Clostridium difficile and Other Antibiotic-Associated Diarrhea

The use of antibiotics causes diarrhea by three mechanisms. Mild diarrhea is a side effect of many antibiotics, more often seen with broad-spectrum antibiotics and when multiple antibiotics are used simultaneously. Antibiotic-associated hemorrhagic colitis may rarely occur following the use of penicillins. A good example is the hemorrhagic colitis associated with ampicillin-clavulanic acid use caused by the bacteria Klebsiella oxytoca. However, Clostridium difficile –associated disease (CDAD) is one of the important causes of antibiotic-associated diarrheal disorders of tremendous public health importance.

In the United States, C. difficile is one of the leading causes of nosocomially acquired diarrheal syndromes. CDAD is increasing in its incidence and severity. Some recent observations on the epidemics are of concern. Once, CDAD was predominantly a hospital-acquired disease. Currently, community-acquired CDAD is increasing, one-quarter of the cases being nursing home acquired. The recurrence rate has increased, as well as the severity of the disease along with the indications for colectomy for toxic megacolon or intestinal perforations.

C. difficile is a spore-forming, gram-positive, anaerobic, toxin-producing bacteria. C. difficile colonizes the intestinal tract in up to 15% of healthy adults ( Fig. 112.1 ).

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Clostridium difficile Colitis.

(Martin JS, Monaghan TM, Wilcox MH: Clostridium difficile infection: epidemiology, diagnosis and understanding transmission. Nat Rev Gastroenterol Hepatol 13(4):206-216, 2016.)