Clostridium difficile infection overview
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Yazan Daaboul, M.D.
Overview
Clostridium difficile or CDF/cdf' is a species of bacteria of the genus Clostridium which are Gram-positive, anaerobic, spore-forming rods (bacillus).[1] Clostridium difficile (C. diff) is one of the most common hospital-acquired infections, particularly in elderly hospitalized patients, and also one of the most common complications of antibiotics in hospitalized patients. Patients are rarely infected unless the normal flora of the intestinal tract has been altered by antibiotics. Up to 10% of patients hospitalized >2 days are affected.Of note, most antibiotic-associated diarrhea is not due to C. diff, but is due to an osmotic type diarrhea. The antibiotics wipe out the gastrointestinal (GI) tract’s normal flora, which usually break down unabsorbed carbohydrates. These unabsorbed carbohydrates remain in the lumen and carry with them water, resulting in diarrhea.C. difficile is the most significant cause of pseudomembranous colitis,[2] a severe infection of the colon, often after normal gut flora is eradicated by the use of antibiotics.
Diagnosis
Symptoms
In adults, a clinical prediction rule found the best signs are[3] significant diarrhea ("new onset of > 3 partially formed or watery stools per 24 hour period"), exposure of antibiotics, abdominal pain, foul stool odor.
The presence of any one of these findings has a sensitivity of 86% and a specificity of 45%.[3] In a study on hospitalized patients with a prevalence of positive cytotoxin assays of 14%, the positive predictive value was 20% and the negative predictive value was 95%.
Treatment
Medical Therapy
Many persons will also be asymptomatic and colonized with Clostridium difficile. Treatment in asymptomatic patients is controversial, also leading into the debate of clinical surveillance and how it intersects with public health policy.
It is possible that mild cases do not need treatment.[4]
Patients should be treated as soon as possible when the diagnosis of Clostridium difficile colitis (CDC) is made to avoid frank sepsis or bowel perforation. Treatment is by stopping any antibiotics and commencing specific anticlostridial antibiotics, e.g. metronidazole.
References
- ↑ Ryan KJ; Ray CG (editors) (2004). Sherris Medical Microbiology (4th ed. ed.). McGraw Hill. pp. pp. 322-4. ISBN 0-8385-8529-9.
- ↑ "Pseudomembranous Colitis". eMedicine. WebMD. 1 July 2005. Retrieved 2007-01-11.
- ↑ 3.0 3.1 Katz DA, Lynch ME, Littenberg B (1996). "Clinical prediction rules to optimize cytotoxin testing for Clostridium difficile in hospitalized patients with diarrhea". Am. J. Med. 100 (5): 487–95. doi:10.1016/S0002-9343(95)00016-X. PMID 8644759.
- ↑ Nelson R. Antibiotic treatment for Clostridium difficile-associated diarrhea in adults. Cochrane Database Syst Rev. 2007 Jul 18;(3):CD004610. PMID 17636768