Abstract

Clostridium difficile (C. difficile) is a formidable pathogen causing various symptoms ranging from asymptomatic colonization to fulminant colitis among the elderly. C. difficile associated mortality rate has quadrupled in the last five years. A recent 10 year-literature review was conducted to determine a practical approach for elderly patients with C. difficile infection (CDI) in post-acute settings (PAS). Risk factors for CDI include antibiotic use, age over 65 years old, a prior history of CDI, institutionalization, and use of protein pump inhibitors (PPIs) or H-2 blockers. Diagnostic testing to confirm CDI can be challenging because of the relatively low sensitivity of most commercially available tests. Strategies for the cost-effective management and prevention of CDI include surveillance of at-risk patients with appropriate testing, contact precaution of suspected patients, discontinuation of PPIs or H-2 blockers in selected patients, use of probiotics, and antibiotic stewardship. Treatment and management should be individualized based on risk factors, symptom severity, comorbidities, and history of prior CDI.

Highlights

  • Clostridium difficile (C. difficile) is a formidable pathogen causing various symptoms ranging from asymptomatic colonization to fulminant colitis [1]

  • The aim of this paper is to provide healthcare providers with updated C. difficile related infection (CDI) information for practical management including diagnosis and management for elderly patients with CDI in post-acute care settings (PAS)

  • Persons with compromised immune systems and predisposing medical conditions are more vulnerable to CDI, with the risk increasing in patients with any or multiple antibiotic exposures, use of protein pump inhibitors (PPIs)/H-2 blockers, gastrointestinal surgery, long length of stay in healthcare settings, serious underlying

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Summary

Background

Clostridium difficile (C. difficile) is a formidable pathogen causing various symptoms ranging from asymptomatic colonization to fulminant colitis [1]. Persons with compromised immune systems and predisposing medical conditions are more vulnerable to CDI, with the risk increasing in patients with any or multiple antibiotic exposures, use of protein pump inhibitors (PPIs)/H-2 blockers, gastrointestinal surgery, long length of stay in healthcare settings, serious underlying. PPIs, in short, exert a multitude of influences that create a preferential environment for C. difficile proliferation and subsequent toxin production, in the setting of previous antibiotic use, which suggests the discontinuation of PPIs for patients with CDI to prevent symptom exacerbation and recurrent CDI. When these patients are discharged to PAS, the PPIs are generally continued unless medication reconciliation is thoroughly reviewed This practice is unlikely to change until providers understand that the risk of significant gastrointestinal side effects is much lower than that of CDI.

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