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15 maggio 2026
POLITICA PER IL CORRETTO IMPIEGO DEGLI ANTIBIOTICI
Articolo
The Comeback Infection: How Scientists Are Racing against C. difficile
Clostridioides difficile, or C. diff, is a type of bacteria that can cause severe diarrhea and even life-threatening complications, especially in hospitals and clinics. Even with better infection control, it remains a major problem because it spreads easily and can be hard to diagnose.1
This article looks at how scientists and doctors are tackling these problems. They are creating better ways to detect C. diff, learning more about the infection, and working to make diagnoses quicker and more accurate to help patients recover. Dr. Michael Perry first began tracking Clostridioides difficile (CDI) in Wales. Years of declining infection rates had brought cautious optimism to microbiology labs and infection prevention and control (IPC) teams across the United Kingdom (UK). But by 2024, the tide had turned again, and fast. Wales saw +69%2 (2024/25 vs 2020/21) of CDI rates, while England is shown separately at +49,8%,2 a reminder that this pathogen has never gone quietly.
Few people understand that shift better than Dr. Michael Perry, Consultant Clinical Scientist at the Public Health Wales Microbiology UK Anaerobe Reference Unit.
A Pathogen That Refuses to Disappear
C. difficile has always been hard to contain. Its spores persist in the environment and resist many commonly used cleaning products. Hypervirulent strains such as RT027 and RT078 have already caused global disruption, but now new ribotypes,3 like RT955, are emerging with concerning traits, including reduced metronidazole susceptibility and association with large healthcare-associated outbreaks.
Even more worrying is where infections are appearing.
Data show an uptick in community‑onset cases, reinforcing concerns that CDI transmission is not limited to hospital settings alone.4
When Testing Isn’t Simple
European and UK guidelines now recommend multistep approaches, using Glutamate Dehydrogenase (GDH) screening, toxin assays, and Nucleic Acid Amplification Test (NAAT), but even these are not foolproof. Recent studies highlight limitations in traditional testing approaches. For example, one study found that approximately one in six GDH/toxin tests failed to detect C. difficile infections, pointing to a risk of false negatives, including cross‑reactivity with S. aureus, highlighting the importance of assay selection5 NAATs and GDH tests, while highly sensitive, detect both true infections and asymptomatic carriers, demanding careful clinical interpretation. CDI remains, at its core, a clinical diagnosis.
Yet, despite these challenges, there is hope that the diagnostic landscape may shift in the future. Ultra‑sensitive toxin assays might refine accuracy further, and laboratories across the UK are upgrading algorithms to close gaps that once allowed outbreaks to go unnoticed.
Genomics: The Turning Point
While traditional diagnostic and typing methods struggle, genomics is providing answers. Wales now performs Next Generation Sequencing (NGS) typing on more than 90%6 of PCR/GDH positive isolates, giving clinicians and infection control teams unprecedented clarity.
NGS can help distinguish genuine transmission from pseudo-outbreaks; supporting more targeted infection prevention decisions or highlighting misplaced interventions. It identifies resistance genes, tracks virulence factors, and maps how strains spread within and between healthcare facilities.
Il contenuto presentato in questa pagina è destinato a scopi informativi e formativi. Sebbene sia disponibile a livello globale, può riflettere pratiche cliniche o considerazioni sul sistema sanitario specifiche di una determinata regione.
1. Czepiel, J., Dróżdż, M., Pituch, H., Kuijper, E. J., Perucki, W., Mielimonka, A., ... & Biesiada, G. (2019). Clostridium difficile infection: Review. European Journal of Clinical Microbiology & Infectious Diseases, 38(7), 1211–1221. https://doi.org/10:1007/s10096-019-03539-6
2. Source - HCAI Mandatory Surveillance Monthly Dashboard: HB Monthly Dashboard - Tableau Server (cymru.nhs.uk) PHW staff only.
3. Predrag Stojanovic, Margriet Kraakman, Daan W.Notermans, James Groot, Céline Harmanus, Joffrey van Prehn, Mark Wilcox, ED J.Kujiper, Wiep Klass Smits and on behalf of the Dutch National Expertise Centre for Clostridioides difficile infections group. Emerging Clostidioides difficile strains belonging to PCR ribotype 955 in Serbia are distinct from metronidazole-resistant RT955 outbreak isolates from the UK.
4. Centers for Disease Control and Prevention. (2026, April 13). C. diff: Facts for clinicians. https://www.cdc.gov/c-diff/hcp/clinical-overview/index.html
5. Prosty, C., Hanula, R., Katergi, K., Longtin, Y., McDonald, E. G., & Lee, T. C. (2024). Clinical outcomes and management of NAAT-positive/toxin-negative Clostridioides difficile infection: A systematic review and meta-analysis. Clinical Infectious Diseases, 78(2), 430–438. https://doi.org/10:1093/cid/ciad523
6. Michael D. Perry, P.Lewis White, Trefor E.Morris (2021). Impact of te introducytion of nucleic amplification testing on Clostridioides difficile detection and ribotype distribution in Wales. Elsevier, Journal Homepage.
7. Perry, M. (2025, October). Difficultas cum CDI [Conference presentation slides]. EU Excellence Champions Club, Solna, Sweden.
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