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Clostridium difficile (C diff) is a ubiquitous, spore-forming bacterium commonly found in the soil, hospital environments, and nursing homes. The gram-positive bacillus is often present as a part of the normal intestinal bacterial flora in healthy children and adults. However, when the bacterial flora of healthy people is disrupted (see risk factors), C diff may overpopulate the intestinal tract, causing a range of gastrointestinal disorders. Clostridium difficile-associated disease (CDAD) spans a range of presentations, from self-limiting diarrhea to life-threatening toxic megacolon and pseudomembranous colitis. Between 15% and 20% of diarrhea cases and up to 95% of pseudomembranous colitis cases are attributable to C diff infections, and mounting evidence from the United States, Canada, and Europe confirms increasing incidence and severity of CDAD. Recent evidence points to the emergence of new C diff strains that produce unusually high levels of disease-causing toxins, as well as strains that are resistant to antibiotics commonly used to treat C diff infections.
Between 1996 and 2003, the number of patients discharged from short-term care hospitals with a diagnosis of CDAD increased from 31/100,000 to 61/100,000 cases, with a similar trend noted in a report from the Veterans Health Administration hospital system. C diff colonization is detected in 14% of patients admitted to hospitals, with an additional 17% of patients becoming colonized during their hospitalization. CDAD infections are associated with longer hospital stays and increased hospital costs, which are estimated to exceed $1 billion in extra charges.
C diff is a common cause of acute diarrheal disease in long-term care (LTC) facilities, where C diff acquisition is estimated to be 0.52/1000 resident days and 19% of individuals will remain colonized for more than 3 months. Adding to the LTC challenge is the growing number of CDAD patients being admitted to LTC facilities for care.
Beyond healthcare settings, CDAD outbreaks have recently been reported in low-risk community patient populations and children with diarrhea seen in the emergency room, suggesting a poorly described C diff community burden.
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