Clostridium difficile Infection and Pseudomembranous Colitis

Colonization of the colon with Clostridium difficile bacteria can have varying outcomes, from asymptomatic carriage to pseudomembranous colitis to fulminant colitis. Risk factors traditionally associated with the development of C. difficile infection (CDI) include current or recent antibiotic use, advanced age, hospitalization, and comorbid illnesses. Inflammatory bowel disease (IBD) has recently been recognized as an additional risk factor, being present in 16% of CDI cases in one series. Patients with CDI typically develop frequent semiformed or watery diarrhea, in association with crampy abdominal pain. Treatment of CDI has four main tenets, which apply to all cases of confirmed CDI: discontinue the causative antibiotics, initiate anti-C. difficile antibiotic therapy, monitor for, and manage, complications, and initiate infection control measures. Three antibiotics are available for the treatment of acute infection: metronidazole, vancomycin, and fidaxomicin. Most patients treated for an initial episode of uncomplicated CDI are symptom-free after 7 days' treatment with metronidazole or vancomycin.