Combating Infection: Clostridium difficile: Trouble for adults and children
Michelle Snow MSHR, MSPH, RN

August 2011 
Volume 41  Number 8
Pages 67 - 68
  PDF Version Available!

CLOSTRIDIUM DIFFICILE infections (CDIs) aren't new. Historically, CDIs were diagnosed in older adults who were taking antibiotics, had gastrointestinal surgery or manipulation, were hospitalized for long periods, had a serious underlying illness, or were immunocompromised.1What is new, however, is a recent study that shows the rate of hospital-acquired CDI in children almost doubled (from 7.24% to 12.80%) from 1997 through 2006.2 But in contrast to trends in adults, the researchers found no increasing trend in the severity of CDI in children.3Other studies have identified a decrease in nosocomial CDIs and an increase in community-acquired CDIs in adults. More adult patients with CDIs hadn't previously received prescribed antibiotics, suggesting that C. difficile can now be found outside of the hospital setting.2-5C. difficile is a Gram-positive anaerobic spore-forming, toxin-producing bacillus that commonly causes antibiotic-associated diarrhea. The major reservoirs are infected patients, both symptomatic and asymptomatic, and items or surfaces contaminated with feces. C. difficile is often transferred to patients via the hands of healthcare personnel who have direct contact with infected patients or who have touched a contaminated surface or item.1 Signs and symptoms of CDI include watery diarrhea, fever, anorexia, nausea, and abdominal pain. Untreated, CDIs may lead to pseudomembranous colitis, toxic megacolon, colonic perforation, sepsis, and, rarely, death.1A CDI is diagnosed through history and physical assessment, stool cultures, and polymerase chain reaction (PCR) assays. Unfortunately, stool culture results may not be available for 48 to 96 hours. PCR assays can be run with a high degree of sensitivity within 1 to 2 hours. If stool specimens won't be processed or picked up by the lab within 2 hours, they must be refrigerated because the toxins rapidly deteriorate at room temperature.1According to the CDC, 20% of CDIs resolve after discontinuation of the antibiotic

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