Clostridioides difficile infection
Antibiotic-associated, toxin-mediated colitis in which loss of gut colonisation resistance permits C. difficile to proliferate, causing diarrhoea that may progress to ileus, toxic megacolon and perforation.
Definition
Clostridioides difficile infection is symptomatic diarrhoeal illness caused by toxin-producing C. difficile, diagnosed by compatible clinical features and appropriate laboratory evidence. It can cause colitis, pseudomembranes, ileus, toxic megacolon, perforation and systemic illness.
First principles
Antibiotics remove colonisation resistance
C. difficile spores may be acquired from the environment or already be present without causing disease. A diverse colonic microbiota normally limits germination and expansion; antimicrobial exposure disrupts this protection, particularly with broad-spectrum agents such as clindamycin, cephalosporins, fluoroquinolones, co-amoxiclav and piperacillin-tazobactam. This is why antimicrobial stewardship is part of both treatment and prevention.
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