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Medical Grand Rounds

Recurrent Clostridioides difficile infection: Recognition, management, prevention

Constantine Tsigrelis, MD
Cleveland Clinic Journal of Medicine June 2020, 87 (6) 347-359; DOI: https://doi.org/10.3949/ccjm.87gr.20001
Constantine Tsigrelis
Department of Infectious Disease, Cleveland Clinic; Assistant Professor, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
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  • For correspondence: tsigrec@ccf.org
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    Figure 1

    Antibiotic therapy can paradoxically lead to recurrent Clostridioides difficile infection by disrupting the normal colonic microbiota.

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    Figure 2

    Photomicrograph showing the presence of Clostridioides difficile bacteria, many of which have assumed an endospore morphology. This is from a blood agar impression smear incubated for 72 hours anaerobically.

    From the US Centers for Disease Control and Prevention, Dr. Gilda Jones; Public Domain; Available at: https://phil.cdc.gov/phil/details.asp?pid=3876

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    Figure 3

    Fecal microbiota transplantation involves instilling fecal material from a healthy donor to restore the normal intestinal flora.

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    TABLE 1

    Diagnostic tests for Clostridioides difficile

    TestCharacteristicsSensitivity, specificity
    Organism detection assays
    Nucleic acid amplification tests (eg, polymerase chain reaction)Detects toxin gene (ie, organism) but not toxinsHigh sensitivity
    Low to moderate specificity
    Glutamate dehydrogenaseC difficile common antigenHigh sensitivity
    Low specificity
    Toxigenic C difficile cultureGrowth of C difficile organism
    Testing not readily available
    Slow turnaround time
    High sensitivity
    Low specificity
    Toxin detection assays
    Enzyme immunoassayDetects free toxinsLow sensitivity
    Moderate specificity
    Cell culture cytotoxicity neutralization assayDetects free toxins
    Lacks standardization
    Slow turnaround time
    High sensitivity
    High specificity, if optimized
    • Information from McDonald et al, reference 2.

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Cleveland Clinic Journal of Medicine: 87 (6)
Cleveland Clinic Journal of Medicine
Vol. 87, Issue 6
1 Jun 2020
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Recurrent Clostridioides difficile infection: Recognition, management, prevention
Constantine Tsigrelis
Cleveland Clinic Journal of Medicine Jun 2020, 87 (6) 347-359; DOI: 10.3949/ccjm.87gr.20001

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Recurrent Clostridioides difficile infection: Recognition, management, prevention
Constantine Tsigrelis
Cleveland Clinic Journal of Medicine Jun 2020, 87 (6) 347-359; DOI: 10.3949/ccjm.87gr.20001
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  • Article
    • ABSTRACT
    • DIAGNOSIS
    • TREATMENT OF A FIRST EPISODE
    • RECURRENT CDI
    • TREATMENT OF RECURRENT CDI
    • FIDAXOMICIN
    • BEZLOTOXUMAB, A NEWER AGENT
    • FECAL MICROBIOTA TRANSPLANTATION
    • PROBIOTICS
    • PRIMARY AND SECONDARY CDI PROPHYLAXIS
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