Recurrent clostridium difficile infection and its treatment options

Tomas Masilionis1, Paulius Vargalis1, Ilja Skalskis1

1 Faculty of Medicine, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania


Recurrent Clostridium difficile (Cl. difficile) infection is an infectious intestinal disease caused by Cl. difficile bacteria. This anaerobic gram-positive bacterium forms spores and produces A and B toxins. Cl. difficile carriers secrete spores into the environment with feces without any symptoms of infection. The infection is usually spread by faecal-oral transmission in the form of spores. But the main symptoms of the disease are caused by exotoxins A and B. Toxin A causes inflammation, which promotes the secretion of intestinal fluid, damages the intestinal mucosa, and directly activates neutrophils. Toxin B is 10 times stronger than toxin A, which in practice determines the overall severity and course of the disease. This disease, if not fully cured, tends to reinfect. Even 25 percent. patients recur within a period of two months. This suggests that the disease tends to recur even after recovery. The main unchanging risk factors for this infection are older age (> 65 years), female gender. Other factors associated with an increased risk of recurrent CDI include chronic kidney disease and living in a nursing home, taking antibiotics, proton pump inhibitors, or corticosteroids. There are several treatments for this infection. The main treatment is antibiotic therapy. Metronidazole is used to treat the first mild episode of infection and first mild reinfection. But studies have been done that in some cases can also use vancomycin and get a better treatment result, or a combination of both. Recurrent CDI: At least 3 episodes of mild to moderate CDI and repeated administration of vancomycin for 6-8 weeks with or without an alternative antibiotic are indicated for faecal microbial transplantation. Donors for this transplant are usually relatives or family members to reduce the risk of transmitting the infectious agent. Short-term adverse effects of fecal microbial transplantation include diarrhea, spasmodic abdominal pain, and regurgitation. Subsequent side effects are constipation.

Keywords: Clostridium difficile infection; Clostridium difficile bacteria; Cl. difficile, faecal microbiota transplantation.