title: Clostridium difficile infection in patients with liver disease: a review.
abstract: Over the past two decades, there has been a dramatic worldwide increase in both the incidence and severity of Clostridium difficile infection (CDI). Paralleling the increased incidence of CDI in the general population, there has been increased interest in CDI among patients with liver disease, particularly in those with liver cirrhosis and post liver transplantation. MEDLINE and several other electronic databases from January 1995 to December 2014 were searched in order to identify potentially relevant literature. Patients with cirrhosis and liver transplant recipients are at high risk for the development CDI because of antibiotics and proton pump inhibitors use, frequent and prolonged hospitalization, immunosuppressant therapy, and multiple comorbidities. Enzyme immunoassay to detect C. difficile toxins A and B in stool remains the most widely used test for CDI diagnosis, although, more recently, polymerase chain reaction (PCR)-based assays have become the preferred diagnostic test in many laboratories. Metronidazole and vancomycin, given orally, have proved to be effective in the treatment of CDI. Both cirrhotic patients and liver transplant recipients with CDI have longer length of hospital stay, increased mortality, and higher healthcare costs than those without CDI. A rapid diagnosis and adequate therapy of CDI are of paramount importance to improve liver disease patients' outcome. The aim of this review is to provide up-to-date information on the epidemiology, risk factors, pathogenesis, treatment, and outcomes in liver disease patients with CDI.
authors.affiliation: "Gr. T. Popa" University of Medicine and Pharmacy, 700111, Iasi, Romania.|Institute of Gastroenterology and Hepatology, "St. Spiridon" Emergency University Hospital, Independentei Street no. 1, 700111, Iasi, Romania.
authors.forename: A
authors.initials: A
authors.lastname: Trifan
authors.affiliation: "Gr. T. Popa" University of Medicine and Pharmacy, 700111, Iasi, Romania.
authors.forename: O
authors.initials: O
authors.lastname: Stoica
authors.affiliation: Institute of Gastroenterology and Hepatology, "St. Spiridon" Emergency University Hospital, Independentei Street no. 1, 700111, Iasi, Romania. stanciucarol@yahoo.com.
authors.forename: C
authors.initials: C
authors.lastname: Stanciu
authors.affiliation: "Gr. T. Popa" University of Medicine and Pharmacy, 700111, Iasi, Romania.|Institute of Gastroenterology and Hepatology, "St. Spiridon" Emergency University Hospital, Independentei Street no. 1, 700111, Iasi, Romania.
authors.forename: C
authors.initials: C
authors.lastname: Cojocariu
authors.affiliation: "Gr. T. Popa" University of Medicine and Pharmacy, 700111, Iasi, Romania.|Institute of Gastroenterology and Hepatology, "St. Spiridon" Emergency University Hospital, Independentei Street no. 1, 700111, Iasi, Romania.
authors.forename: A-M
authors.initials: AM
authors.lastname: Singeap
authors.affiliation: "Gr. T. Popa" University of Medicine and Pharmacy, 700111, Iasi, Romania.
authors.forename: I
authors.initials: I
authors.lastname: Girleanu
authors.affiliation: Hospital of Infectious Diseases, "Gr. T. Popa" University of Medicine and Pharmacy, 700111, Iasi, Romania.
authors.forename: E
authors.initials: E
authors.lastname: Miftode
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016360:Clostridioides difficile / Q000302:isolation & purification*; D003015:Clostridium Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology / Q000473:pathology; D003955:Diagnostic Tests, Routine / Q000379:methods; D003967:Diarrhea / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology / Q000473:pathology; D004359:Drug Therapy, Combination; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D016031:Liver Transplantation / Q000009:adverse effects*; D008795:Metronidazole / Q000627:therapeutic use; D016896:Treatment Outcome; D014640:Vancomycin / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D008795:Metronidazole; D014640:Vancomycin