Universität zu Köln

Lieberknecht, S. and Vehreschild, M. J. G. T. (2020). Update on Clostridioidesdifficile infection. Gastroenterologe, 15 (3). S. 168 - 178. HEIDELBERG: SPRINGER HEIDELBERG. ISSN 1861-969X

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Abstract

Background New findings warrant the re-evaluation of diagnostic and therapeutic recommendations on the management of Clostridioides difficile infection (CDI). Objectives To provide a clinical evaluation of novel findings on the diagnosis and treatment of CDI. Materials and methods Review of the literature and provision of an expert opinion. Results To establish the diagnosis of CDI, a two-stage strategy with a highly sensitive glutamate dehydrogenase enzyme immunoassay (GDH-EIA) or nucleic acid amplification test (NAAT) followed by a specific toxin A/B EIA is recommended. With the exception of individual, well-argued cases, oral metronidazole should no longer be used for the treatment of CDI. Fidaxomicin is superior to vancomycin with respect to prevention of recurrence. Bezlotoxumab has been introduced as a new option for secondary prophylaxis, in particular for patients with recurrent CDI. Fecal microbiota transfer (FMT) is another secondary prophylaxis option with high clinical efficacy. At this point, it is, however, only available in the context of an individualized treatment trial. Conclusions Based on an improved understanding of the pathophysiology of CDI and on published clinical data, we recommend fidaxomicin as the treatment of choice for the first episode, as well as for the treatment of recurrence, independent of the severity of disease. In clinical practice, the implementation of this evidence-based recommendation is often hampered by the high market price of fidaxomicin. In this context, we recommend prioritization of patients with a high risk of recurrence or who would benefit from a diverse microbiota during their further course of treatment, e.g. those undergoing or being scheduled for allogeneic stem cell transplantation.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Lieberknecht, S. UNSPECIFIED UNSPECIFIED UNSPECIFIED Vehreschild, M. J. G. T. UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-340516
DOI:	10.1007/s11377-020-00435-w
Journal or Publication Title:	Gastroenterologe
Volume:	15
Number:	3
Page Range:	S. 168 - 178
Date:	2020
Publisher:	SPRINGER HEIDELBERG
Place of Publication:	HEIDELBERG
ISSN:	1861-969X
Language:	German
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language CLOSTRIDIUM-DIFFICILE INFECTION; VANCOMYCIN; FIDAXOMICIN; METRONIDAZOLE; EPIDEMIOLOGY; PROTECTION; SOCIETY; OPT-80 Multiple languages Gastroenterology & Hepatology Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/34051