title: Clostridium difficile infection: guideline-based diagnosis and treatment.
abstract: BACKGROUND
  Clostridium difficile (C. difficile) is the pathogen that most commonly causes nosocomial and antibiotic-associated diarrheal disease. Optimized algorithms for diagnosis, treatment, and hygiene can help lower the incidence, morbidity, and mortality of C. difficile infection (CDI).
  
  
  METHODS
  This review is based on pertinent articles that were retrieved by a selective search in PubMed for recommendations on diagnosis and treatment(up to March 2014), with particular attention to the current epidemiological situation in Germany.
  
  
  RESULTS
  The incidence of CDI in Germany is 5 to 20 cases per 100,000 persons per year. In recent years, a steady increase in severe, reportable cases of CDI has been observed, and the highly virulent epidemic strain Ribotype 027 has spread across nearly the entire country. For therapeutic and hygiene management, it is important that the diagnosis be made as early as possible with a sensitive screening test, followed by a confirmatory test for the toxigenic infection. Special disinfection measures are needed because of the formation of spores. The treatment of CDI is evidence-based; depending on the severity of the infection, it is treated orally with metronidazole, or else with vancomycin or fidaxomicin. Fulminant infections and recurrences call for specifically adapted treatment modalities. Treatment with fecal bacteria (stool transplantation) is performed in gastroenterological centers that have experience with this form of treatment after multiple failures of drug treatment for recurrent infection. For critically ill patients, treatment is administered by an interdisciplinary team and consists of early surgical intervention in combination with drug treatment. A therapeutic algorithm developed on the basis of current guidelines and recommendations enables risk-adapted, individualized treatment.
  
  
  CONCLUSIONS
  The growing clinical and epidemiological significance of CDI compels a robust implementation of multimodal diagnostic, therapeutic, and hygienic standards. In the years to come, anti-toxin antibodies, toxoid vaccines, and focused bacterial therapy will be developed as new treatment strategies for CDI.
authors.affiliation: Division of Infectious Diseases and Tropical Medicine, Department of Gastroenterology and Rheumatology, Department of Internal Medicine, Neurology and Dermatology, Leipzig University Hospital, Department of General, Visceral and Vascular Surgery, University Hospital of Halle (Saale), Institute of Medical Microbiology and Hygiene, Saarland University Medical Center, National Advisory Laboratory for Clostridium difficile.
authors.forename: Christoph
authors.initials: C
authors.lastname: Lübbert
authors.forename: Endres
authors.initials: E
authors.lastname: John
authors.forename: Lutz
authors.initials: L
authors.lastname: von Müller
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001688:Biological Products / Q000627:therapeutic use; D016360:Clostridioides difficile / Q000302:isolation & purification*; D004761:Enterocolitis, Pseudomembranous / Q000175:diagnosis* / Q000628:therapy*; D005243:Feces / Q000382:microbiology; D006801:Humans; D055552:Infectious Disease Medicine / Q000592:standards*; D017410:Practice Guidelines as Topic
chemical_list: D000900:Anti-Bacterial Agents; D001688:Biological Products