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Antibiotic-associated diarrhoea occurs during antibiotic treatment or within eight weeks of its cessation. Almost all antibiotics induce acute dysbiosis, which is responsible for almost all cases of antibiotic-associated diarrhoea or colitis. Most cases of antibiotic-induced diarrhoea present as mild, brief diarrhoea without fever, attributed to a reduction in the fermentative capacity of colonic bacteria and/or altered bile salt metabolism. More rarely, dysbiosis favors the development of intestinal infection by bacteria resident in the microbiota, or present in the environment, particularly in hospitals. The clinical presentation of Clostridioides difficile infection (CDI) with toxigenic strains ranges from brief, spontaneously resolving mild diarrhoea to colitis, the therapeutic management of which is adapted to severity criteria that need to be well known. Non-severe forms of CDI can be treated on an outpatient basis with a ten-day course of oral vancomycin (125 mg four times a day, hospital dispensing) or oral fidaxomycin (200 mg twice a day, hospital prescription and dispensing), which is costly but particularly indicated for patients at high risk of recurrence (patients over 65 years and/or previous history of CDI). Severe and complicated forms of CDI require multidisciplinary inpatient management. Fecal microbiota transplantation (FMT) is now part of the therapeutic arsenal for refractory (no response to 3 to 5 days of well-managed treatment), severe and even complicated ICD (except peritonitis). In recurrent forms of CDI, patients are eligible for FMT from the second recurrence. Colitis caused by toxigenic strains of Klebsiella oxytoca is rarer, presenting clinically as haemorrhagic due to a mixed pathogenesis (acute inflammation and ischemia), and usually regresses as soon as antibiotic therapy is stopped. [ABSTRACT FROM AUTHOR]

Clostridium difficile was reclassified in 2016 under a new name of Clostridioides difficile. In 2021 to 2022, some changes were implemented into the main clinical guidelines on the diagnosis and treatment of infections caused by this pathogen. A two-step algorithm based on identification of C. difficile and then its toxins is still recommended for the diagnosis. The treatment regimens for the first episode and relapses of C. difficile-associated infection are based on metronidazole, vancomycin and fidaxomycin. Additional effectiveness of therapy has been associated with the use of microbiocenosis-oriented technologies aimed at restoration of the colon microbiota. In the Russian Federation, all widely applied diagnostic methods are available and all recommended antimicrobials, except fidaxomycin, as well as bezlotoxumab and fecal microbiota transplantation.

Clostridium difficile infection (CDI) is one of the most common cause of nosocomial infection. Patients at high risk of infection are 65 years or over, immunocompromised, or after exposure to antibacterial therapy or taking immunosuppressive drug, both in hospitals or nursing home. Fidaxomycin (FDX ) is novel antibacterials, recommended from 2013 in CDI treatment. Two double-blind, randomised controlled trials showed non-inferiority of fidaxomycin compared to vancomycin with respect to initial CDI cure rates, and significantly lower recurrence rates in patients treated with FDX . This appears to affect its impact on CDI outcome with maximal cost reduction. Except of clinical studies, first observational data are recently published. The main objective of such evaluation is to collect robust real-world data to understand the effectiveness of FDX in routine practice. [ABSTRACT FROM AUTHOR]

Clostridium difficile infection (CDi) is one of the most common cause of nosocomial infection worldwide. Exposure to antibacterial therapy, most notably broad-spectrum agents, is the main risk factor for the development of CDi. Patients at high risk of infection are 65 years or over, immunocompromised or taking immunosuppressive drugs, however some other factors can also influence incidence of CDi. CDi infection can result in a number of clinical sequelae, from postantibiotics watery diarrhea trough pseudomebranous colitis to potentially life-treating disease like fulminant colitis or toxic megacolon. During treatment stoping of previous antibacterial therapy, or at least changing for antibiotics with smaller risk of CDI is recommended. in treatment of infection oral metronidazole or vancomycin are used, depending on disease severity. in severe or recurrent infection vancomycin or fidaxomycin are recommended. Fidaxomycin is the first in a new class of antibacterials known as macrocycles, nonabsorbable, with gastrointestinal route of elimination, shown to act as antibacterial agent with suppression of toxin A and B production and sporulation of Clostridium difficile, with minimal only influence on colonic microbiom. in the treatment of CDI stool transplantation and probiotics should also be taken under account. [ABSTRACT FROM AUTHOR]

Residents of long-term care facilities are at high risk for Clostridium difficile infection due to frequent antibiotic exposure in a population already rendered vulnerable to infection due to advanced age, multiple comorbid conditions and communal living conditions. Moreover, asymptomatic carriage of toxigenic C. difficile and recurrent infections are prevalent in this population. Here, we discuss epidemiology and management of C. difficile infection among residents of long-term care facilities. Also, recognizing that both the population and culture differs significantly from that of hospitals, we also address prevention strategies specific to LTCFs.