Guidelines for prevention, surveillance, diagnosis, and treatment, in this new era of more virulent strains of antibiotic associated diarrhea (AAD), Clostridium difficile-associated diseases/diarrhea (CDAD) and Clostridium difficile colitis (CDAC)

Perry Hookman, Jamie S. Barkin

Research output: Contribution to journalReview article

2 Scopus citations

Abstract

In December, 2005 the NIH/Center for Disease Control's (CDC) newsletter MMWR reported that in the past Clostridium difficile-associated diseases which usually affected hospital patients, are now appearing in cases of relatively healthy adults, including some who have not even been exposed to a hospital. In the same month The New England Journal of Medicine printed an early edition with several reports suggesting that not only is the rate of disease associated with C. difficile increasing, but a previously uncommon strain of C. difficile has been found. The new found strain of C. difficile has variations in toxin genes and is more resistant to fluoroquinolones and has emerged as a cause of geographically dispersed outbreaks of Antibiotic Associated Diarrhea (AAD), specifically C. difficile diseases (CDD), and Clostridium Difficile-Associated Diarrhea (CDAD). Bacteria are constantly mutating to become resistant to antibiotics. These more virulent toxin producing C. difficile infections include CDAD, C. difficile-associated colitis or pseudomembranous colitis (CDAC). This latter can progress to toxic megacolon (TM). CDAC is increasing in frequency and severity. C. difficile also accounts for an unknown but increasing percentage of community acquired diarrhea. Fluoroquinolones, especially C-8-methoxy fluoroquinolones like moxifloxacin and gatifloxacin have been incriminated in CDAD epidemics in different health care facilities. This article describes the methods of prevention, early diagnosis and prompt aggressive treatment which are critical in managing CDAD/CDAC. A very important method of controlling outbreaks of C. difficile-associated disease must be interventions on the prevention and use of antimicrobial agents implicated as risk factors for the disease. These interventions have been shown to be cost effective and successful in improving antibiotic prescribing to hospital inpatients. These interventions have also been shown to reduce antimicrobial resistance or hospital acquired infections. Guidelines to prevent and curtail AAD, and CDAD epidemics are presented in this article for this new era of virulent nosocomial and community acquired bacterial resistant infections.

Original languageEnglish (US)
Pages (from-to)65-82
Number of pages18
JournalPractical Gastroenterology
Volume30
Issue number6
StatePublished - Jun 1 2006

ASJC Scopus subject areas

  • Gastroenterology

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