C lostridium difficile, an anaerobic, spore-forming, toxin-forming, gram-positive bacillus, has become the leading cause of health care-associated infectious diarrhea.1,2 The spectrum of C difficile infection (CDI) ranges from uncomplicated diarrhea to systemic toxic effects marked by sepsis and death.2 Fulminant cases, requiring colectomy, have a mortality rate up to 80%. 3 CDI is increasingly common and causes marked morbidity and mortality, prolonged hospital lengths of stay, and increased health care costs. Recent excess health care costs of hospital-onset CDI are estimated to be $5042 to $7179 per case, with a national annual estimate (limited to hospital-onset CDI) of $897 million to $1.3 billion. 4 The emergence of a hypervirulent epidemic strain and community-acquired disease in populations previously at low risk for CDI most likely will place an even greater burden on patients and the health care system.
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