Clostridium difficile

Gerald Friedman

Research output: Chapter in Book/Report/Conference proceedingChapterpeer-review


Clostridium difficile is an anaerobic, gram-positive, spore-forming rod causing acute diarrhea ranging from mild diarrhea and abdominal pain to severe, fulminant disease associated with shock, toxic megacolon, and death. Risk factors include hospitalized elderly patients, exposure to antibiotics, immunosuppression, chemotherapy, inhibition of gastric acid, and long-term hospitalization. Community risk factors include post-partum females and inflammatory bowel disease, especially ulcerative colitis. C. difficile releases two potent exotoxins, enterotoxin A and cytotoxin B, which mediate colitis and diarrhea. A hypervirulent strain, NAP1/B1/027, has been implicated in recent outbreaks of colitis. Treatment includes discontinuation of the precipitating antibiotic, supportive IV fluid and electrolytes, and appropriate antibiotics including metronidazole, vancomycin, or fadixomicin. Recurrent infection may occur in >20% of cases and should be treated initially with a repeat course of antibiotics. Refractory cases may be treated with fecal microbial transfer. Preventive measures include single-room isolation, personal toilet, handwashing with soap and water, protective gloves and gown, disposable medical equipment, and in-room chlorination of surfaces.

Original languageEnglish
Title of host publicationGastroenterology
Number of pages11
ISBN (Electronic)9781118932759
ISBN (Print)9781118519967
StatePublished - 1 Jan 2014


  • Clostridium difficile
  • Exotoxins
  • Fadixomicin
  • Fecal microbial transfer
  • Fulminant disease
  • Hypervirulent strain
  • Immune suppression
  • Inflammatory bowel disease
  • Spore-forming rod
  • Vancomycin


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