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Clostridium difficile 

Clostridium difficile

Chapter:
Clostridium difficile
Author(s):

John G. Bartlett

DOI:
10.1093/med/9780199204854.003.070623_update_001

Update:

Diagnosis—molecular diagnostic methods.

Treatment—fidaxomicin.

Further reading—updated references for PCR and fidaxomicin trial.

Updated on 31 May 2012. The previous version of this content can be found here.
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date: 23 April 2017

Clostridium difficile is a Gram-positive spore-forming anaerobic bacillus found in the environment. Its spores are part of the colonic flora in about 2 to 3% of healthy adults, with colonization rates increasing during hospitalization to 20 to 40%. Disease occurs when the organism shifts to its replicating vegetative form with toxin (A and B) production, this typically happening when there is inhibition of the competing colonic flora by antibiotics. C. difficile infection is now recognized as the most important bacterial enteric pathogen in wealthier countries, with a new NAP-1 epidemic strain appearing to produce more toxin than many others.

Clinical features—these range from trivial diarrhoea that subsides rapidly when antibiotics are stopped to fulminant pseudomembranous colitis, which may progress to toxic megacolon; most cases have watery and voluminous diarrhoea, accompanied by evidence of colonic inflammation.

Diagnosis and treatment—the condition should be suspected in any patient who has diarrhoea in association with antibiotic use. Diagnosis is established by demonstrating C. difficile toxin in stool by enzyme immunoassay or cytotoxin assay. Treatment is by stopping the implicated antibiotic, supportive care, avoiding antiperistaltic agents, and giving oral metronidazole or vancomycin.

Prevention—the most important issues are avoidance of the major antibiotic causes of C. difficile, and infection control in acute and chronic care facilities, including patient isolation and barrier precautions.

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