A 79 year old gentleman presented to me with profuse watery diarrhea. An exam of the colon revealed yellowish exudates with inflammation. He had recently been on clindamycin. I submitted my findings in a letter to the Annals of Internal Medicine which was published. Several similar reports were published under the title Clindamycin Colitis. The year was 1974.
Since then the bacteria Clostridium was identified and cultured with great difficulty, hence the name Clostridium Difficile. Symptoms and signs include watery diarrhea, nausea, loss of appetite, abdominal pain/tenderness and fever. The incidence of C. difficile has been rising both in the hospital and in the community. It is now the most common hospital acquired infection and is the most common cause of hospitalized acquired diarrhea. The bacteria produce a toxin which causes tissue injury to the colon. Certain individuals are more susceptible to the infection. They are the elderly 65-yrs and older, immunocompromised individuals, those with IBD (inflammatory bowel disease), people in long term care facilities, and individuals who have recently taken antibiotics. The infection is thought to be related to a disturbance in the normal intestinal ecosystem, the host’s microbiome. The host’s normal bacterial flora work to prevent colonization of bacteria which can then lead to disease.
Newer diagnostic tests that are very sensitive and specific are now available to make the diagnosis earlier. Treatment with metronidazole, vancomycin and now fidaxomicin are available but recurrent infection after treatment can occur. The latest innovative treatment available is Fecal Microbiota Transplantation, (FMT). This procedure has been shown to restore the intestinal flora aiding in combating the infection. The procedure involves obtaining stool from a healthy donor and then infusing it via a colonoscope or nasogastric tube.
Antibiotic stewardship (eliminate unnecessary antibiotic treatments) and meticulous hand hygiene are the keys to help limit the number and spread of eliminate the infection. Antibiotics should only be used for well documented bacterial infections. Cleaning potentially contaminated areas with bleach, hand washing with soap and water and isolation of materials and individuals known to be infected will limit the spread.