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Overview

Overview of C. difficile infection (CDI)*

Clostridium difficile is a gram positive, spore-forming bacillus that produces two exotoxins: toxin A and toxin B. These toxins are responsible for the diarrhea and inflammation seen in infected patients. Toxin A is an enterotoxin that can cause extensive mucosal damage and is an activator of mast cells and neutrophils, which trigger inflammatory mediators. Toxin B is a cytotoxin that is known to cause morphological changes in tissue culture cells.4

C. diff is the most commonly recognized cause of diarrhea in hospitalized patients and in patients in long term care facilities. Approximately 15% of antibiotic associated diarrhea can be attributed to CDI.5 Most CDI cases are healthcare facility acquired.6 However, a recent study has noted a trend toward community associated disease.7 The estimated annual cost of CDI in 2007 ranged from 1.14 to 1.62 billion dollars.8

In the last decade, a C. diff strain, BI/NAP1/027, thought to be more virulent has become widely prevalent, possibly due to its facility for sporulation.4 It produces more of toxins A and B than other strains as well as a 3rd binary toxin.4 However, there is evidence from clinical studies that BI/NAP1/027 may not produce disease that is more virulent than that produced by other C. diff strains when factors such as age are controlled.9,10

*Some sources refer to the illness as C. difficile-associated disease (CDAD).

Association of Professionals in Infection Control (APIC) statistical portrait of CDI patients11

  • 55.9% were female, 44.1% male
  • 84.7% were on the medical service
  • 69.2% were >60 years of age
  • 57.9% had an initial episode of mild or moderate disease
  • 10.94% had severe to complicated disease
  • 72.5% were considered healthcare-associated infections
  • 45.5% were detected >48 hours after admission
  • 26.6% required ICU admission, 18.2% had shock, and 16.5% required vasopressors
  • 79.4% had antimicrobial before onset
  • 47.4% had hospitalization within 90 days of onset
  • 46.5% had resolution of diarrhea within six days

Find information on the differential diagnosis and diagnostic protocol for CDI