Clinical Pathology Glossary: C. difficile Colitis
Note: this bacterium was originally named Clostridium difficile; it has been renamed Clostridioides difficile. Historically associated with hospitalized patients, we’ve seen a rise in community-acquired cases. Furthermore, older age and recent hospitalization also increase risk.
Etiology and Pathogenesis
A major cause of C. difficile infection is antibiotics that suppress the non-pathogenic colonic flora, which allows the opportunistic C. difficile to flourish. C. difficile infection acts on the colon; patients often experience abdominal pain/cramping with severe watery diarrhea, fever, and leukocytosis.
Pseudomembranous colitis is the most serious form of C. difficile infection; characterized by yellowish-white exudate on the mucosal surface of the colon. The pseudomembrane comprises fibrin and inflammatory cells in mucus.
Diagnosis and Management
Regarding diagnostics, note that C. difficile toxin can persist in stool after resolution, so repeat stool sampling is not recommended. For the prevention of spread, prevention of reinfection with handwashing is important. If a patient has multiple episodes, consider fecal microbiota transplant.
Summary of Treatment Options
- Initial Therapy: Initial treatment options include fidazomicin, vancomycin, or metronidazole.
- Recurrent Therapy: Recurrent episode treatment options include fidazomicin, vancomycin, and bezlotoxumab.