[Clostridium-difficile-associated diarrhea].
Clostridium difficile is the most frequent cause of nosocomial diarrhea and is a significant cause of morbidity among hospitalized patients. The inflammation is produced as a result of a non-specific response to toxins. In the last few years, a hypervirulent strain, NAP1/BI/027, has been reported. Symptoms usually consist of abdominal pain and diarrhea. The diagnosis should be suspected in any patient who develops diarrhea during antibiotic therapy or 6-8 weeks after treatment. Diagnosis should be confirmed by the detection of CD toxin in stool and by colonoscopy in special situations. The treatment of choice is metronidazole or vancomycin. In some patients who do not respond to this therapy or who have complications, subtotal colectomy may be required. Relapse is frequent and must be distinguished from reinfection. Prevention and control in healthcare settings requires careful attention.
Bujanda
Luis
L
Servicio de Aparato Digestivo, Hospital Donostia, Centro de Investigación Biomédica en Enfermedades Hepáticas y Digestivas (CIBEREHD), San Sebastián, España. medik@telefonica.net
Cosme
Angel
A
D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001427:Bacterial Toxins / Q000032:analysis; D001691:Biological Therapy; D016360:Clostridioides difficile / Q000302:isolation & purification / Q000502:physiology*; D003082:Colectomy; D003113:Colonoscopy; D003131:Combined Modality Therapy; D003428:Cross Infection / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control / Q000628:therapy; D004269:DNA, Bacterial / Q000032:analysis; D003967:Diarrhea / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology* / Q000517:prevention & control / Q000628:therapy; D004761:Enterocolitis, Pseudomembranous / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology* / Q000517:prevention & control / Q000628:therapy; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007231:Infant, Newborn; D008297:Male; D008795:Metronidazole / Q000627:therapeutic use; D019936:Probiotics / Q000627:therapeutic use; D012008:Recurrence; D012307:Risk Factors; D015163:Superinfection / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control; D014640:Vancomycin / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D001427:Bacterial Toxins; D004269:DNA, Bacterial; D016756:Immunoglobulins, Intravenous; D008795:Metronidazole; D014640:Vancomycin