Education And Debate

Fortnightly Review: Diagnosis and management of Clostridium difficile infection

BMJ 1995; 310 doi: (Published 27 May 1995) Cite this as: BMJ 1995;310:1375
  1. Soad Tabaqchali, professor of medical microbiologya,
  2. Pauline Jumaa, senior lecturera
  1. a Department of Medical Microbiology, St Bartholomew's Hospital Medical College, London EC1A 7BE
  1. 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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