Clostridium difficile Infection: an update on treatment and prevention.

Disruption of the colonic microflora is one of the most significant adverse effects of antibiotic (ATB) therapy. Excessive multiplication of toxigenic Clostridioides difficile strains is responsible for about 20 % of cases of post-antibiotic diarrhoea. The global trend of Clostridium colitis incidence, severity, mortality and in particular therapeutic failure keeps rising. At the Department of Infectious Diseases we work on long-term monitoring of the most important colitis-associated risk factors and evaluation of individual therapeutic and preventive procedures (selective ATB therapy, faecal bacteriotherapy). A diligent analysis of risk factors and knowledge of pathogenesis are a prerequisite to practical implementation of effective and rational precautions to curb spreading of this illness. In the future, we anticipate increased use of fecal microbiota transplant, improvements in faecal transplant administration, wider use of probiotics and selective ATBs and further introduction of passive and active immunization into practice.

[Guideline for fecal bacteriotherapy to treat recurrent Clostridium difficile colitis].

We present a case of a 17-year-old female with anti-NMDAR encephalitis probably associated with vaccination against yellow fever. Her symptoms occurred 27 days after vaccination against yellow fever. Anti-NMDAR encephalitis manifested as acute psychosis, memory loss and catatonia following fever with complex partial epileptic seizures. Interictal electroencephalogram showed slow-wave delta background activity with "delta brushes". The diagnosis was confirmed by NMDAR antibody positivity in serum and cerebrospinal fluid. Since ovarian teratoma, as the most common cause of anti-NMDAR encephalitis, did not develop within five years from its onset, the association with vaccination against yellow fever seems to be highly probable.

[A study of patients with Clostridium difficile infection hospitalized at Brno Clinic of Infectious Diseases in 2007-2010]. / Analýza souboru pacientu s onemocnením vyvolaným toxinem Clostridium difficile hospitalizovaných na Klinice infeckcních chorob v Brne v letech 2007-2010.

BACKGROUND: To describe a set of patients hospitalized at the Clinic of Infectious Diseases of the University Hospital Brno with Clostridium difficile infection (CDI), to interpret clinical and epidemiological data, and to determine the risk factors for the disease and its complications. MATERIAL AND METHODS: A retrospective study of 284 patients with confirmed diagnosis of Clostridium difficile infection hospitalized between 1 January 2007 and 31 December 2010. Epidemiological, clinical and laboratory data were collected from their clinical documentation. RESULTS: Of the 284 patients with a mean age of 73.2 years, 38.0 % were men. Risk factors for developing CDI include the use of antibiotics in the previous 8 weeks (89.1 % of patients), age over 65 years (77.6 %), hospitalization in the previous 4 weeks (65.5 %), and the use of proton pump inhibitors (41.9 %). Recurrence was noted in 89 (31.3 %) cases. Sixty-six (23.2 %) patients required intensive care and 50 (14.6 %) patients died during their hospitalization. Isolates of C. difficile from the stool of 4 patients were sent for ribotyping and identified as ribotype 176. CONCLUSIONS: The CDI rates at the clinic KICH have increased in the recent years. The rise is consistent with the global trends. The study confirmed the disease risk factors reported in the literature. The disease is associated with a high percentage of relapses and complications.