Epidemiology of Antimicrobial Agent-Associated Diarrhoea and Colitis

Abstract

The epidemiology of Clostridium difficile-induced intestinal disease is an important and intriguing subject not only because the disease is in many ways unique, but also because there are so many basic questions that remain to be answered. C. difficile appears to be a rather special pathogen: rarely harmful to the completely healthy host, but not known to be more pathogenic in the severely immunocompromised. Instead, most cases of C. difficile-induced diarrhea and colitis occur simply in association with antimicrobial therapy (Bartlett, 1979; Mogg et al., 1979); it appears that this alone is enough to alter host resistance to this organism. Indeed, altered intestinal ecology is one apparent risk factor for disease (Fekety et al., 1980); however the nature of this predisposing alteration is not yet fully understood. In addition, although the disease is frequently seen in seriously ill, elderly, hospitalized patients (Bartlett, 1979; Lusk et al., 1977; Mogg et al., 1979), the specific risk factors for this and other populations and the details of host defense are not yet identified. Furthermore, it has become apparent that there must be important unknown factors which, in addition to antimicrobial therapy and the presence of the organism, contribute to the development of the illness.