title: [Clostridium difficile infections in geriatric patients].
abstract: Clostridium difficile is the main cause of nosocomial antibiotic-associated diarrhea in adults in Europe and North America. Infections with C. difficile typically occur in elderly patients with comorbidities and prior antibiotic therapy. Other risk factors are proton pump inhibitors, which are taken by many elderly patients. The main virulence factors are toxins A and B. The clinical spectrum ranges from asymptomatic colonization to severe disease with abdominal complications and sepsis. The current diagnostic gold standard is anaerobic culture but is impractical in routine use due to the long duration. Proven techniques involve glutamate dehydrogenase, toxins A and B immunoassays and PCR. First infections and recurrences can be treated with 400-500 mg metronidazole 3 times a day for 10 days. Further recurrences, serious infections or patients ﻿with more than two positive pred﻿ictors should be treated orally with 125 mg vancomycin 4 times a day for at least 10 days. Fidaxomicin, rifaximin, stool transplantation and monoclonal antibodies are promising alternative therapies.
authors: Medizinische Klinik 2, Schwerpunkt Geriatrie, Paracelsus Medizinische Privatuniversität, Klinikum Nürnberg, 90419, Nürnberg, Deutschland. robert.simmerlein@klinikum-nuernberg.de.
authors: R
authors: http://orcid.org/0000-0001-6497-6684
authors: R
authors: Simmerlein
authors: Medizinische Klinik 2, Schwerpunkt Geriatrie, Paracelsus Medizinische Privatuniversität, Klinikum Nürnberg, 90419, Nürnberg, Deutschland.
authors: A
authors: A
authors: Basta
authors: Medizinische Klinik 2, Schwerpunkt Geriatrie, Paracelsus Medizinische Privatuniversität, Klinikum Nürnberg, 90419, Nürnberg, Deutschland.
authors: M
authors: M
authors: Gosch
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D015373:Bacterial Typing Techniques / Q000379:methods*; D016360:Clostridioides difficile / Q000302:isolation & purification; D003428:Cross Infection / Q000175:diagnosis* / Q000000981:diagnostic imaging* / Q000453:epidemiology; D004761:Enterocolitis, Pseudomembranous / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology; D005260:Female; D015577:Geriatric Assessment / Q000379:methods*; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D012307:Risk Factors
chemical_list: D000900:Anti-Bacterial Agents
keywords: Antibodies; Metronidazole; Nosocomial infections; Pseudomembranous colitis; Ribotype; Vancomycin