Clostridium Difficile Infection
Clostridium difficile is a gram-positive anaerobic bacterium that often causes antibiotic-associated diarrhea. Symptoms may range from asymptomatic carrier states to severe pseudomembranous colitis and are caused by the exotoxins produced by the organism: Toxin A is an enterotoxin and toxin B is a cytotoxin.
Causes
C. difficile colitis can be caused by almost any antibiotic that disrupts bowel flora, but it is classically associated with clindamycin. High-risk groups include individuals receiving more than one antibiotic, those having abdominal surgery, patients receiving antineoplastic agents that have antibiotic activity, immunocompromised individuals, and patients in nursing homes.
Pediatric pointerPediatric patients who attend day care can be at risk for developing C. difficile because it’s commonly found in day-care centers and may be passed from child to child.
Other factors that alter normal intestinal flora include enemas and intestinal
stimulants. C. difficile is most often transmitted directly from patient to patient by contaminated hands of facility personnel; it also may be indirectly spread by contaminated equipment, such as bedpans, urinals, call bells, rectal thermometers, nasogastric tubes, and contaminated surfaces, such as bed rails, floors, and toilet seats.
stimulants. C. difficile is most often transmitted directly from patient to patient by contaminated hands of facility personnel; it also may be indirectly spread by contaminated equipment, such as bedpans, urinals, call bells, rectal thermometers, nasogastric tubes, and contaminated surfaces, such as bed rails, floors, and toilet seats.
Complications
Complications of C. difficile include electrolyte abnormalities, hypovolemic shock, anasarca (caused by hypoalbuminemia), toxic megacolon, colonic perforation, peritonitis, sepsis, and hemorrhage. In rare cases, death may result.
Assessment
Risk of C. difficile begins 1 to 2 days after antibiotic therapy is started and extends for as long as 2 to 3 months after the last dose. The patient may be asymptomatic or may exhibit any of the following symptoms: soft, unformed, or watery diarrhea (more than three stools in a 24-hour period) that may be foul-smelling or grossly bloody; abdominal pain, cramping, or tenderness; and fever. The patient’s white blood cell count may be elevated to 20,000 μl. In severe cases, toxic megacolon, colonic perforation, and peritonitis may develop.
Diagnostic tests
Diagnosis is by identification of the toxin through one of the following methods:
