Historical Perspectives on Studies ofClostridium difficileandC. difficileInfection
Open Access
- 15 January 2008
- journal article
- review article
- Published by Oxford University Press (OUP) in Clinical Infectious Diseases
- Vol. 46 (s1), S4-S11
- https://doi.org/10.1086/521865
Abstract
The initial period of studies on Clostridium difficile (published during 1978–1980) appeared to provide a nearly complete portfolio of criteria for diagnosing and treating C. difficile infection (CDI). The putative pathogenic role of C. difficile was established using Koch's postulates, risk factors were well-defined, use of a cell cytotoxicity assay as the diagnostic test provided accurate results, and treatment with oral vancomycin was highly effective and rapidly incorporated into practice. During the next 10 years, enzyme immunoassays (EIAs) were introduced as diagnostic tests and became the standard for most laboratories. This was not because EIAs were as good as the cell cytotoxicity assay; rather, EIAs were inexpensive and yielded results quickly. Similarly, metronidazole became the favored treatment because it was less expensive and quelled fears of colonization with vancomycin-resistant organisms, not because it was better than vancomycin therapy. Cephalosporins replaced clindamycin as the major inducers of CDI because they were so extensively used, rather than because they incurred the same risk. Some serious issues remained unresolved during this period: the major challenges were to determine ways to treat seriously ill patients for whom it was not possible to get vancomycin into the colon and to find methods that stop persistent relapses. These concerns persist today.Keywords
This publication has 74 references indexed in Scilit:
- Evaluation of C. diff.-CUBE test for detection of Clostridium difficile-associated diarrheaDiagnostic Microbiology and Infectious Disease, 1992
- Survival ofLactobacillus species (strain GG) in human gastrointestinal tractDigestive Diseases and Sciences, 1992
- Treatment with intravenously administered gamma globulin of chronic relapsing colitis induced by Clostridium difficile toxinThe Journal of Pediatrics, 1991
- Nosocomial Acquisition ofClostridium difficileInfectionNew England Journal of Medicine, 1989
- Comparison of culture, cytotoxicity assays, and enzyme-linked immunosorbent assay for toxin A and toxin B in the diagnosis of Clostridium difficile-related enteric diseaseDiagnostic Microbiology and Infectious Disease, 1986
- Antibiotic-associated colitis with normal-appearing rectumDiseases of the Colon & Rectum, 1981
- Research Review Antibiotic-associated Pseudomembranous ColitisDrugs, 1980
- Randomised controlled trial of vancomycin for pseudomembranous colitis and postoperative diarrhoea.BMJ, 1978
- Antibiotic-Associated Pseudomembranous Colitis Due to Toxin-Producing ClostridiaNew England Journal of Medicine, 1978
- Iatrogenic Staphylococcal EnterocolitisAnnals of Surgery, 1964