolitis, Pseudomembranous / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control / Q000628:therapy; D014943:Global Health; D006801:Humans; D015994:Incidence; D016133:Polymerase Chain Reaction / Q000379:methods; D012307:Risk Factors
chemical_list: D000900:Anti-Bacterial Agents