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Clostridium difficile–Associated Diarrhea and Colitis: A Significant Cause of Nosocomial Infection

Two epidemiological investigations in the United States and Canada (24,26) independently examined samples of C. difficile and found that a mutated version of the “wild” strain was responsible for outbreaks in Quebec and increased rates of CDAD in hospitals in the United States recently (22,23). Clinical epidemiologists at the CDC investigated C. difficile isolates from hospitals in the United States with recent (i.e., 2001–2004) CDAD outbreaks (22,23). The report indicates the emergence of a new epidemic strain, “BI” (distinct from the “J” strain of 1989–1992), which may be responsible for the recent increase in rates and apparent severity of CDAD (26).

CDAD and colitis in most cases can be treated by the administration of metronidazole or vancomycin. In some patients severe life-threatening toxicity develops despite appropriate and timely medical treatment, and surgical intervention is necessary. Systemic symptoms of infection with C. difficile are reported not to derive from bacteremia, colonic perforation or ischemia, but from toxin-induced inflammatory mediators released from the colon (27-29). Early surgical intervention should be employed in refractory cases of severe disease. Surgical intervention is far from ideal, however, and carries a very high rate of complications and significant risk of mortality (22). The future clinical approach to the treatment of nosocomial C. difficile colitis may eventually involve specific antitoxin hyperimmunoglobulins and inhibitors of the inflammatory cascade (28,30,31).

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