Clostridium Difficile Colitis: Epidemiology, Diagnosis, Treatment, and Modalities

Abstract

Clostridium difficile infection (CDI) or Clostridium difficile colitis is an infection that causes significant morbidity and mortality. It accounts for 20-30% of antibiotic associated diarrhea and is occurring more often in the absence of antibiotics. It is the leading cause of hospital associated diarrhea. The organism has a remarkable ability to thrive outside of the colon, making hand washing and other preventative measures particularly important. The diagnosis of CDI involves obtaining a stool specimen positive for toxigenic Clostridium difficile or Clostridium difficile toxins. Pseudomembranous colitis findings during colonoscopy may also be utilized to make the diagnosis. Polymerase chain reaction (PCR) test is the ideal testing method because it is highly sensitive and specific and results may be obtained in approximately one hour. The treatment of CDI involves terminating the offending agent followed by antimicrobial therapy dictated by these classifications: 1) mild, moderate or severe 2) complicated vs. non-complicated 3) first episode, first recurrence or second recurrence Metronidazole and vancomycin remain the initial treatment of choice, but other considerations such as possible offending agents, severity of disease and number of previous episodes are also of great importance. There are several other treatments available including fecal microbiota transplant although this is reserved for severe cases or third recurrences. However the best way to combat the disease remains through preventative measures such as proper hand sanitation.