[Recommendations for diagnosis and therapy of colitis caused by Clostridium difficile]

Clostridium difficile infection (CDI) is a disease of varying severity. Its manifestations range from mild diarrhea to life-threatening paralytic ileus, painful distension of the large bowel and sepsis. Another possible manifestation of the disease is recurrent colitis that can exhaust the patient. For establishing the diagnosis, the patient's stool should be examined with two or three different microbiological methods. Immunochemical testing for the presence of clostridial toxins A and B shows good specificity but poor sensitivity. Therefore, it must be combined with other methods: stool testing for glutamate dehydrogenase (Clostridium antigen), anaerobic culture or PCR detection. An alternative way of assessing the etiology is colonoscopic examination; the disease is confirmed if typical pseudomembrane isles are present in the bowel mucosa. The basic drugs to treat CDI are still metronidazole (oral or parenteral) and/or vancomycin (oral or rectal). Fidaxomicin seems to be promising. Stool transplant via a nasojejunal tube is effective in recurrent disease. In the hospital setting, patients suffering from CDI should be isolated for the entire duration of diarrhea. Surveillance rules should also be applied, together with early treatment of symptomatic patients and prevention of the spread of the infection. Higher incidence of CDI in a ward implies that the local antibiotic prescription habits should be revised.