Pseudomembranous colitis, a complication of erythromycin and preterm prelabour rupture of membranes

Clostridioides difficile infection: history, epidemiology, risk factors, prevention, clinical manifestations, treatment, and future options

SUMMARYClostridioides difficile infection (CDI) is one of the major issues in nosocomial infections. This bacterium is constantly evolving and poses complex challenges for clinicians, often encountered in real-life scenarios. In the face of CDI, we are increasingly equipped with new therapeutic strategies, such as monoclonal antibodies and live biotherapeutic products, which need to be thoroughly understood to fully harness their benefits. Moreover, interesting options are currently under study for the future, including bacteriophages, vaccines, and antibiotic inhibitors. Surveillance and prevention strategies continue to play a pivotal role in limiting the spread of the infection. In this review, we aim to provide the reader with a comprehensive overview of epidemiological aspects, predisposing factors, clinical manifestations, diagnostic tools, and current and future prophylactic and therapeutic options for C. difficile infection.

Clostridium difficile infection rates and spectrum of disease among peripartum women at one hospital from 2003 to 2007 with molecular typing analysis of recovered Clostridium difficile isolates

BACKGROUND

Peripartum women are at risk for Clostridium difficile infection (CDI), but the risk magnitude and clinical disease spectrum are unknown. We determined the incidence and clinical features of CDI in peripartum women in the Loyola University Medical Center system and describe typing of C difficile isolates by restriction endonuclease analysis (REA).

METHODS

A retrospective chart review of peripartum CDI from 2003 to 2007 was performed after identifying patients from the clinical laboratory log of positive C difficile toxin assays. Available stool samples were cultured and isolates typed using REA.

RESULTS

We found 12 CDI cases over 5 years for an incidence of 0.7 cases/1,000 obstetrics ward admissions. Prior antibiotic use was documented in 11 (92%) cases, and 8 (67%) were health care facility associated. The rate of CDI following cesarean section was 2.2 per 1,000 live births compared with 0.2 per 1,000 following vaginal delivery (relative risk, 11.6; 95% confidence interval: 1.39-96.23). Typing revealed 4 different REA strain groups; 6 of the 7 REA types were toxin variants.

CONCLUSION

CDI in peripartum women is similar to CDI in other groups except for age. CDI was caused by multiple REA types. Cesarean section may be a particular risk for CDI that develops in the postpartum period.