title: Clostridium difficile infection: update on diagnosis, epidemiology, and treatment strategies.
abstract: BACKGROUND
  Clostridium difficile infection (CDI) has increased in incidence and severity over the past quarter century, and is now considered a major cause of healthcare-associated infections.
  
  
  METHODS
  Review of the pertinent English-language medical literature.
  
  
  RESULTS
  There has been a substantial change in the management of CDI. The emergence of the NAP1/BI/O27 strain in the early to mid-2000s has been associated with more severe forms of CDI. The pathophysiology, epidemiology, clinical manifestations and diagnosis, as well as new strategies for medical and surgical management are discussed in this review.
  
  
  CONCLUSIONS
  Clostridium difficile infection can range from benign diarrhea to severe disease associated with substantial morbidity and mortality. Treatment modalities vary based on disease severity and timing of onset. The mainstay of medical treatment remains metronidazole and oral/rectal vancomycin. New management strategies are evolving, including adjunctive treatments such as monoclonal antibodies, vaccination, and fecal transplant. In patients with severe disease or clinical deterioration, early surgical consultation for total colectomy or loop ileostomy may be life-saving. Infection control measures are vital to mitigating the spread of CDI.
authors.affiliation: Department of Surgery, University of Michigan , Ann Arbor, Michigan.
authors.forename: Kathleen B
authors.initials: KB
authors.lastname: To
authors.forename: Lena M
authors.initials: LM
authors.lastname: Napolitano
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016360:Clostridioides difficile / Q000302:isolation & purification*; D003015:Clostridium Infections / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D006801:Humans
chemical_list: D000900:Anti-Bacterial Agents