Keywords

Clostridium difficile infection; Epidemiology; Gastrointestinal

Introduction

Antibiotic-associated diarrhea (AAD) is a highly common condition; antibiotics are given to almost half of all hospitalised patients, and up to 25% of those individuals develop AAD. While numerous infectious etiologies for AAD have been widely documented, such as Clostridium difficile infection (CDI), a new study from Taiwan identified Clostridium Innocuum (CI) as a previously unknown cause of AAD with multidrug resistance, even to vancomycin. In humans and a mouse intestinal model of infection, this study found that CI induces gastrointestinal illness that is indistinguishable from CDI, which can include severe and pseudomembranous colitis. In contrast to its previous designation as a clinically harmless intestinal commensal, CI is now recognised as having pathogenic potential [1]. This was based on a single study from 1962 that found no evidence of CI pathogenicity in a non-intestinal mouse model. Our preliminary clinical, microbiologic, and genomic data suggest that CI should be reclassified as an emerging pathogen. We recently isolated CI from more than 20 children with CDI (the contribution of CI to disease in these children is unknown) and one adult with recurrent AAD (in whom CI caused AAD). According to further investigation, many of these youngsters were colonised with C. difficile and had an unexplained diarrheal aetiology. Furthermore, several of our CI strains tested positive for C. Enzyme immunoassay of difficult toxins A/B (EIA) [2]. Thus, our first findings point to a paradigm in which some CI strains can create a protein that is recognised by C. difficile anti-toxin antibodies, and that CI can induce AAD in some individuals, possibly due to this unidentified protein.

Determine the clinical and molecular epidemiology of CI in symptomatic and asymptomatic adults and children to further characterise the epidemiologic importance and microbiologic characteristics of this emerging disease in US adults and children [3]. A/B toxin of Clostridium difficile Determine the relationship between this protein and CI pathogenicity (across-reactivity, and) Because vancomycin is being used more often for CDI in the United States, selective pressure may favour an increase in clinical infections caused by multidrug-resistant CI. Because C. difficile-specific diagnostic assays are widely used for CDI, diagnosing clinically indistinguishable CI AAD will necessitate significant changes in clinical microbiology practise [4]. For these reasons, it's critical to comprehend the magnitude of CI AAD in the United States. The proposed studies' successful completion will lead future research into the pathophysiology, diagnosis, and clinical aspects of CI infection. Our staff and the academic environment at Northwestern University have the abilities and resources needed to complete the proposed investigations, which include patient cohort assembly, microbiology, and bacterial pathogenesis [5].

Conclusion

Current clinical microbiology techniques are insufficient for diagnosing C. inoculum, and it is commonly misidentified. C. inoculum was first recognized as a virulent Gram-positive spore-forming rod. In immunocompromised individuals and/or patients with comorbidities, C. inoculum is a well-documented opportunistic pathogenic. C. inoculum, a vancomycin-resistant extra intestinal and diarrheal pathogen with clinical similarities to C. difficult, may be on the rise.

References

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2. Appelbaum PC, Spangler SK, Pankuch GA, Philippon A, Jacobs MR, et al. (1994) Characterization of a beta lactamase from Clostridium clostridioforme. J Antimicrob Chemother 33: 33-40.
3. Brazier JS, Levett PN, Stannard AL, Phillips KD, Willis AT (1985) Antibiotic susceptibility of clinical isolates of Clostridia. J Antimicrob Chemother 15: 181-5.
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5. Rao S, Kupfer Y, Pagala M, Chapnick E, Tessler S (2011) Systemic absorption of oral vancomycin in patients with Clostridium infection. Scand J Infect Dis 43: 386-8.