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Clin Microbiol Rev. 2018 Mar 14;31(2). pii: e00021-17. doi: 10.1128/CMR.00021-17. Print 2018 Apr.

Understanding Clostridium difficile Colonization.

Author information

1
Department of Medical Microbiology, Centre for Infectious Diseases, Leiden University Medical Centre, Leiden, the Netherlands m.j.t.crobach@lumc.nl.
2
Department of Microbiology, Leeds Teaching Hospitals NHS Trust & University of Leeds, Leeds, United Kingdom.
3
Division of Infectious Diseases, Department of Medicine, McGill University Health Centre, McGill University, Montréal, Québec, Canada.
4
Department of Medical Microbiology, McGill University Health Centre, McGill University, Montréal, Québec, Canada.
5
Unités Bactéries Pathogènes et Santé (UBaPS), Université Paris-Sud, Université Paris-Saclay, Châtenay-Malabry, France.
6
Department of Medical Microbiology, Centre for Infectious Diseases, Leiden University Medical Centre, Leiden, the Netherlands.

Abstract

Clostridium difficile is the main causative agent of antibiotic-associated and health care-associated infective diarrhea. Recently, there has been growing interest in alternative sources of C. difficile other than patients with Clostridium difficile infection (CDI) and the hospital environment. Notably, the role of C. difficile-colonized patients as a possible source of transmission has received attention. In this review, we present a comprehensive overview of the current understanding of C. difficile colonization. Findings from gut microbiota studies yield more insights into determinants that are important for acquiring or resisting colonization and progression to CDI. In discussions on the prevalence of C. difficile colonization among populations and its associated risk factors, colonized patients at hospital admission merit more attention, as findings from the literature have pointed to their role in both health care-associated transmission of C. difficile and a higher risk of progression to CDI once admitted. C. difficile colonization among patients at admission may have clinical implications, although further research is needed to identify if interventions are beneficial for preventing transmission or overcoming progression to CDI.

KEYWORDS:

Clostridium difficile; health care-associated infections; intestinal colonization

PMID:
29540433
PMCID:
PMC5967689
DOI:
10.1128/CMR.00021-17
[Indexed for MEDLINE]
Free PMC Article

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