Saturday, January 3, 2009

Clostridium difficile-associated disease (CDAD)

Clostridium difficile-associated disease (CDAD) is an important nosocomial infection associated with healthcare, and it may recur in 15% to 30% of patients. The agent, Clostridium difficile, is a Gram-positive, anaerobic spore-forming bacillus. C. difficile was first identified as an aetiological agent of antibiotic-associated pseudomembranous colitis in the late 1970s. Approximately 15% to 20% of antibiotic-associated cases of diarrhea and nearly all cases of pseudomembranous colitis have been attributed to this bacteri. The incidence of CDAD has steadily climbed in the past decade, and it is an important cause of morbidity both in North America and in Europe.
Rapid diagnosis of CDAD further allows implementation of infection control measures and timely treatment. Stool assays is not a good strategy for rapid diagnostic since the false-negative rates is very significant. The best methods for rapid identification of C. difficile–associated pseudomembranous colitis is sigmoidoscopy.
Control of C difficile infection requires prudent use of antimicrobial agents, prevention of cross-infection, and ongoing surveillance. For patients with mild CDAD, discontinuation of the causative antibiotics without further treatment may be sufficient. Many guidelines recommend the use of metronidazole, an imidazole derivative, in patients thought to need antibiotic treatment, however it has a high failure rates and and resistance to metronidazole has been reported. Controlled clinical trials have shown efficacy for CDAD treatment with vancomycin, a glycopeptide. The mean duration of symptoms was also significantly shorter with vancomycin comparing with that of metronidazole. For patients with severe CDAD, intensive care unit (ICU) admission may be needed. A combined medical and surgical approach is recommended, with surgical resection of the inflamed colon as a therapeutic option.

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