clostridium%20difficile%20infection
CLOSTRIDIUM DIFFICILE INFECTION
Clostridium difficile infection is commonly associated with antibiotic treatment and is one of the most common nosocomial infections.
Symptoms usually start on days 4-9 of antibiotic treatment, but may also occur up to 8-10 weeks after discontinuation of antibiotics.
Discontinuation of antibiotics may be the only measure needed for patients with only mild diarrhea, no fever, no abdominal pain nor a high WBC count.
Cessation of antibiotics allows for reconstitution of the normal colonic microflora and markedly reduces risk of relapse.

Introduction

  • C difficile infection is commonly associated w/ antibiotic treatment & is one of the most common nosocomial infections

Signs and Symptoms

  • Symptoms usually start on days 4-9 of antibiotic treatment, but may also occur up to 8-10 weeks after discontinuation of antibiotics

Mild Disease

  • Watery diarrhea which is rarely bloody
  • Cramping abdominal pain, tenesmus
  • Anorexia, malaise
  • Slightly increased white blood cell (WBC) count

Moderate Disease

  • Fever
  • Dehydration
  • Nausea & vomiting
  • Abdominal tenderness
  • Leukemoid reaction

Severe Disease

  • Sepsis or shock
  • Acute abdomen which may be due to colonic perforation
  • Toxic megacolon, ascites, paralytic ileus
  • Hypoalbuminemia, increased WBC count & serum creatinine & lactate levels
  • Diarrhea may be of lesser severity in severe disease

Risk Factors

  • Antibiotic therapy
    • Antibiotics most commonly implicated are the cephalosporins, aminopenicillins & Clindamycin
    • Macrolides & other penicillins are less commonly involved
    • Prolonged antibiotic administration increases the risk of C difficile colitis, but even a brief exposure to a single antibiotic may cause disease
  • Intensive care unit (ICU) admission
  • Advanced age
  • Severe comorbid illnesses
  • Immunosuppressive therapy
  • Recent surgery
  • Use of a nasogastric tube
  • Use of antacids
  • Prolonged stay in the hospital
  • Residing in a nursing home
  • Sharing a hospital room w/ a C difficile-infected patient
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