For whatever reason, the college examiners love this microbe. However, they don't love it enough to write extensively about it in Oh's Manual. It has been made the main subject of several past paper questions:
Owing to this historical attention and to the weird predictability of the biannual appearance of these questions, the candidates have been performing better and better in their answers. In the early 2014 appearance of this microbe the examiners commented on how "Overall, candidates' knowledge of this topic was limited." On the other hand, of the late 2018 candidates, 97.1% passed the question and some bacteriology genius got a mark of 8.7.
An excellent resource for rapid revision is this LITFL page dedicated to pseudomembranous colitis. If one were in need of published material and were to limit oneself to only one source, this 2021 update statement from the IDSA would probably be it.
Incidentally, in 2016, Clostridium difficile was renamed Clostridioides difficile because the genus Clostridium was reserved for organisms genetically similar to C.butyricum, and C.difficile was more closely related to peptostreptococci. This excellent article from the Lancet outlines the nightmarish taxonomic work done by the CDC in this space.
A good solid review of the microbiology can be found in this 1988 article.
The risk factors for C.difficile infection are discussed here, in a NEJM article.
Another earlier (1998) article adds several other lesser-known risk factors:
To this, the college answers also add, on the basis of Leffler et al (2015):
For specific diagnostic investigations for C.difficile, you could do no better than the ASID guidelines (Cheng et al, 2011).
Clinical suspicion
Radiological diagnosis:
Biochemical diagnosis:
The diagnostic recommendations are:
Sigmoidoscopy (endoscopic diagnosis)
Not all pseudomembranous colitis is due to C.difficile infection.
Alternative pathogens include:
Markers of "severe" enterocolitis, which means the sort that ends up either killing you or results in a colectomy, are deliniated in this retrospective study. They are as follows:
To this list, another study adds more markers of severity:
Again, from ASID:
The abovementioned guidelines statement makes the following suggestions:
As it had become the specific topic of Question 1 from the second paper of 2018, this therapy has attracted more words here than its importance merits. On the stage of C.difficile management, it is a minor actor, with no speaking lines. The college called it a Faecal Microbial Transplant, even though the literature specifically refers to microbiota. The latter is a scientific term referring to a collection of microorganisms which inhabit a particular site or system.
In summary, the rationale is:
Guidelines (ISDA/SHEA, 2018) recommend faecal microbiota transplantation for patients with multiple recurrences of C.difficile infection who have failed appropriate antibiotic treatments
These suggest themselves on the basis of the college answer to Question 12 from the first paper of 2016
Johnson, Stuart, et al. "Clinical practice guideline by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA): 2021 focused update guidelines on management of Clostridioides difficile infection in adults." Clinical Infectious Diseases 73.5 (2021): e1029-e1044.
Chida, Natasha. "IDCM: Updates in C Diff: Rapid Review of the 2018 IDSA Guidelines."
Surawicz, Christina M., et al. "Guidelines for diagnosis, treatment, and prevention of Clostridium difficile infections." The American journal of gastroenterology 108.4 (2013): 478-498.
Lawrence, Steven J., et al. "Clostridium difficile in the intensive care unit: epidemiology, costs, and colonization pressure." Infection Control 28.02 (2007): 123-130.
Louie, Thomas J., et al. "Fidaxomicin versus vancomycin for Clostridium difficile infection." New England Journal of Medicine 364.5 (2011): 422-431.
Sailhamer, Elizabeth A., et al. "Fulminant Clostridium difficile colitis: patterns of care and predictors of mortality." Archives of surgery 144.5 (2009): 433-439.
Loo, Vivian G., et al. "Host and pathogen factors for Clostridium difficile infection and colonization." New England Journal of Medicine 365.18 (2011): 1693-1703.
Thomas, Claudia, Mark Stevenson, and Thomas V. Riley. "Antibiotics and hospital-acquired Clostridium difficile-associated diarrhoea: a systematic review." Journal of antimicrobial chemotherapy 51.6 (2003): 1339-1350.
Anand, Ajay, and Aaron E. Glatt. "Clostridium difficile infection associated with antineoplastic chemotherapy: a review." Clinical Infectious Diseases 17.1 (1993): 109-113.
Cunningham, R., et al. "Proton pump inhibitors as a risk factor for Clostridium difficile diarrhoea." Journal of Hospital Infection 54.3 (2003): 243-245.
Pépin, Jacques, Louis Valiquette, and Benoit Cossette. "Mortality attributable to nosocomial Clostridium difficile–associated disease during an epidemic caused by a hypervirulent strain in Quebec." Canadian Medical Association Journal 173.9 (2005): 1037-1042.
Cunney, Robert J., et al. "Clostridium difficile colitis associated with chronic renal failure." Nephrology Dialysis Transplantation 13.11 (1998): 2842-2846.
Surawicz, Christina M., et al. "Guidelines for diagnosis, treatment, and prevention of Clostridium difficile infections." The American journal of gastroenterology 108.4 (2013): 478-498.
