Clostridium difficile infection

Clostridium difficile infection

Clostridium difficile infection (CDI) is a bacterial infection that affects the colon and is a significant cause of antibiotic-associated diarrhea. It is caused by the bacterium *Clostridioides difficile*, formerly known as *Clostridium difficile*. CDI can range from mild diarrhea to severe colitis, and it is a major concern in healthcare settings due to its association with antibiotic use and its potential for causing outbreaks.

Pathophysiology

• Clostridioides difficile* is a spore-forming, gram-positive anaerobic bacillus. The spores are resistant to many common disinfectants and can persist in the environment for long periods. Infection occurs when the normal gut flora is disrupted, often due to antibiotic therapy, allowing *C. difficile* to proliferate and produce toxins.

The two main toxins produced by *C. difficile* are toxin A (an enterotoxin) and toxin B (a cytotoxin). These toxins damage the intestinal lining, leading to inflammation and diarrhea. In severe cases, this can result in pseudomembranous colitis, toxic megacolon, and even death.

Risk Factors

Several factors increase the risk of developing CDI:

• Antibiotic use: Broad-spectrum antibiotics, such as clindamycin, cephalosporins, and fluoroquinolones, are particularly associated with CDI.
• Hospitalization: Prolonged hospital stays increase exposure to *C. difficile* spores.
• Age: Older adults are at higher risk.
• Immunocompromised state: Patients with weakened immune systems are more susceptible.
• Previous CDI: A history of CDI increases the risk of recurrence.

Symptoms

Symptoms of CDI can vary from mild to severe and include:

• Watery diarrhea (at least three bowel movements per day for two or more days)
• Abdominal cramping and pain
• Fever
• Nausea
• Loss of appetite

In severe cases, patients may develop dehydration, electrolyte imbalances, and complications such as bowel perforation.

Diagnosis

Diagnosis of CDI is based on clinical symptoms and laboratory tests. The most common tests include:

• Stool tests: Detection of *C. difficile* toxins or the presence of the bacterium's DNA using PCR.
• Endoscopy: In severe cases, a colonoscopy may reveal pseudomembranes in the colon.

Treatment

The primary treatment for CDI involves discontinuing the inciting antibiotic and initiating specific antibiotic therapy against *C. difficile*. Common treatments include:

• Metronidazole: Often used for mild to moderate cases.
• Vancomycin: Preferred for severe cases or when metronidazole is ineffective.
• Fidaxomicin: An alternative for patients with recurrent CDI.

In cases of severe colitis or complications, surgical intervention may be necessary.

Prevention

Preventive measures focus on reducing transmission and recurrence:

• Antibiotic stewardship: Limiting the use of broad-spectrum antibiotics.
• Infection control: Rigorous hand hygiene and environmental cleaning in healthcare settings.
• Probiotics: May help restore normal gut flora, though evidence is mixed.

Also see

• Antibiotic-associated diarrhea
• Pseudomembranous colitis
• Nosocomial infection
• Antibiotic stewardship