Clostridium difficile

Abstract

Clostridium difficile is the causal organism of a predominantly endogenous gastrointestinal infection which is characterised by its association with the prior administration of antibiotics. It is now well recognised that the spectrum of disease produced may be very wide, ranging from mild diarrhoeal illness to severe life-threatening pseudo-membranous colitis (PMC). Systemic infection with this organism is rare and, in common with other clostridial diseases, pathogenesis is thought to be the result of the action of two major protein exotoxins A and B which respectively result in loss of fluid from the gut mucosa and a direct local cytopathic effect. Between 2–3% of healthy adults carry the organism in their gastrointestinal tract, but this figure rises to 36% in the hospitalised population. Neonates and elderly patients may have even higher rates of carriage, although in the former group this does not seem to cause clinical disease. It is thought that antibiotic therapy results in an alteration of the gut flora which permits the overgrowth of Clostridium difficile which is already present in the patient’s gut, or which may be acquired nosocomially from the hospital environment.