Clostridium difficile-associated diarrhea: risk factors, diagnostic methods, and treatment.
Clostridium difficile-associated diarrhea (CDAD) has become the most common cause of infectious diarrhea acquired in the hospital, with an estimated 3 million annual cases and an annual cost of $1 billion. Risk factors for CDAD include antibiotic use (especially ampicillin, clindamycin, and cephalosporins), advanced age, and gastrointestinal surgery. Specific diagnosis of CDAD is made with an enzyme immunoassay to detect toxins A and B. Metronidazole remains the initial treatment of choice, with a 95% success rate. Vancomycin is reserved for failures. Despite the high initial success rates, recurrence of CDAD remains a significant problem in 20% to 30% of cases, with increased cost and substantial morbidity. Efforts to prevent CDAD will need to be strengthened, including education and better compliance with isolation, use of gloves, and hand washing.
Oldfield
Edward C
EC
Division of Infectious Diseases, Department of Medicine, Eastern Virginia Medical School, Norfolk, Virginia, USA.
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003967:Diarrhea / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D016099:Endoscopy, Gastrointestinal; D004761:Enterocolitis, Pseudomembranous / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D005243:Feces / Q000382:microbiology; D006801:Humans; D007124:Immunoenzyme Techniques; D008795:Metronidazole / Q000627:therapeutic use; D012008:Recurrence; D012307:Risk Factors; D014640:Vancomycin / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D008795:Metronidazole; D014640:Vancomycin