Hépato-Gastro & Oncologie Digestive


Diagnosis and treatment of Clostridium difficile infection in 2012 Volume 19, issue 8, Octobre 2012


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Hôpital Saint-Antoine, 184 rue du faubourg Saint-Antoine 75571 Paris cedex 12, France ; Université Pierre et Marie Curie, Paris, France

Clostridium difficile infections are a major cause of diarrhoea and morbidity in hospitalized patients. In the last years, their incidence increased significantly in Europe and North America, and they are now considered as a public health problem. Diagnosis of Clostridium difficile infection has to be fast and reliable in order to start the treatment as soon as possible and to prevent transmission to other patients. Beside reference methods which are time consuming and expensive, rapid diagnosis tests have been developed. Diagnosis strategy are still evaluated, but it is now acknowledged that enzyme immunoassay testing for C. difficile toxin A and B should not be used alone as diagnosis test. Treatment of Clostridium difficile infection is based on stopping potentially involved antibiotics, correcting hydroelectrolytic disorders and prescribing specific antimicrobials. Non severe infections should be treated with metronidazole whereas severe infections should be straightaway treated with vancomycin. Recurrence occurs in 20 to 30% of the cases and should be treated as the first episode (adapted to severity). For second and further recurrences, many treatments have been proposed but none of them have been validated. Prevention and control of Clostridium difficile infection are based on rapid diagnosis and on preventing horizontal transmission notably by hand hygiene and environmental cleaning and disinfection using chlorine-containing cleaning agents.