title: Update on Clostridium difficile infections.
abstract: Clostridium difficile infections (CDI) occur primarily in hospitalized patients with risk factors such as concomitant or recent use of antibiotics. CDI related additional costs are important for the global population and health-care facilities. CDI epidemiology has changed since 2003: they became more frequent boosted by large outbreaks, more severe, more resistant to antibiotic treatment, and spread to new groups of population without any risk factor. This is partly due to the emergence and worldwide dissemination of new and more virulent C. difficile strains such as the epidemic clone 027/NAP1/BI. The host immune response plays a central role in the pathogenesis of CDI and could also be involved in the occurrence of recurrent or severe forms. New guidelines including new molecular tests (NAAT) have recently clarified and simplified the diagnostic strategies for the microbiological diagnosis of CDI. The CDI incidence was proven to be related to the level of clinical suspicion and the frequency of microbiological screening for C. difficile. The current recommendations for the treatment of CDI mention oral metronidazole as the first line treatment for mild to moderate diarrhea. Oral vancomycin use should be restricted to severe cases. In the absence of consensus, the treatment of multiple recurrences remains a major concern. New and more targeted antibiotics and innovative therapeutic strategies (fecal transplantation, monoclonal antibodies, and vaccination) have emerged as new therapies for CDI.
authors.affiliation: Unité de microbiologie clinique, groupe hospitalier Paris Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France; Université Paris-Sud, EA4043 écosystème microbien digestif et santé, 92296 Châtenay-Malabry cedex, France. Electronic address: alemonnier@hpsj.fr.
authors.forename: A
authors.initials: A
authors.lastname: Le Monnier
authors.affiliation: Unité de prévention et de lutte contre les infections nosocomiales, université d'Angers, CHU d'Angers, 49100 Angers, France.
authors.forename: J-R
authors.initials: JR
authors.lastname: Zahar
authors.affiliation: Laboratoire Clostridium difficile associé au CNR des anaérobies et du botulisme, 75012 Paris, France; Groupe de recherche clinique n(o) 2 EPIDIFF, université Pierre-et-Marie-Curie, 75012 Paris, France.
authors.forename: F
authors.initials: F
authors.lastname: Barbut
mesh_terms: D016360:Clostridioides difficile; D003015:Clostridium Infections / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology / Q000382:microbiology / Q000503:physiopathology; D017281:Cost of Illness; D006801:Humans; D012307:Risk Factors
keywords: Clostridium difficile; Colite; Colitis; Diarrhée post-antibiotique; Post-antibiotic diarrhea