TY - JOUR
T1 - Clinical recognition and diagnosis of Clostridium difficile infection
AU - Bartlett, John G.
AU - Gerding, Dale N.
N1 - Funding Information:
Supplement sponsorship. This article was published as part of a supplement entitled “Understanding Antimicrobial Exposure and Clostridium difficile Infection: Implications of Fluoroquinolone Use,” sponsored by the University of South Florida College of Medicine and SynerMed Communications.
Funding Information:
Financial support. This program is supported by an educational grant from PriCara (a unit of Ortho-McNeil), administered by Ortho-McNeil Janssen Scientific Affairs.
PY - 2008/1/15
Y1 - 2008/1/15
N2 - Prompt and precise diagnosis is an important aspect of effective management of Clostridium difficile infection (CDI). CDI causes 15%-25% of all cases of antibiotic-associated diarrhea, the severity of which ranges from mild diarrhea to fulminant pseudomembranous colitis. Several factors, especially advanced age and hospitalization, should be considered in the diagnosis of CDI. In particular, nosocomial diarrhea arising >72 hours after admission among patients receiving antibiotics is highly likely to have resulted from CDI. Testing of stool for the presence of C. difficile toxin confirms the diagnosis of CDI. However, performance of an enzyme immunoassay is the usual method by which CDI is confirmed, but this test appears to be relatively insensitive, compared with the cell cytotoxicity assay and stool culture for toxigenic C. difficile on selective medium. Endoscopy and computed tomography are less sensitive than stool toxin assays but may be useful when immediate results are important or other confounding conditions rank high in the differential diagnosis. Often overlooked aspects of this diagnosis are high white blood cell counts (which are sometimes in the leukemoid range) and hypoalbuminemia.
AB - Prompt and precise diagnosis is an important aspect of effective management of Clostridium difficile infection (CDI). CDI causes 15%-25% of all cases of antibiotic-associated diarrhea, the severity of which ranges from mild diarrhea to fulminant pseudomembranous colitis. Several factors, especially advanced age and hospitalization, should be considered in the diagnosis of CDI. In particular, nosocomial diarrhea arising >72 hours after admission among patients receiving antibiotics is highly likely to have resulted from CDI. Testing of stool for the presence of C. difficile toxin confirms the diagnosis of CDI. However, performance of an enzyme immunoassay is the usual method by which CDI is confirmed, but this test appears to be relatively insensitive, compared with the cell cytotoxicity assay and stool culture for toxigenic C. difficile on selective medium. Endoscopy and computed tomography are less sensitive than stool toxin assays but may be useful when immediate results are important or other confounding conditions rank high in the differential diagnosis. Often overlooked aspects of this diagnosis are high white blood cell counts (which are sometimes in the leukemoid range) and hypoalbuminemia.
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U2 - 10.1086/521863
DO - 10.1086/521863
M3 - Review article
C2 - 18177217
AN - SCOPUS:39749170731
SN - 1058-4838
VL - 46
SP - S12-S18
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
IS - SUPPL. 1
ER -