infectious diseases
Clostridioides (formerly Clostridium) difficile–Induced Diarrhea
Introduction
Toxins produced byClostridioides difficilestrains in the gastrointestinal tract cause pseudomembranous colitis, typically after antibiotic use. Symptoms are diarrhea, sometimes bloody, rarely progressing to toxic megacolon, colonic perforation, sepsis, and acute abdomen. Diagnosis is by identifyingC. difficiletoxin in stool. First-line treatment is with oralvancomycinorfidaxomicin. (See also Overview of Anaerobic Bacteria and C. difficileis the most common cause of antibiotic-associated colitis and is typically hospital-acquired, but community-acquired cases are increasing.C. difficile–induced diarrhea. Risk factors forC. difficile–induced diarrhea include Extremes of age Prolonged hospital stay Living in a nursing home Severe underlying disease Use of proton pump inhibitors and H2 blockers is carried asymptomatically in 4 to 15% of healthy adults, up to 21% of hospitalized adults, and 15 to 30% of residents in long-term care facilities ( Reference ). It is common in the environment (eg, soil, water, household pets). Disease may follow overgrowth of endogenous A more virulent strain, BI/NAP1/027 (binary/North American pulsed-field type 1 [NAP1]/ribotype 027), has become prominent in hospital outbreaks. This strain produces substantially more toxin, causes more severe illness with greater chance of relapse, is more transmissible, and does not respond as well to antibiotic treatment. 