C. difficile Colitis

Transmitted via the fecal-oral route Common colonizer of the human colon. Historically associated with hospitalized patients, we’ve seen a rise in community-acquired cases. A major cause of C. difficile infection is antibiotics that suppress the non-pathogenic colonic flora, which allows the opportunistic C. difficile to flourish. 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. Note: this bacterium was originally named Clostridium difficile; it has been renamed Clostridioides difficile. Caused by overgrowth of C. difficile infection. Symptoms appear 5-10 days after antibiotic use. Older age and recent hospitalization also increase risk. Can be recurrent. C. difficile infection acts on the colon; patients often experience abdominal pain/cramping with severe watery diarrhea, fever, and leukocytosis. Stool sample - C. difficile DNA, toxins Note that C. difficile toxin can persist in stool after resolution, so repeat stool sampling is not recommended. Discontinue inciting antibiotic. Initial treatment options include fidazomicin, vancomycin, or metronidazole. Recurrent episode treatment options include fidazomicin, vancomycin, and bezlotoxumab. Prevention of reinfection with handwashing is important. If a patient has multiple episodes, consider fecal microbiota transplant.