Clostridium difficile-associated diarrhea: current strategies for diagnosis and therapy.
Clostridium difficile, a spore-forming toxigenic bacterium, is one of the most common causes of infectious diarrhea and colitis in the United States. Most patients with C. difficile infection have recently received antimicrobial therapy--usually clindamycin, cephalosporins, or the extended-spectrum penicillins. Clinical presentation varies from asymptomatic colonization to mild diarrhea to severe colitis. The mainstay of diagnosis is detection of C. difficile toxin A, toxin B, or both with a cytotoxin test or enzyme immunoassay of the stool of patients who have received antibiotic therapy and have features of C. difficile-associated diarrhea. Enzyme immunoassays that detect both toxins are preferred because of their higher diagnostic accuracy. If the first assay is negative and C. difficile-associated diarrhea is strongly suspected, a second assay may be performed. Ten days of oral metronidazole is the preferred therapy for most initial infections. Vancomycin is considered second-line therapy because of its cost and potential to select for vancomycin resistance. About 20% to 25% of patients experience reinfection or relapse after initial therapy and require retreatment. The disease can best be prevented by limiting the use of broad-spectrum antibiotics and adhering to control techniques.
Moyenuddin
Munshi
M
Section on Infectious Diseases, Wake Forest University Baptist Medical Center, 100 Medical Center Boulevard, Winston-Salem, NC 27157, USA.
Williamson
John C
JC
Ohl
Christopher A
CA
D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000494:pharmacology; D016360:Clostridioides difficile / Q000187:drug effects* / Q000302:isolation & purification*; D003113:Colonoscopy; D003967:Diarrhea / Q000188:drug therapy* / Q000382:microbiology*; D004352:Drug Resistance, Microbial; D004761:Enterocolitis, Pseudomembranous / Q000188:drug therapy* / Q000382:microbiology*; D005260:Female; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D011379:Prognosis; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents