Diagnosis, management, and prevention of Clostridium difficile infection in long-term care facilities: a review

Journal of the American Geriatrics Society
Andrew E Simor

Abstract

Clostridium difficile is a significant healthcare-associated pathogen and the major cause of antibiotic-associated diarrhea. The incidence and severity of C. difficile infection have increased in many parts of North America and Europe in the past few years with the widespread dissemination of a hypervirulent strain of C. difficile, referred to as North American pulsed-field type 1, polymerase chain reaction ribotype 027 (NAP1/027). C. difficile infection appears to affect older adults disproportionately. Long-term care facility (LTCF) residents are at greater risk because of advanced age, the frequent need for hospitalization, and recurrent exposures to antimicrobial agents. Early identification of C. difficile infection and prompt initiation of appropriate therapy are required to reduce morbidity and mortality. Diagnosis is based on the detection of C. difficile toxins A or B in diarrheal stool specimens. The treatment of choice for moderate or severe C. difficile infection (defined as the presence of pseudomembranous colitis, treatment in an intensive care unit, or two of (i) aged 60 and older, (ii) fever greater than 38.3°C, (iii) peripheral leukocytosis (>15,000 cells/mm(3) ), or (iv) hypoalbuminemia (<2.5 mg/dL) should be ...Continue Reading

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