Patients usually present with diarrhoea, abdominal pain, and leukocytosis, and a history of recent antibiotic use. Other common symptoms include fever, abdominal tenderness, and distension.
Testing should be limited to patients with unexplained, new-onset diarrhoea (defined as 3 or more unformed stools in 24 hours). Molecular testing alone or as part of a multistep algorithm is recommended depending on local institutional protocols. May be evidence of pseudomembranes on sigmoidoscopy or colonoscopy in some patients.
Treatment is to discontinue the inciting antimicrobial agent and start therapy with oral vancomycin or fidaxomicin. Surgery may be required in fulminant disease.
About 5% to 50% of treated patients have recurrence after discontinuation of therapy, but most respond to a second course of therapy. Faecal microbiota transplantation may be recommended in patients with multiple recurrences.
Infection of the colon caused by the bacteria Clostridium difficile. Characterised by inflammation of the colon and the formation of pseudomembranes. Occurs in patients whose normal bowel flora has been disrupted by recent antibiotic use. Also known as pseudomembranous colitis, CDI, or CDAD. This topic covers the diagnosis and management of adults only.
The US Clinical and Laboratory Standards Institute announced a nomenclature change of the species name from Clostridium difficileto Clostridioides difficile in 2018; however, this name change has not been widely adopted yet.
This topic focuses on the diagnosis and management of C difficile infection in adults only.
History and exam
- antibiotic exposure
- advanced age
- hospitalisation or residence in a nursing home
- history of Clostridium difficile-associated disease
- use of acid-suppressing drugs
- inflammatory bowel disease
- solid organ transplant recipients
- haematopoietic stem cell transplant recipients
- chronic kidney disease
- HIV infection
- immunosuppressive agents or chemotherapy
- gastrointestinal surgery
- vitamin D deficiency
Ali Hassoun, MD, FACP, FIDSA, AAHIVS
Clinical Associate Professor of Medicine
Alabama Infectious Diseases Center
AH declares that he has no competing interests.
Julius Atashili, MD, MPH
Department of Epidemiology
Division of General Medicine and Epidemiology
UNC at Chapel Hill
JA declares that he has no competing interests.
Satish Keshav, MBBCh, DPhil, FRCP
Department of Gastroenterology
John Radcliffe Hospital
SK declares that he has no competing interests.
Ian Beales, MD, FRCP
Clinical Reader and Consultant Gastroenterologist
Norfolk and Norwich University Hospital
IB declares that he has no competing interests.
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