Clinical update for the diagnosis and treatment of Clostridium difficile infection

Abstract

Clostridium difficile infection (CDI) presents a rapidly evolving challenge in the battle against hospital-acquired infections. Recent advances in CDI diagnosis and management include rapid changes in diagnostic approach with the introduction of newer tests, such as detection of glutamate dehydrogenase in stool and polymerase chain reaction to detect the gene for toxin production, which will soon revolutionize the diagnostic approach to CDI. New medications and multiple medical society guidelines have introduced changing concepts in the definitions of severity of CDI and the choice of therapeutic agents, while rapid expansion of data on the efficacy of fecal microbiota transplantation heralds a revolutionary change in the management of patients suffering multiple relapses of CDI. Through a comprehensive review of current medical literature, this article aims to offer an intensive review of the current state of CDI diagnosis, discuss the strengths and limitations of available laboratory tests, compare both current and future treatments options and offer recommendations for best practice strategies.

Keywords: Clostridium difficile; Antibiotic-associated diarrhea; Fidaxomicin; Rifaximin; Fecal transplantation; Probiotics

Core tip: This paper seeks to explore the treatment and diagnosis of Clostridium difficile infection (CDI) through an extensive literature review of available laboratory techniques and new treatment options. For diagnosis, this includes the glutamate dehydrogenase of stool and polymerase chain reaction for gene toxin. For treatment this includes guidelines based on severity, newer antibiotics for the treatment of CDI, fecal microbiota transplantation, and several new experimental treatment options. Finally, this manuscript offers suggested clinical guidelines for how to optimizing diagnosis and treatment of CDI.