Clostridium difficile

Clostridium difficile

 

Clostridium difficile is the major cause of antibiotic-associated diarrhea (AAD) and pseudomembranous colitis (PMC).

Epidemiology

  • Incidence – 60-65/100,000 in U.S. for clostridial disease (2003)
  • Transmission – more than 90% of cases occur after antibiotic administration in patients who are colonized with C. difficile

Organism

  • Gram-positive, spore-forming rod
  • Obligate anaerobe
  • Produces toxins – A, B and binary
    • A and B activate cytokines
    • Binary toxin is less well understood
  • Cultured from the stool of 3% of healthy adults and up to 35% of hospitalized patients

Risk factors

  • Previous history of C. difficile disease
  • Antimicrobial administration within previous 60 days
  • Age >65 years
  • Severe underlying illness
  • Residence in long-term care center
  • Antiulcer medication (proton pump inhibitors)
  • Hospital admission

Clinical Presentation

  • Mild – diarrhea, abdominal cramping (>3 stools/day)
  • Severe – abdominal pain, severe diarrhea, fulminant disease (toxic megacolon)
  • Recurrent disease (15-25%)

Diagnosis

  • Indication for testing
    • Clinical suspicion based on symptoms and risk factors
  • Laboratory testing
    • Testing for presence of toxins A and B
    • Testing may include stool specimen (culture or cytotoxic assay) or pseudomembrane specimen from colonoscopy

See Also