Clostridium Difficile Clinical Information

Risk Factors for CDI

  • Advanced age (>65 years)
  • Recent antimicrobial exposure (within 3 months of symptom onset)
    • Clindamycin, beta-lactams, cephalosporins have historically been associated with CDI, though all antibiotic classes have been implicated
    • Brief antibiotic exposure may result in CDI, though prolonged exposure or use of more than one antibiotic may further increase risk
  • Recent hospitalization or long-term care facility admission
  • Other potential contributing factors
    • Serious underlying illness; immunocompromising conditions
    • Use of proton-pump inhibitors (causing alteration in stomach acidity) may be considered a risk factor

Signs and Symptoms

  • Watery liquid diarrhea 3-15 times per day is the most common symptom
  • Other symptoms for mild-moderate disease include:
    • Fever
    • Loss of appetite
    • Nausea
    • Abdominal pain/tenderness
  • Complications of severe disease
    • Pseudomembranous colitis
    • Toxic megacolon
    • Colon perforation
    • Ileus
    • Death (rare)

Transmission

  • C. difficile is a fastidious anaerobe that dies rapidly in its vegetative state.
  • C. difficile produces spores that can remain in the environment for days to months. 
  • Any environmental surface can transmit C. difficile spores which are highly resistant to cleaning and disinfection measures.
  • Transmission of C. difficile occurs through the fecal-oral route

Diagnosis

  • CDI should be considered in any patient with watery liquid diarrhea or abdominal pain following:
    • antibiotic exposure
      and/or
    • exposure to a healthcare setting within the past 3 months
  • Due to the changing epidemiology of C. difficile, consider CDI in patient with diarrhea lasting longer than three days with fever and/or abdominal pain in the absence of recent antibiotic use or healthcare exposure.
  • In some situations, C. difficile may be diagnosed through the identification of pseudomembranes identified by endoscopy.

 

Updated Tuesday, 10-Jan-2012 12:22:33 CST