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Clostridium difficile-associated diarrhea and colitis

D N Gerding1, S Johnson, L R Peterson

  • 1Veterans Affairs Lakeside Medical Center, Chicago, Illinois, USA.

Infection Control and Hospital Epidemiology
|August 1, 1995
PubMed
Summary
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Clostridium difficile-associated disease (CDAD) is a common nosocomial infection, primarily diagnosed through symptoms and specific lab tests. Effective treatments include metronidazole or vancomycin, with strategies to manage recurrence.

Area of Science:

  • Infectious Diseases
  • Gastroenterology
  • Hospital Epidemiology

Background:

  • Clostridium difficile is the leading cause of nosocomial diarrhea, with antimicrobial exposure being the primary risk factor.
  • The pathogen persists in healthcare environments, transmitted via contaminated surfaces and personnel.
  • Both symptomatic and asymptomatic patients serve as reservoirs for C. difficile, facilitating environmental contamination.

Purpose of the Study:

  • To provide a comprehensive review of Clostridium difficile-associated disease (CDAD).
  • To summarize current knowledge on CDAD diagnosis, epidemiology, infection control, and treatment.
  • To highlight key risk factors and effective management strategies for CDAD.

Main Methods:

  • Case definition requires symptoms (diarrhea) and positive diagnostic tests (endoscopy, stool toxin assays, or stool culture).

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  • Diagnostic methods include endoscopy (limited sensitivity), stool culture (sensitive but less specific), and toxin assays.
  • Epidemiologic investigation is enhanced by genotypic and phenotypic typing systems for C. difficile.

    • Main Results:

    • Antimicrobial exposure is the major risk factor for CDAD.
    • Effective infection control measures include glove use, environmental disinfection, and antimicrobial restriction.
    • Metronidazole or vancomycin for 10 days effectively treats symptomatic CDAD, with recurrence rates of 7-20%.

    Conclusions:

    • Accurate diagnosis of CDAD relies on clinical symptoms combined with appropriate laboratory testing.
    • Strict infection control protocols, including antimicrobial stewardship, are crucial for preventing CDAD transmission.
    • While initial treatment is effective, strategies for managing recurrent CDAD are essential, including combination therapies.