title: Trends inClostridium difficileDisease: Epidemiology and Intervention.
abstract: Clostridium difficileis the most common cause of nosocomial infectious diarrhea. The incidence ofC difficileinfection (CDI) is increasing in both inpatients and outpatients, and outbreaks caused by a hypervirulent strain ofC difficileare resulting in more severe disease. Moreover, community-associated CDI is occurring in persons who lack the traditional risk factors, which include antibiotic use, advanced age, and severe underlying disease. The clinical severity of CDI ranges from a mild, self-limited diarrheal illness to a fulminant, life-threatening colitis. Enzyme-linked immunosorbent assay is the most common laboratory method used for detection ofC difficiletoxins and can confirm the diagnosis within several hours. The choice of treatment should be based on disease severity. Oral metronidazole is generally regarded as the treatment of choice for mild to moderate CDI, while oral vancomycin is recommended for severe disease. Timely surgical intervention is important in patients who have severe complicated CDI.
authors.affiliation: Divisions of internal medicine and pediatric infectious diseases, Washington University School of Medicine in St. Louis.
authors.forename: David J
authors.initials: DJ
authors.lastname: Riddle
authors.affiliation: Division of infectious diseases, Washington University School of Medicine in St. Louis.
authors.forename: Erik R
authors.initials: ER
authors.lastname: Dubberke
keywords: Clostridium difficile; Pseudomembranous colitis