Clostridium difficile--more difficult than ever.

Copyright © 2008 Massachusetts Medical Society. In 1935, Hall and O’Toole first isolated a gram-positive, cytotoxinproducing anaerobic bacterium from the stool of healthy neonates.1 They named it Bacillus difficilis to reflect the difficulties they encountered in its isolation and culture. We now face the opposite problem of being unable to contain the growth and spread of the same bacterium, now called Clostridium difficile, which is a frequent cause of infectious colitis, usually occurring as a complication of antibiotic therapy, in elderly hospitalized patients. In this article we review recent changes in the epidemiology of C. difficile infection, discuss changes in disease severity and response to therapy, and review new approaches to the management of this increasingly problematic infectious diarrhea.