Clostridium difficile–Associated Diarrhea and Colitis in the Hospitalized Patient

Hospital Physician July 2007 21 D iarrhea and colitis caused by Clostridium difficile infection is a significant clinical problem in hospitalized patients. There are an estimated 3 million new cases of C. difficile– associated diarrhea and colitis in US hospitals each year, affecting as many as 10% of patients hospitalized for more than 2 days.1 The incidence of C. difficile– associated diarrhea is increasing.2 Data from the US Centers for Disease Control and Prevention (CDC) reveal that hospitalizations with a discharge diagnosis of C. difficile–associated disease have increased from 31 per 100,000 persons in 1996 to 61 per 100,000 persons in 2003.3 The severity of observed disease also may be increasing, with an attributable 1-year mortality rate approaching 17% in 1 study.4 It is not surprising that several studies have reported substantial increases in length of hospital stay associated with this disease.5,6 The increased frequency of C. difficile– associated disease as well as the increasingly severe clinical presentations and poorer outcomes have been attributed to a recently recognized strain of C. difficile that was responsible for outbreaks of disease in North America. This article discusses the evolving virulence of C. difficile and reviews the current approach to recognition and management of diarrhea and colitis associated with this infection.