title: Clostridium difficile infection: clinical challenges and management strategies.
abstract: Clostridium difficile has become the leading cause of nosocomial diarrhea in adults. A substantial increase has occurred in morbidity and mortality associated with disease caused by C difficile and in the identification of new hypervirulent strains, warranting a high clinical index of suspicion for infections due to this organism. Prevention of infection requires a multidisciplinary approach, including early recognition of disease, effective contact isolation precautions, adherence to disinfectant policies, and judicious use of antibiotics. Current treatment approaches are based on the severity of illness. As hypervirulent strains evolve, unsuccessful treatments are more common. Complicated colitis caused by C difficile may benefit from surgical intervention. Subtotal colectomy and end ileostomy have been the procedures of choice, but are associated with a high mortality rate because of late surgical consultation and use of surgery as a salvage therapy. A promising surgical alternative is creation of a diverting loop ileostomy with colonic lavage.
authors.affiliation: Pamela R. Walters is a nurse practitioner for the University of Pittsburgh Center for Sports Medicine, Pittsburgh, Pennsylvania.Brian S. Zuckerbraun is an associate professor at the University of Pittsburgh and the VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania. pamelarwalters@gmail.com.
authors.forename: Pamela R
authors.initials: PR
authors.lastname: Walters
authors.affiliation: Pamela R. Walters is a nurse practitioner for the University of Pittsburgh Center for Sports Medicine, Pittsburgh, Pennsylvania.Brian S. Zuckerbraun is an associate professor at the University of Pittsburgh and the VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.
authors.forename: Brian S
authors.initials: BS
authors.lastname: Zuckerbraun
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016360:Clostridioides difficile / Q000302:isolation & purification*; D003015:Clostridium Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000401:mortality; D003092:Colitis / Q000175:diagnosis / Q000601:surgery; D003428:Cross Infection / Q000517:prevention & control / Q000601:surgery; D003967:Diarrhea / Q000188:drug therapy*; D018562:Disease Transmission, Infectious / Q000517:prevention & control; D006801:Humans; D017053:Infection Control / Q000191:economics / Q000379:methods*; D012720:Severity of Illness Index
chemical_list: D000900:Anti-Bacterial Agents