Clostridium difficile Colitis, Treatment and Management

Clostridium difficile is a gram positive, anaerobic, spore forming bacilli, which is an ever-present danger within hospitalized patients accounting for ~15,000 deaths each year in the United States CDC (MMWR 61:157–162, 2012 ). Clostridium difficile infection is generally defined by the presence of diarrhea, leukocytosis and testing positive for the organism’s toxin via toxin assay. As with most bacterial organisms that developed resistance to antibiotics, the organism has developed several fluoroquinolone resistant strains, BI, NAP1, and toxinotype III and ribotype 027 Warney et al. (Lancet 366:1079–1084, 2005 ). Not only do we see this bacterium with acute and chronic disruption of the intestinal flora, but it has also been associated with chronic proton pump inhibitor usage and elevation of gastric pH Howell et al. (Arch Intern Med 170:784–790, 2010 ••). Proper hand sanitation and contact precautions are two of the most effective methods in preventing the spread of spores. Treatment modalities for this infection have steadily progressed to include metronidazole, vancomycin, oral administration of IV vancomycin, fidaxomicin, and lastly fecal transplantation. Of greatest importance remains our ability to properly diagnose, treat, and prevent this costly and dangerous infection.