From the Research
Introduction to Pseudomembranous Colitis
Pseudomembranous colitis, also known as Clostridioides difficile (C. diff) infection, is a significant nosocomial and public health challenge 1. It is characterized by diarrhea and colitis, and its severity can vary, leading to increased morbidity and mortality among hospitalized patients.
Risk Factors
Several risk factors contribute to the development of C. diff infection, including:
- Prior hospitalization
- Age older than 65 years
- Antibiotic use
- Chronic disease
- Gastric acid suppression
- Infection with a hypervirulent strain 2, 3
- Surgical patients, particularly those undergoing perioperative prophylaxis with antibiotics 1
- Immunocompromised individuals
Prevention
Prevention of C. diff infection is crucial and can be achieved through:
- Proper hygiene, including hand washing and isolation of patients 3
- Vaccinations
- Early detection of the infection
- Judicious use of antibiotics to reduce the risk of overprescription 3
Signs and Symptoms
The signs and symptoms of C. diff infection can vary depending on the severity of the disease. Common symptoms include:
- Diarrhea
- Abdominal pain
- Fever
- Nausea and vomiting
- Blood in the stool
Treatment
Treatment of C. diff infection depends on the severity of the disease:
Mild to Moderate Colitis
- Antibiotics, such as vancomycin or fidaxomicin, are the primary treatment for mild to moderate colitis 4
- Metronidazole may also be used for initial mild to moderate episodes or first recurrence 4
Severe Colitis
- Severe colitis requires a more aggressive approach, which may include surgery, such as open total abdominal colectomy with end ileostomy 5
- Alternative therapies, such as fecal transplants, intravenous immunoglobulin, and the use of cholestyramine and tigecycline, have shown promising results 3
Recurrent C. diff Infection
- Treatment of recurrent C. diff infection often involves a combination of antibiotics and alternative therapies, such as fecal microbiota transplant (FMT) 2
- Vancomycin and fidaxomicin are commonly used antibiotics for the treatment of recurrent C. diff infection 2, 4
Differential Diagnosis and Caveats
It is essential to consider other causes of diarrhea and colitis when diagnosing C. diff infection. A thorough medical history, physical examination, and laboratory tests, such as stool assays and radiography, can help confirm the diagnosis. Additionally, the use of antibiotics should be carefully considered, as overprescription can contribute to the development of C. diff infection.