Henrich, Timothy J., et al. "Clinical risk factors for severe Clostridium difficile–associated disease." Emerging infectious diseases 15.3 (2009): 415.
FujitaniMD, Shigeki, W. Lance GeorgeMD, and A. Rekha MurthyMD. "Comparison of clinical severity score indices for Clostridium difficile infection."Infection Control and Hospital Epidemiology 32.3 (2011): 220-228.
Bignardi, G. E. "Risk factors for Clostridium difficile infection." Journal of Hospital Infection 40.1 (1998): 1-15.
Bakken, Johan S., et al. "Treating Clostridium difficile infection with fecal microbiota transplantation." Clinical Gastroenterology and Hepatology 9.12 (2011): 1044-1049.
Lowy, Israel, et al. "Treatment with monoclonal antibodies against Clostridium difficile toxins." New England Journal of Medicine 362.3 (2010): 197.
Dallal, Ramsey M., et al. "Fulminant Clostridium difficile: an underappreciated and increasing cause of death and complications." Annals of surgery 235.3 (2002): 363.
Fekety, Robert. "Diagnosis and management of C. difficile-associated diarrhea and colitis." Am. J. Gastroenterol 92 (1997): 739-750.
Bartlett, John G. "Clostridium difficile: history of its role as an enteric pathogen and the current state of knowledge about the organism." Clinical infectious diseases 18.Supplement 4 (1994): S265-S272.
Rupnik, Maja, Mark H. Wilcox, and Dale N. Gerding. "Clostridium difficile infection: new developments in epidemiology and pathogenesis." Nature Reviews Microbiology 7.7 (2009): 526-536.
Hellickson, L. A., and K. L. Owens. "Cross-contamination of Clostridium difficile spores on bed linen during laundering." American Journal of Infection Control 35.5 (2007): E32-E33.
Johnson, Stuart, et al. "Prospective, controlled study of vinyl glove use to interrupt Clostridium difficile nosocomial transmission." The American journal of medicine 88.2 (1990): 137-140.
Lyerly, David M., Howard C. Krivan, and TRACY D. Wilkins. "Clostridium difficile: its disease and toxins." Clinical microbiology reviews 1.1 (1988): 1-18.
Valiquette, Louis, et al. "Impact of a reduction in the use of high-risk antibiotics on the course of an epidemic of Clostridium difficile-associated disease caused by the hypervirulent NAP1/027 strain." Clinical Infectious Diseases45.Supplement 2 (2007): S112-S121.
Vonberg, Râ€P., et al. "Infection control measures to limit the spread of Clostridium difficile." Clinical Microbiology and Infection 14.s5 (2008): 2-20.
Wullt, Marlene, Inga Odenholt, and Mats Walder. "Activity of three disinfectants and acidified nitrite against Clostridium difficile spores." Infection Control 24.10 (2003): 765-768.
Jernigan, John A., et al. "A randomized crossover study of disposable thermometers for prevention of Clostridium difficile and other nosocomial infections." Infection Control 19.07 (1998): 494-499.
Wilcox, M. H., et al. "Comparison of the effect of detergent versus hypochlorite cleaning on environmental contamination and incidence of Clostridium difficile infection." Journal of Hospital Infection 54.2 (2003): 109-114.
Hannonen, P., et al. "Reactive oligoarthritis associated with Clostridium difficile colitis." Scandinavian journal of rheumatology 18.1 (1989): 57-60.
Mallari, Alexander, Joyce Koh, and Emmanuel Gorospe. "Pseudomembranous Colitis from Non-Clostridial Infections: A Systematic Review." AMERICAN JOURNAL OF GASTROENTEROLOGY. Vol. 105. 75 VARICK ST, 9TH FLR, NEW YORK, NY 10013-1917 USA: NATURE PUBLISHING GROUP, 2010.- This is not available even as an abstract!
Janvier, Jack, Susan Kuhn, and Deirdre Church. "Not all pseudomembranous colitis is caused by Clostridium difficile." The Canadian Journal of Infectious Diseases & Medical Microbiology 19.3 (2008): 256.
Deshpande, Abhishek, et al. "Association between proton pump inhibitor therapy and Clostridium difficile infection in a meta-analysis." Clinical Gastroenterology and Hepatology 10.3 (2012): 225-233.
Wilcox, Mark H., et al. "Bezlotoxumab for Prevention of Recurrent Clostridium difficile Infection." New England Journal of Medicine 376.4 (2017): 305-317.
Leffler, Daniel A., and J. Thomas Lamont. "Clostridium difficile infection." New England Journal of Medicine 372.16 (2015): 1539-1548
McDonald, L. Clifford, et al. "Clinical practice guidelines for Clostridium difficile infection in adults and children: 2017 update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA)." Clinical infectious diseases 66.7 (2018): e1-e48.
Cheng, Allen C., et al. "Australasian Society for Infectious Diseases guidelines for the diagnosis and treatment of Clostridium difficile infection." Medical Journal of Australia 194.7 (2011): 353-358.