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Clostridium Difficile Infection

Sally-Ann L. Pantin, MD, FAAFP and Thomas A. Waller, MD Reviewed 06/2019
 


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 because patients may shed for weeks following an acute infection. 

Patient Monitoring

  • Relapses of colitis occur in 15–30%.

  • Relapses ...

REFERENCES

1
Khanna S, Pardi DS. Clostridium difficile infection: management strategies for a difficult disease. Therap Adv Gastroenterol.  2014;7(2):72–86. [View Abstract on OvidMedline]
2
Leffler ...

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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