Description

This review examines the epidemiology, pathogenesis, clinical manifestations, diagnosis, treatment and prevention of Clostridium difficile infection. The information was obtained using a Medline search of articles from 1996-2000. Clostridium difficile is a gram-positive organism. Prior use of antibiotics, especially clindamycin and second and third generation cephalosporins predisposes to C. difficile infection. The clinical manifestations range from asymptomatic carriers, mild diarrhea, and pseudomembranous colitis to toxic megacolon. Diagnosis is made by isolating C.difficile toxins in the stool using ELISA. Oral vancomycin and metronidazole are the drugs of choice in the treatment of C. difficile infection. Relapsing C. difficile infection is usually treated with the same antibiotics and in severe cases the addition of immunoglobulins and probiotics may prove to be of some value. Fulminant colitis and toxic megacolon warrant surgical intervention such as subtotal colectomy. Restricted use of antibiotics, hand washing and the use of disposable gloves when handling patients with C. difficile infection are important preventive measures. The cost in terms of prolonged length of stay, medical and surgical management and in some cases closure of wards can be high.