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Review
. 2004 Jul 6;171(1):51-8.
doi: 10.1503/cmaj.1031189.

Clostridium difficile-associated diarrhea in adults

Susan M Poutanen  1 , Andrew E Simor
Affiliations
Review

Clostridium difficile-associated diarrhea in adults

Susan M Poutanen et al. CMAJ. .

Abstract

Clostridium difficile is the most important cause of nosocomial diarrhea in adults. Illness may range from mild watery diarrhea to life-threatening colitis. An antecedent disruption of the normal colonic flora followed by exposure to a toxigenic strain of C. difficile are necessary first steps in the pathogenesis of disease. Diagnosis is based primarily on the detection of C. difficile toxin A or toxin B. First-line treatment is with oral metronidazole therapy. Treatment with oral vancomycin therapy should be reserved for patients who have contraindications or intolerance to metronidazole or who fail to respond to first-line therapy.

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Figures

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Fig. 1: Pathogenesis of Clostridium difficile-associated diarrhea in adults. Photo: Lianne Friesen and Nicholas Woolridge
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Fig. 2: Factors contributing to the development of Clostridium difficile colonization and diarrhea [adapted, with permission, from Johnson S, Gerding DN. Clostridium difficile-associated diarrhea. Clin Infect Dis 1998;26:1027-36, published by the University of Chicago Press, Infectious Diseases Society of America; 1998]. Photo: Lianne Friesen and Nicholas Woolridge
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Box 1
See this image and copyright information in PMC

Comment in

  • Clostridium difficile: a formidable foe.
    Loo VG, Libman MD, Miller MA, Bourgault AM, Frenette CH, Kelly M, Michaud S, Nguyen T, Poirier L, Vibien A, Horn R, Laflamme PJ, René P. Loo VG, et al. CMAJ. 2004 Jul 6;171(1):47-8. doi: 10.1503/cmaj.1040836. CMAJ. 2004. PMID: 15238496 Free PMC article. No abstract available.
  • Treating C. difficile.
    Johnston BC, Vohra S. Johnston BC, et al. CMAJ. 2005 Feb 15;172(4):447-8. doi: 10.1503/cmaj.1041646. CMAJ. 2005. PMID: 15710916 Free PMC article. No abstract available.
  • Treating C. difficile.
    Parmar MS. Parmar MS. CMAJ. 2005 Feb 15;172(4):448; author reply 448. doi: 10.1503/cmaj.1041195. CMAJ. 2005. PMID: 15710921 Free PMC article. No abstract available.

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