[Clostridioides difficile infection: Current perspectives on diagnosis and therapy].

Abstract

Clostridioides difficile is an important opportunistic pathogen mainly linked to healthcare-associated infections, which arise when the intestinal microbiota is disrupted - most often due to antibiotic treatment. In recent years, however, its presence in the community has been reported more frequently. The incidence of C. difficile infection reflects both the quality of antibiotic policies and the rigor of infection control, while mortality remains substantial, especially among the elderly and patients with multiple comorbidities. The pathogenesis of the disease is based on the production of toxins A and B, which damage the intestinal epithelium and lead to the development of manifestations ranging from mild diarrhea to fulminant colitis. Diagnosis requires correlation of the clinical presentation with evidence of a toxigenic strain or its toxins while colonization alone, without clinical symptoms, is not an indication for treatment. The high rate of recurrence remains a significant problem. A rational antibiotic policy and strict hygiene measures play a crucial role in prevention. The treatment of C. difficile infection has undergone a significant shift in recent years. Current recommendations favor fidaxomicin as the first-line treatment for the initial episode due to a lower risk of recurrence; oral vancomycin is an alternative. For recurrent forms, an individualized approach is necessary, including the possibility of using fecal microbiota transplant or monoclonal antibodies. In the Czech Republic, oral vancomycin is still widely used; it is now also available in a standardized capsule form, which improves pharmaceutical safety and facilitates dosing. Keywords: Clostridioides difficile, fidaxomicin, oral vancomycin, antimicrobial stewardship.