Clostridium difficile-associated Enteric Disease

Clostridium difficile was identified as the putative agent of antibiotic-associated pseudomembranous colitis in 1978 and is now recognized as the major identifiable cause of antibiotic-associated diarrhea. This microbe causes a spectrum of enteric disease ranging from nuisance diarrhea to life-threatening colitis. Risk factors include increasing age, exposure to antibiotics, colonization or acquisition of toxin-producing strains of C. difficile, and lack of circulating antibody to C. difficile toxin A. Detection is relatively simple by stool assay for C. difficile toxin--usually an enzyme immunoassay that will detect toxin A and B. Most nonsevere cases will respond with discontinuation of the implicated antibiotic. More severe cases require metronidazole and supportive care. The major complications include ileus, toxic megacolon, relapsing disease after antibiotic treatment, and nosocomial epidemics.