Clostridium difficile associated diarrhea
| Clostridium difficile infection | |
|---|---|
| Synonyms | C. difficile associated diarrhea (CDAD), Clostridium difficile colitis |
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| Pathological specimen showing pseudomembranous colitis | |
| Specialty | Infectious disease |
| Symptoms | Diarrhea, fever, nausea, abdominal pain |
| Complications | Pseudomembranous colitis, toxic megacolon, perforation of the colon, sepsis |
| Causes | Clostridium difficile spread by the fecal-oral route |
| Risk factors | Antibiotics, proton pump inhibitors, hospitalization, other health problems, older age |
| Diagnostic method | Stool culture, testing for the bacteria's DNA or toxins |
| Prevention | Hand washing, terminal room cleaning in hospital |
| Treatment | Metronidazole, vancomycin, fidaxomicin, fecal microbiota transplantation |
| Frequency | 453,000 (US 2011) |
| Deaths | 29,000 (US) |
| Classification |
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| External resources |
Clostridium difficile infection (CDI) is a symptomatic infection due to the spore-forming bacterium, Clostridium difficile. Symptoms include watery diarrhea, fever, nausea, and abdominal pain. It makes up about 20% of cases of antibiotic-associated diarrhea. Complications may include pseudomembranous colitis, toxic megacolon, perforation of the colon, and sepsis.
Clostridium difficile infection is spread by bacterial spores found within feces. Surfaces may become contaminated with the spores with further spread occurring via the hands of healthcare workers. Risk factors for infection include antibiotic or proton pump inhibitors use, hospitalization, other health problems, and older age. Diagnosis is by stool culture or testing for the bacteria's DNA or toxins. If a person tests positive but has no symptoms it is known as C. difficile colonization rather than an infection.
Prevention is by limiting antibiotic use; and by hand washing, and terminal room cleaning in hospital. Discontinuation of antibiotics may result in resolution of symptoms within three days in about 20% of those infected. Often the antibiotics metronidazole, vancomycin or fidaxomicin will cure the infection. Retesting after treatment, as long as the symptoms have resolved, is not recommended as the person may remain colonized. Recurrences have been reported in up to 25% of people. There is tentative evidence that fecal microbiota transplantation and probiotics may decrease the risk of recurrence.
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