Gastrointestinal infections: Edited by Mitchell CohenRenewed interest in a difficult disease: Clostridium difficile infections – epidemiology and current treatment strategiesMcFarland, Lynne VAuthor Information Department of Health Services Research and Development, Puget Sound VA HealthCare System, Seattle, Washington, USA Correspondence to Lynne V. McFarland, PhD, Department of Health Services Research and Development, Puget Sound VA HealthCare System, 1100 Olive Way #1400, S-152, Seattle, WA 98101, USA Tel: +1 206 277 1095; e-mail: [email protected] Current Opinion in Gastroenterology: January 2009 - Volume 25 - Issue 1 - p 24-35 doi: 10.1097/MOG.0b013e32831da7c4 Buy Metrics Abstract Purpose of review Renewed interest in Clostridium difficile infections (CDI) is stimulating research into the pathogenesis and virulence factors for this pathogen. This review summarizes recent progress in the field, particularly in relation to the changing epidemiologic trends and new investigational treatments. Recent findings Elucidation of the role of different toxins of C. difficile (tcdA, tcdB and binary toxin) is deepening our understanding of CDI. Stain typing of C. difficile isolates is documenting the spread of an emergent strain (BI/NAP1/027) associated with large outbreaks of severe disease. Typing of isolates around the world shows global spread of this strain. Reliance upon metronidazole is questioned due to a lower response rate and newer investigational therapies are reported. Summary After being considered a manageable pathogen for decades, C. difficile recently caused large outbreaks of severe disease. Refocused research is determining patients who are at risk for CDI, what methods are more effective in diagnosing CDI and what new treatments may be effective. This article reviews the recent findings in the literature regarding this difficult and challenging pathogen. © 2009 Lippincott Williams & Wilkins, Inc.