Clostridium difficile: an update for the primary care clinician

Clostridium difficile infection (CDI) is an important cause of intestinal disease, primarily affecting hospitalized patients exposed to antibiotics. Infection has been associated with prolonged hospital stays and excess healthcare expenditures. Recent changes in the epidemiology, pathogenesis, and treatment of CDI have occurred, leading to renewed scrutiny of this pathogen. Increases in its incidence and severity have been documented, possibly due to the emergence of a hypervirulent strain that produces high levels of toxins. Community-acquired cases in individuals without traditional risk factors have been reported. Furthermore, oral metronidazole may not be as effective as oral vancomycin for patients with severe CDI. New therapies are being investigated for patients with recurrent disease. This review highlights the new developments in the epidemiology, pathogenesis, and management of CDI, serving as an up-to-date resource for primary care clinicians.