Clostridioides difficile infection

Clostridioides difficile infection (CDI) is a symptomatic infection due to the spore-forming bacterium Clostridioides difficile. Symptoms include watery diarrhea, fever, nausea, and abdominal pain. It makes up about 20% of cases of antibiotic-associated diarrhea.

Signs and symptoms

The primary symptom of CDI is diarrhea, which can range from mild to severe. Other symptoms may include:

• Fever
• Nausea
• Abdominal pain
• Loss of appetite
• Dehydration

In severe cases, CDI can lead to pseudomembranous colitis, a severe inflammation of the colon, and can result in toxic megacolon, sepsis, and even death.

Causes

CDI is caused by the bacterium Clostridioides difficile. The infection typically occurs after the use of antibiotics that disrupt the normal gut flora, allowing C. difficile to proliferate. Common antibiotics associated with CDI include clindamycin, fluoroquinolones, cephalosporins, and penicillins.

Pathophysiology

C. difficile produces toxins, TcdA and TcdB, which cause inflammation and damage to the intestinal lining. These toxins disrupt the cytoskeleton of the intestinal epithelial cells, leading to cell death and the formation of pseudomembranes.

Diagnosis

Diagnosis of CDI is typically confirmed by:

• Stool tests for C. difficile toxins
• Polymerase chain reaction (PCR) tests for toxin genes
• Enzyme immunoassay (EIA) for toxins A and B
• Glutamate dehydrogenase (GDH) antigen test

Treatment

Treatment of CDI involves:

• Discontinuation of the inciting antibiotic
• Administration of specific antibiotics such as metronidazole, vancomycin, or fidaxomicin
• In severe cases, fecal microbiota transplantation (FMT) may be considered

Prevention

Preventive measures include:

• Judicious use of antibiotics
• Proper hand hygiene with soap and water
• Use of contact precautions in healthcare settings
• Environmental cleaning and disinfection with agents effective against C. difficile spores

Epidemiology

CDI is a significant cause of healthcare-associated infections (HAIs). It is more common in older adults and individuals with weakened immune systems. The incidence of CDI has been increasing, partly due to the emergence of hypervirulent strains such as the BI/NAP1/027 strain.

See also

• Antibiotic-associated diarrhea
• Pseudomembranous colitis
• Fecal microbiota transplantation
• Healthcare-associated infections