title: Clostridium difficile-associated diarrhea: an emerging threat to pregnant women.
abstract: 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.
authors.affiliation: Division of Bacterial Diseases, Epidemic Intelligence Service Field Assignments Branch,Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Nadine G
authors.initials: NG
authors.lastname: Rouphael
authors.forename: Judith A
authors.initials: JA
authors.lastname: O'Donnell
authors.forename: Julu
authors.initials: J
authors.lastname: Bhatnagar
authors.forename: Felicia
authors.initials: F
authors.lastname: Lewis
authors.forename: Philip M
authors.initials: PM
authors.lastname: Polgreen
authors.forename: Susan
authors.initials: S
authors.lastname: Beekmann
authors.forename: Jeannette
authors.initials: J
authors.lastname: Guarner
authors.forename: George E
authors.initials: GE
authors.lastname: Killgore
authors.forename: Becky
authors.initials: B
authors.lastname: Coffman
authors.forename: Jennifer
authors.initials: J
authors.lastname: Campbell
authors.forename: Sherif R
authors.initials: SR
authors.lastname: Zaki
authors.forename: L Clifford
authors.initials: LC
authors.lastname: McDonald
mesh_terms: 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