Clostridium difficile associated diarrhoea: diagnosis and treatmentBMJ 2005; 331 doi: https://doi.org/10.1136/bmj.331.7515.498 (Published 01 September 2005) Cite this as: BMJ 2005;331:498
- John Starr, consultant physician (firstname.lastname@example.org)
- University of Edinburgh
Clostridium difficile associated diarrhoea is a serious condition with a mortality of up to 25% in frail elderly people.1 It affects older, frailer, hospitalised patients and also younger patients who are immunosuppressed.
Cross infection by C difficile is common in neonatal units, but neonates do not seem to develop C difficile associated diarrhoea.
The diagnosis of C difficile associated diarrhoea depends on:
Presence of diarrhoea, defined as an increase in stool liquidity usually accompanied by an increased frequency of bowel motions. A formal cut-off is the passing of more than 300 ml of liquid stool in 24 hours
Detection of toxins produced by C difficile in the stools.
The patient may also experience abdominal pain and have systemic features of malaise, fever, dehydration, and delirium. A pseudomembranous colitis is present in severe cases. In this state there is sloughing of the colonic epithelium, which is severely inflamed due to the cytotoxic action of C difficile.
C difficile associated diarrhoea is classically associated with clindamycin, but it may occur after exposure to a wide range of antibiotics.
Symptoms usually start during antibiotic treatment or shortly afterwards. Symptoms can be delayed by a few weeks, so it is worth asking patients whether they are currently taking, or have recently taken, antibiotics.
How does it happen?
C difficile is spread by the faecal-oral route, albeit indirectly through spores left on surfaces. C difficile is an anaerobic, Gram positive, spore forming bacterium that is the major identifiable cause of antibiotic associated diarrhoea.