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The changing epidemiology of Clostridium difficile infection

Honda, Hitoshia; Dubberke, Erik R.b

Current Opinion in Gastroenterology: January 2014 - Volume 30 - Issue 1 - p 54–62
doi: 10.1097/MOG.0000000000000018
LARGE INTESTINE: Edited by Ciarán P. Kelly

Purpose of review Clostridium difficile infection (CDI) is a growing concern and has a substantial impact on morbidity and mortality. Epidemiology of CDI has dramatically changed over the last decade. Diagnostic and treatment strategies are even more complicated given the wide variety of available diagnostic methods and the emergence of refractory or recurrent CDI. This review is intended to provide information on current CDI epidemiology and guidance for evidence-based diagnosis and management strategies.

Recent findings Various studies from the United States, Europe, and Canada revealed increased incidence of CDI since 2000. Although CDI has long been associated with healthcare settings, recent studies indicate it is more common in the community than previously recognized. For diagnostic strategies, newer testing methods, including nucleic acid amplification tests, have enhanced sensitivity compared with toxin testing, but at the expense of decreased specificity. New agents for treating CDI are being developed and higher quality data to support fecal microbiota transplantation for treating recurrent CDI are emerging.

Summary CDI epidemiology continues to evolve. Prompt recognition and an evidence-based treatment approach is the key to successfully manage CDI. Further, studies on diagnostic and therapeutic strategies are needed to further improve patient outcomes.

aDivision of Infection Prevention, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan

bDivision of Infectious Diseases, Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri, USA

Correspondence to Hitoshi Honda, MD, Tokyo Metropolitan Tama Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo 183-8524, Japan. Tel: +1 81 42 323 5111; fax: +1 81 42 323 9205; e-mail:

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins