Introduction

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.

• The …