Clostridium difficile-associated colitis.
OBJECTIVE
To review the basic microbiology, pathogenesis of disease, and diagnosis of the nosocomial pathogen Clostridium difficile and to examine therapies recommended by the Canadian Task Force on Preventive Health Care. QUALITY OF EVIDENCE MEDLINE: was searched using MeSH headings. Controlled trials for therapy were sought, but case-control studies and observational reviews were included.


RESULTS
Clostridium difficile causes approximately 20% of cases of diarrhea associated with antibiotics, including clindamycin and the second- and third-generation cephalosporins. Diarrhea is usually mild, but can be severe; extreme cases develop toxic megacolon. Diagnosis is dependent on demonstrating presence of clostridial toxin in stool specimens or of pseudomembranes through sigmoidoscopy. First-line therapy for C. difficile diarrhea is restricted to metronidazole. Second-line therapy for treatment failure is vancomycin. For relapse, a second course of metronidazole is recommended; tapering courses of vancomycin and probiotics are used for multiple recurrences.


CONCLUSIONS
Clostridium difficile is an important nosocomial pathogen requiring prudent use of antibiotics and strict infection-control policies to prevent large health care costs.
Hull
Mark W
MW
Department of Medicine, University of British Columbia, Vancouver.
Beck
Paul L
PL
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016360:Clostridioides difficile / Q000472:pathogenicity*; D003428:Cross Infection; D003967:Diarrhea / Q000209:etiology; D004761:Enterocolitis, Pseudomembranous / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology*; D017048:Health Care Costs; D006801:Humans; D017053:Infection Control; D012812:Sigmoidoscopy
D000900:Anti-Bacterial Agents