Practice parameters for the management of Clostridium difficile infection.

Diseases of the Colon & ReCtum Volume 58: 1 (2015) of pseudomembranous colitis. although the bacteria are present the stool of ~3% of healthy adults, up to 50% of those exposed to an in-patient facility are asymptomatic carriers. higher rates have been cited in patients following a prolonged duration of exposure to antibiotics, and in those with severe underlying comorbid disease. infection can result in a wide range of presentations, from an asymptomatic carrier state or mild C difficile infection (CDi) to a severe and life-threatening condition (table 1). the prevalence and severity of CDi has dramatically increased since the early 2000s when a surge in morbidity and mortality rates occurred. C difficile infection most commonly involves the colon, where it is also commonly known as “pseudomembranous colitis” because of the common endoscopic finding of pseudomembranes covering the colonic mucosa. in rare circumstances, it may also involve the small bowel. Globally, CDi is increasingly more prevalent and severe; this may be due to the emergence of certain strains (ie, ribotypes) of the bacteria, which can result in not only a life-threatening infection, but also a surgical emergency. a number of studies have demonstrated an association between ribotype 027 and fulminant (heretofore referred as severe) CDi. a wide variety of practice measures and collaborative efforts have been implemented to reverse this trend, with occasional reports of success. Despite these efforts, reported cases of CDi increased 200% between 2000 and 2005, and have since continued to rise almost exponentially annually. Given the growing incidence of CDi, the economic burden of prevention and treatment has surged, and is increasingly important in the population of patients with colorectal diseases. this practice parameter will focus on the evaluation, management, and prevention of CDi.