Epidemiology

Etiology

Risk factors for CDI

• Recent antibiotic treatment
  • Antibiotics destroy the normal intestinal bacterial flora that normally suppresses C. difficile overgrowth. C. difficile is resistant to most of the commonly used antibiotics.
  • High-risk antibiotics (odds ratio ≥ 5)
    • Clindamycin
    • Cephalosporins
    • Fluoroquinolones
• Advanced age
• Gastric acid suppression (e.g., with proton pump inhibitors) or bypass (e.g., enteral feeding)
• Recent hospitalization

Pathophysiology

• Toxin A (enterotoxin): binding to brush border of enterocytes → disruption of actin cytoskeleton functioning → increase in epithelial permeability and apoptosis → diarrhea
• Toxin B (cytotoxin): same as in toxin A, but can also cause pore formation within the endosomal membrane via insertion of the translocation domain → release of endosomal content into the cytosol → cytopathic effect

Clinical features

Diagnostics

Treatment