Curriculum · Gastroenterology
Clostridioides difficile colitis
What it is
Clostridioides difficile colitis develops after the use of antibiotics. C. difficile infection is one of the most clinically important causes of acute and recurrent diarrhea, especially in hospitalized patients and in post-antibiotic settings. The organism is a Gram +ve bacillus, an anaerobe and spore-forming, and it causes antibiotic-associated diarrhea and pseudomembranous colitis.
Causes and risk
It can be caused by any antibiotic, and clindamycin is the one commonly named. Previous antibiotic use is the link to look for in a patient with diarrhea, the way fried rice points to Bacillus cereus, and contaminated water or fresh water on a camping trip points to Giardia lamblia and cryptosporidiosis. It is common among hospitalized patients and residents in long-term care facilities, because C. difficile spores are easily transmitted by the fecal-oral route. The disease typically begins 7 to 10 days after the institution of antibiotic therapy, most often in hospitalized patients, although the incidence in the community is rising.
How it presents
It presents as acute diarrhea, and it also recurs. Most acute diarrhea in developed countries comes from viral gastroenteritis or food poisoning and is self-limited, so what marks this one out is the antibiotic history and the hospital setting rather than the stool itself. Severe CDI may manifest with paralytic ileus, toxic megacolon, leukocytosis, and elevated lactate and creatinine.