Epidemiological Survey of the Multiple Antibiotic Resistant Human Pathogen Clostridium difficile

Yu-Ping Hong^＊1.2, Zih-Cian Su², I-Hsiu Huang², Chien-Chou Lin¹, Ho-Sheng Wu¹

2015 Vol.31 NO.4

Correspondence Author： Yu-Ping Hong

Abstract：

       Clostridium difficile is an endospore-forming, Gram-positive human pathogen and is the leading cause of antibiotic-associated diarrhea. Ingestion of broad-spectrum anti-microbial agents are often the trigger for C. difficile infections (CDI) which result in a wide range of symptoms ranging from diarrhea, pseudomembranous colitis to the lethal toxic megacolon. A major cause of CDI is the disruption of indigenous microbiota by the anti-microbial agents and the presence of C. difficile in the gut mucosa which leads to colonization resistance. The two major virulence factors of C. difficile are the TcdA and TcdB toxins. The current treatment of CDI first calls for the cessation of broad-spectrum antibiotics, followed by the administration of metronidazole and/or vancomycin depending on disease severity. Currently, C. difficile vaccines based on toxoid preparations are under clinical trial but have not been approved to be used for the general public. The emergence of hyper-virulent C. difficile strains have contributed to increasing mortality in North America and many other European nations. The incidence in Asian countries is gradually rising as well.  Between 2003 and 2007, the number of confirmed CDI patients among the 65 years or older group has increased by 5 to 6 fold. It is pertinent for infection control personnel in hospitals to raise awareness for CDI cases here in Taiwan, and to perform molecular typing when necessary. Since C. difficile is known to spread rapidly, increase geographical monitoring of CDIs is also recommended.