Clostridium difficile Colitis

Abstract

Clostridium difficile colitis should be suspected in patients with watery foul-smelling diarrhea who have recently been hospitalized or exposed to antibiotics. Stool should be evaluated for C. difficile toxin to establish the diagnosis. Abdominal exam, white blood cells (WBC), and renal function should be used to determine the severity of infection. Patients with fulminant colitis, such as signs of systemic toxicity, should have a computed tomography (CT) scan to determine the extent of inflammation and dilation of the colon. If the colon is perforated, a total abdominal colectomy with end ileostomy should be performed. Management of mild disease is with metronidazole and per oral (PO) vancomycin for severe disease. Severe-complicated disease is treated with a combination of vancomycin PO and metronidazole IV and vancomycin enemas if ileus is suspected. Fecal transplant should be considered in patients with relapsing or refractory disease.