Does Recurrent Clostridium difficile Infection Mean Reinfection or Relapse?

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Does Recurrent Clostridium difficile Infection Mean Reinfection or Relapse?

Even after months, most recurrences appear to be relapses.

Both nosocomial and community-acquired Clostridium difficile infections are becoming common enough that when patients have repeated infections, distinguishing between relapse and reinfection often is difficult. Making this distinction can be important both for tracking and for management.

Researchers used a polymerase chain reaction assay to type organisms from 134 paired stool isolates obtained from 102 patients with recurrent C. difficile infections who were seen during 30 months at a single New York City hospital; 24 patients had three or more episodes. Among stool isolates obtained 2 to 8 weeks apart, 88% yielded identical strains, which suggested relapse rather than reinfection; among isolates obtained 8 weeks to 11 months apart, 65% yielded identical strains. Similar patterns were seen among the patients with more than one recurrence: Among the 17 patients with four or more episodes, 11 had the same strain isolated for all episodes.

Comment: These data suggest that recurrent C. difficile infection often represents relapse rather than reinfection, no matter how long between episodes. However, as the authors point out, even patients who are treated and completely asymptomatic can continue to shed organisms into the environment and thus can transmit infection horizontally to themselves, confounding the usual semantics of infection.

— Abigail Zuger, MD

Published in Journal Watch General Medicine December 8, 2011

Citation(s):

Kamboj M et al. Relapse versus reinfection: Surveillance of Clostridium difficile infection. Clin Infect Dis 2011 Nov 15; 53:1003. (http://dx.doi.org/10.1093/cid/cir643)

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general remarks
mamoonurrashid safdar, 12 Dec 2011 12:10 PM EST
Specialty: Internal Medicine
Quite an useful website,would appreciate if the coverage is widened. Nonetheless you are doing a good job.

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