Key Points
Key Points
Î C. difficile is the commonest identifiable cause of antibiotic associated diarrhea.*
Î C. difficile is an opportunistic organism which typically produces two potent toxins, toxin A and toxin B. Some strains produce only toxin B, and some strains also produce a third, unrelated toxin (binary toxin). The role of binary toxin is uncertain and is not identified by most clinical diagnostic tests.
Î The discovery of C. difficile strains (initially in North America and subsequently Europe) that have increased virulence has emphasized the need for effective diagnostic and control measures.*
Î The clinical manifestations of infection with toxin-producing strains of C. difficile range from symptomless carriage, to mild or moderate diarrhea, to fulminant and sometimes fatal pseudomembranous colitis.
Î A case definition of Clostridium difficile infection (CDI) should include the presence of symptoms (usually diarrhea) and either a positive stool test for C. difficile toxins or toxigenic C. difficile, or direct visualization revealing pseudomembranous colitis.
Î A history of treatment with antimicrobial or antineoplastic agents within the previous 8 weeks is present in the majority of patients.
Î Rarely (< 1%), a symptomatic patient will present with ileus and colonic distension with minimal or no diarrhea.
*http://www.rapidmicrobiology.com/test-methods/Clostridium-difficile.php
Prevention
Î Minimize frequency, duration and number of antimicrobial agents prescribed to reduce CDI risk (A-II).
Î Implement an antimicrobial stewardship program (A-II).
> Antimicrobials to be targeted should be based on local epidemiology and the strains present, but cephalosporin and clindamycin restriction (excluding surgical antibiotic prophylaxis) may be particularly useful (C-III).
Î No recommendations can be made regarding prevention of recurrent CDI in patients requiring continued antimicrobial therapy for an underlying infection (C-III).
