Source: Roecker A, Bates B, Martin S. Gastrointestinal infections and enterotoxigenic poisonings. In: DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM. Pharmacotherapy: A Pathophysiologic Approach. 10th ed. New York, NY: McGraw-Hill; 2017. https://accesspharmacy.mhmedical.com/content.aspx?bookid=1861§ionid=133893751. Accessed September 19, 2018.
C. difficile is a gram-positive spore-forming anaerobic bacillus and causes a toxin-mediated disease.
Once antibiotics disrupt normal colonic flora and colonization of C. difficile occurs, two toxins (A and B) are released to mediate diarrhea and colitis.
Most common cause of infectious diarrhea in hospitalized patients in North America and Europe
High rates of disease occur in long-term care facilities and in the elderly
CDI is associated with use of broad-spectrum antimicrobials and accounts for approximately 20% to 30% of all cases of antibiotic-associated diarrhea.
The antibiotics most commonly associated with CDI include clindamycin, ampicillin, cephalosporins, and fluoroquinolones
Clinical diagnosis is based on the onset of diarrhea, defined as three unformed stools in 24 hours, during or after antimicrobial use, and often associated with abdominal discomfort, fever, and polymorphonuclear leukocytosis.
Spectrum of disease ranges from mild diarrhea to life-threatening toxic megacolon and pseudomembranous colitis
Colitis without pseudomembranes: Patients present with malaise, abdominal pain, nausea, anorexia, watery diarrhea, low-grade fever, and leukocytosis.
Pseudomembranous colitis: Characterized by severe abdominal pain, perfuse diarrhea, high fever, marked leukocytosis, and classic pseudomembrane formation
TABLE 1Acute Infectious Diarrhea Clinical Syndromes: Watery versus Dysentery |Favorite Table|Download (.pdf) TABLE 1 Acute Infectious Diarrhea Clinical Syndromes: Watery versus Dysentery
| ||Watery ||Dysentery |
|Percentage of patients ||90–95 ||5–10 |
| Appearance ||Watery ||Bloody |
| Volume ||Increased: ++/+++ ||Increased: +/++ |
| Number per day ||<10 ||>10 |
| Reducing substances ||0 to +++ ||0 |
| pH ||5–7.5 ||6–7.5...|