CLOSTRIDIUM-DIFFICILE-ASSOCIATED DIARRHEA AND COLITIS - CLINICAL MANIFESTATIONS, DIAGNOSIS AND TREATMENT

PURPOSE: This review examines the pathogenesis, clinical manifestation s diagnosis, and current medical and operative strategies in the treat ment of Clostridium difficile diarrhea and colitis. Prevention and fut ure avenues of research are also investigated. METHODS: A review of th e literature was conducted with the use of MEDLINE. RESULTS: C. diffic ile is a gram-positive, spore-forming bacterium capable of causing tox igenic colitis in susceptible patients, usually those receiving antibi otics. Overgrowth of toxigenic strains may result in a spectrum of dis ease, including becoming an asymptomatic carrier, diarrhea, self-limit ed colitis, fulminant colitis, and toxic megacolon. Diagnosis requires a high index of suspicion and depends on clinical data, laboratory st ool studies (enzyme-linked immunoabsorbent assay and cytotoxin test), and endoscopy in selected cases. Protocols for treatment of primary an d relapsing infections are provided in algorithm format. Discontinuati on of antibiotics may be enough to resolve symptoms. Medical managemen t with oral metronidazole or vancomycin is the first-line therapy for those with symptomatic colitis. Teicoplanin, Saccharomyces spp. and La ctobacillus spp., and intravenous IgG antitoxin are reserved for more recalcitrant cases. Refractory or relapsing infections may require van comycin given orally or other newer modalities. Fulminant colitis and toxic megacolon warrant subtotal colectomy. Cost, in terms of extended hospital stay, medical and surgical management, and, in some cases, w ard closure, is thought to be formidable. Review of perioperative anti biotic policies and analysis of hospital formularies may contribute to prevention and decreased costs. CONCLUSION: C. difficile diarrhea and colitis is a nosocomial infection that may result in significant morb idity, mortality, and medical costs. Standard laboratory studies and e ndoscopic evaluation assist in the diagnosis of clinically suspicious cases. Appropriate perioperative antibiotic dosing, narrowing the anti biotic spectrum when treating infections, and discontinuing antibiotic s at appropriate intervals prevent toxic sequelae.