Fortnightly Review: Diagnosis and management of Clostridium difficile infection

BMJ 1995;310:1375-1380 (27 May)

Education and debate

Soad Tabaqchali, professor of medical microbiology,^a Pauline Jumaa, senior lecturer ^a

^a Department of Medical Microbiology, St Bartholomew's Hospital Medical College, London EC1A 7BE

Correspondence to: Professor Tabaqchali.

Summary points

Clostridium difficile is a major nosocomial pathogen causing illness ranging from antibiotic associated diarrhoea to antibiotic associated colitis and pseudomembranous colitis
Antibiotic treatment is an important predisposing factor to C difficile associated disease, and elderly patients and those with serious underlying disease are especially at risk
C difficile is nosocomially acquired and may cause outbreaks of illness by spreading directly from patient to patient or being acquired from the environment and from healthcare workers
Diagnosis depends on clinical presentation and laboratory investigations (culture of C difficile and demonstration of toxins in stools), while sigmoidoscopy is occasionally helpful
Treatment of C difficile infection should include stopping the implicated antibiotic, rehydration, and oral treatment with metronidazole or vancomycin, while severe complications may require emergency surgical intervention
Control measures include isolation of infected patients, implementation of infection control practices, and introduction of strict antibiotic policies

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Popoola, J., Swann, A., Warwick, G. (2000). Clostridium difficile in patients with renal failure -- management of an outbreak using biotherapy. Nephrol Dial Transplant 15: 571-574 [Full text]
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