Editing Infections: Clostridium Difficile Infection

== Epidemiology ==

* Incidence is increasing with a preponderance of the NAP1 hypervirulent strain of C. difficile found in recent epidemics.
** The NAP1 strain is more likely to cause severe and fulminant colitis, characterized by marked leukocytosis, renal failure, hemodynamic instability, and toxic megacolon.
** It is believed the NAP1 strain arose due to the widespread use of fluoroquinolone antibiotics.

== Management ==

* '''Options:'''
*# '''Oral vancomycin (more effective)'''
*# '''Oral metronidazole'''
* '''Neither I.V. vancomycin nor I.V. metronidazole have been found to be more effective than the oral form of the medications for treatment of CDI.'''
* '''No role for fluoroquinolones.'''
* Metronidazole should be avoided in patients on warfarin
** Metronidazole interferes with warfarin metabolism
* '''Worsening diarrhea, fever, and leukocytosis despite appropriate antibiotics is an absolute indication for surgical consultation.'''
** '''Subtotal colectomy with end ileostomy is the procedure of choice for fulminant CD colitis nonresponsive to medications and has been documented to result in improved survival.'''

== Questions ==

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== Answers ==

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== References ==

* Wein AJ, Kavoussi LR, Partin AW, Peters CA (eds): CAMPBELL-WALSH UROLOGY, ed 11. Philadelphia, Elsevier, 2015, vol 2, chap 12