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