SLR - July 2015 - Emily Pepyne

Clostridium Difficile Infection

Reference: Leffler DA, Lamont JT. Clostridium difficile Infection. N Engl J Med. 2015 Apr 16;372(16):1539-48.

Reviewed By: Emily Pepyne, DPM
Residency Program: Cambridge Health Alliance

Podiatric Relevance: Clostridium Difficile (C. Diff), an anaerobic gram-positive, spore-forming, toxin-producing bacillus, is the most frequently reported nosocomial pathogen. C. Diff colitis is highly associated with antibiotic use, which is relevant to the field of podiatric medicine since antibiotics are the mainstay of infection treatment. In this article, the authors discuss C. Diff epidemiology, risk factors, treatment recommendations and strategies for disease control.  

Methods: This article reviews the most up-to-date literature regarding Clostridium difficile.

Results: Symptoms of C. Diff colitis can range from mild diarrhea, to bloody diarrhea or toxic megacolon, which is a life-threatening condition. While all antibiotics can cause C. Diff, the ones most commonly associated with C. Diff are clindamycin, ampicillin, amoxicillin, cephalosporins and fluoroquinolones.  Alcohol-based hand sanitizer does not reduce the number of viable C. difficile spores, whereas washing hands with soap and water does. The most common treatment regimen still consists of metronidazole and oral vancomycin, but new drugs such as fidaxomicin and tolevamer have recently come to the market.  These drugs are more expensive but superior to older treatment regimens in preventing reoccurrence. In recent years, fecal microbial transplantation has emerged as a safe and effective treatment of recurrent infection.

Conclusion: C. Diff colitis is a serious problem which has become increasingly prevalent in the US hospital system. Nosocomial C. difficile infections more than quadruple the cost of hospitalizations. Podiatric physicians need to be aware of the consequences of C. Diff and be mindful of ways to decease the disease burden. When treating patients, we need to prevent the use of unnecessary antibiotics.  In addition, we need to consider initiating probiotic therapy for infection control. Utilizing these principles will help combat the C. Diff epidemic.   


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