SHM's Clinical Quick Talks-Clostridium Difficile Infection: Presentation, Diagnosis, and Management

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Clostridium difficile infection (CDI) is caused by a type of bacteria that resides in the large intestine. The incidence of CDI has shown a decreasing trend in the United States, especially in hospital-acquired infections. The severity of CDI can be classified into non-severe, severe, and fulminant categories based on symptoms and laboratory findings.<br /><br />The toxins produced by Clostridium difficile, called toxin A and toxin B, are responsible for causing diarrhea and pseudomembrane formation. Risk factors for CDI include the use of certain antibiotics, advanced age, and gastric acid suppression. <br /><br />The presentation of CDI includes watery diarrhea (often non-bloody), fever, and abdominal pain. In severe cases, patients may experience hypotension, shock, and megacolon. The diagnosis of CDI can be made through various tests, including nucleic acid amplification testing (NAAT) for C. difficile toxin, enzyme immunoassay for stool toxin, and stool culture. Imaging studies, such as CT scans, may be considered in severe cases.<br /><br />Treatment of CDI depends on the severity of the infection. For non-severe and severe cases, oral antibiotics like vancomycin or fidaxomicin are recommended. In fulminant cases, a combination of oral vancomycin and intravenous metronidazole is used. Recurrent CDI may require a long taper of oral antibiotics, and fecal microbiota transplantation (FMT) can be considered for further recurrences.<br /><br />In summary, CDI is an infection caused by Clostridium difficile bacteria that primarily affects the large intestine. It can range from mild to severe, and the severity determines the treatment approach. Diagnosis is made through various tests, and the incidence of CDI has shown a decreasing trend in recent years.

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Alexander Garcia, Avneet Singh, Christopher Ambrogi, Natalie Morris, Nicholas Young

Keywords

Clostridium difficile infection

CDI

bacteria

large intestine

hospital-acquired infections

toxins

diarrhea

pseudomembrane formation

risk factors

antibiotics