Clostridium difficile-associated diarrhea: an emerging threat to pregnant women.
OBJECTIVE
To estimate if Clostridium difficile-associated disease (CDAD) is increasing in peripartum women.


METHODS
Peripartum CDAD was assessed through 1) passive surveillance collecting clinical and pathology data on severe cases and 2) survey among infectious disease consultants (ICDs) in the Emerging Infections Network.


RESULTS
Ten severe cases were collected; most had associated antibiotic use. Seven women were either admitted to the ICU or underwent colectomy. Three infants were stillborn, and 3 women died. The epidemic Clostridium difficile strain was found in 2 cases. Among 798 ICDs, 419 (52%) participated in the survey. Thirty-seven respondents (9%) recalled 55 cases, mostly in the postpartum period with 21 complications, mainly due to relapse.


CONCLUSIONS
Severe CDAD may be increasing in peripartum women. Clinicians should have a low threshold for testing, be aware of the potential for severe outcomes, and take steps to reduce both the risk of disease and resultant complications.
Rouphael
Nadine G
NG
Division of Bacterial Diseases, Epidemic Intelligence Service Field Assignments Branch,Centers for Disease Control and Prevention, Atlanta, GA, USA.
O'Donnell
Judith A
JA
Bhatnagar
Julu
J
Lewis
Felicia
F
Polgreen
Philip M
PM
Beekmann
Susan
S
Guarner
Jeannette
J
Killgore
George E
GE
Coffman
Becky
B
Campbell
Jennifer
J
Zaki
Sherif R
SR
McDonald
L Clifford
LC
D000328:Adult; D016360:Clostridioides difficile / Q000302:isolation & purification*; D003015:Clostridium Infections / Q000382:microbiology*; D003967:Diarrhea / Q000382:microbiology*; D005260:Female; D006801:Humans; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious; D011256:Pregnancy Outcome; D012307:Risk Factors