Clostridioides difficile infection | |
---|---|
Other names | C. difficile associated diarrhea (CDAD), Clostridium difficile infection, C. difficile colitis |
Pathological specimen showing pseudomembranous colitis | |
Specialty | Infectious disease |
Symptoms | Diarrhea, fever, nausea, abdominal pain[1] |
Complications | Pseudomembranous colitis, toxic megacolon, perforation of the colon, sepsis[1] |
Causes | Clostridioides difficile spread by the fecal-oral route[2] |
Risk factors | Antibiotics, proton pump inhibitors, hospitalization, other health problems, older age[1] |
Diagnostic method | Stool culture, testing for the bacteria's DNA or toxins[1] |
Prevention | Hand washing, terminal room cleaning in hospital[2] |
Treatment | Metronidazole, vancomycin, fidaxomicin, fecal microbiota transplantation[1][3] |
Frequency | 453,000 (US 2011)[2][4] |
Deaths | 29,000 (US)[2][4] |
Clostridioides difficile infection[5] (CDI or C-diff), also known as Clostridium difficile infection, is a symptomatic infection due to the spore-forming bacterium Clostridioides difficile.[6] Symptoms include watery diarrhea, fever, nausea, and abdominal pain.[1] It makes up about 20% of cases of antibiotic-associated diarrhea.[1] Antibiotics can contribute to detrimental changes in gut microbiota; specifically, they decrease short-chain fatty acid absorption which results in osmotic, or watery, diarrhea.[7] Complications may include pseudomembranous colitis, toxic megacolon, perforation of the colon, and sepsis.[1]
Clostridioides difficile infection is spread by bacterial spores found within feces.[1] Surfaces may become contaminated with the spores with further spread occurring via the hands of healthcare workers.[1] Risk factors for infection include antibiotic or proton pump inhibitor use, hospitalization, hypoalbuminemia,[8] other health problems, and older age.[1] Diagnosis is by stool culture or testing for the bacteria's DNA or toxins.[1] If a person tests positive but has no symptoms, the condition is known as C. difficile colonization rather than an infection.[1]
Prevention efforts include terminal room cleaning in hospitals, limiting antibiotic use, and handwashing campaigns in hospitals.[2] Alcohol based hand sanitizer does not appear effective.[2] Discontinuation of antibiotics may result in resolution of symptoms within three days in about 20% of those infected.[1]
The antibiotics metronidazole, vancomycin, or fidaxomicin, will cure the infection.[1][3] Retesting after treatment, as long as the symptoms have resolved, is not recommended, as a person may often remain colonized.[1] Recurrences have been reported in up to 25% of people.[9] Some tentative evidence indicates fecal microbiota transplantation and probiotics may decrease the risk of recurrence.[2][10]
C. difficile infections occur in all areas of the world.[11] About 453,000 cases occurred in the United States in 2011, resulting in 29,000 deaths.[2][4] Global rates of disease increased between 2001 and 2016.[2][11] C. difficile infections occur more often in women than men.[2] The bacterium was discovered in 1935 and found to be disease-causing in 1978.[11] Attributable costs for Clostridioides difficile infection in hospitalized adults range from $4500 to $15,000.[12] In the United States, healthcare-associated infections increase the cost of care by US$1.5 billion each year.[13] Although C. difficile is a common healthcare-associated infection, at most 30% of infections are transmitted within hospitals.[14] The majority of infections are acquired outside of hospitals, where medications and a recent history of diarrheal illnesses (e.g. laxative abuse or food poisoning due to Salmonellosis) are thought to drive the risk of colonization.[15]
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