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Clostridium Difficile Infection

Sally-Ann Pantin, MD and Thomas Waller, MD Reviewed 06/2018
 


BASICS

DESCRIPTION

  • A gram-positive, spore-forming anaerobic bacillus that releases toxins to produce clinical disease

  • Infection caused by Clostridium difficile is frequently associated with antibiotic u...

DIAGNOSIS

HISTORY

  • Age and underlying comorbidities

  • Recent antibiotic use

  • Diarrhea (defined as >3 stools in 24 hours) that is watery, foul-smelling, and sometimes bloody (1)

  • Fever (<10%), anorexia, n...

TREATMENT

GENERAL MEASURES

  • Antimotility agents are contraindicated.

  • Avoid indiscriminate use of antibiotics.

  • Proton pump inhibitors are associated with recurrent infection but have not been shown to be c...

ONGOING CARE

FOLLOW UP RECOMMENDATIONS

Do not repeat testing for toxins, as patients may shed for weeks following an acute infection. 

Patient Monitoring

  • Relapses of colitis occur in 15–30%.

  • Relapses typi...

REFERENCES

1
1 Khanna S, Pardi DS. Clostridium difficile infection: management strategies for a difficult disease. Therap Adv Gastroenterol.  2014;7(2):72–86.
2
2 Leffler DA, Lamont JT. Clostridium ...

ADDITIONAL READING

  • Johnston BC, Ma SS, Goldenberg JZ, et al. Probiotics for the prevention of Clostridium difficile-associated diarrhea: a systematic review and meta-analysis. Ann Intern Med.  20...

CODES

ICD10

A04.7 Enterocolitis due to Clostridium difficile 

ICD9

  • 008.45 Intestinal infection due to Clostridium difficile

SNOMED

  • 186431008 Clostridium difficile infection (disorder)

  • 423590009 Clostridium ...

CLINICAL PEARLS

  • C. difficile is spread by fecal–oral contact.

  • Alcohol-based hand sanitizers are ineffective against C. difficile. Wash hands with soap and water.

  • Testing and treatment of asymptomatic pa...

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