Clostridium difficile Clinical Information

Risk Factors for CDI

  • Advanced age (>65 years)
  • Recent antimicrobial exposure (within previous 3 months)
    • All antibiotics increase the risk of CDI; clindamycin, beta-lactams, fluoroquinolones, and cephalosporins are most often associated with CDI
    • Even 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 (within previous 3 months)
  • Other potential contributing factors
    • Serious underlying illness; immunocompromising conditions
    • Use of proton-pump inhibitors (causing alteration in stomach acidity)

Signs and Symptoms

  • Watery liquid diarrhea 3-15 episodes 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

  • Transmission of C. difficile occurs through the fecal-oral route
  • C. difficile spores can be transmitted to patients via the hands of healthcare personnel who have touched a contaminated surface or item
  • Any environmental surface can transmit C. difficile spores which are highly resistant to cleaning and disinfection measures.
      • C. difficile is a fastidious anaerobe that dies rapidly in its vegetative state
      • C. difficile spores can remain in the environment for days to months and are highly resistant to cleaning and disinfection measures

Diagnosis

  • CDI should be considered in any patient with watery diarrhea or abdominal pain following:
    • antibiotic exposure within previous 3 months
      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 3 days with fever and/or abdominal pain in the absence of recent antibiotic use or healthcare exposure.
  • C. difficile may also be diagnosed through the endoscopic identification of pseudomembranes.

 

Updated Friday, January 10, 2014 at 02:06PM