Clostridium difficile-associated diarrhoea (CDAD): new and contentious issues

Haren MT et al. Oral testosterone supplementation increases muscle and decreases fat mass in healthy elderly males with low–normal gonadal status. A, Kuliczkowska-Plaksej J et al. Relationship between vitamin D receptor BsmI and FokI polymorphisms and anthropometric and biochemical parameters describing metabolic syndrome. A, Shaper AG et al. Can metabolic syndrome usefully predict cardiovascular disease and diabetes: outcomes data from two prospective studies. The metabolic syndrome predicts incident stroke: a 14-year follow-up study in elderly people in Finland. Association between the metabolic syndrome and its components and gait speed among U.S. adults aged 50 years and older: a cross-sectional analysis. Clostridium difficile-associated diarrhoea (CDAD): new and contentious issues The last decade has seen the prevention of healthcare-associated infections (HAIs) become a public and NHS priority [1, 2]. The resultant local and national targets have started to reap some benefits, with a fall in the rate of methicillin-resistant Staphylococcus aureus (MRSA) bacteraemias [3] and a decline in the rate of Clostridium difficile-associated diarrhoea (CDAD) [4]. Despite this, CDAD remains one of the most frequent nosocomial infections (annual incidence >50,000 cases in 2007) [4]. PCR ribotype 027 (also known as BI/NAP1), a previously uncommon strain, has been associated with recent outbreaks in North America [5], Europe and the UK [6]. Ribotype 027 has emerged as the dominant strain in England representing 41% of isolates (up to 60% in certain regions) [7]. Strains of this ribotype are believed to be linked to increased disease severity often manifested with leucocytosis, raised creatinine, hypoalbuminaemia, toxic megacolon, need for colectomy, shock, death and higher rates of relapse. However, this is not always the case. A recent study comparing matched cases of CDAD caused by 027 versus non-027 strains showed that severity as defined by shock, paralytic ileus, pseudomembra-nous colitis or toxic megacolon was not linked to ribotype 027 and can occur with any strain [8]. Enhanced molecular fingerprinting , which enables strain subtyping to a greater extent than ribotyping, may provide further clues about the epidemiology and possible association of 'hypervirulent' strains with disease severity. Community-acquired CDAD is emerging as a previously unrecognised entity. A recent case-control study demonstrated that community-acquired CDAD may be 497