Clostridium difficile in the ICU

Abstract

Clostridium difficile has become an increasingly common infectious agent in the healthcare setting. It is generally associated with antibiotic use and causes diarrhea as well as other complications such as pseudomembranous colitis (PMC) and toxic megacolon. This organism poses a serious threat to patients in the intensive care unit (ICU) as it increases hospital length of stay, morbidity, and mortality. Recurrence rates are typically higher in the ICU population as those patients usually have immunocompromised systems, more exposure to antibiotics and proton pump inhibitors, loss of normal nutritional balance, and alterations in their colonic flora. Emergence of more virulent and pathogenic strains has made combating the infection even more difficult. Newer therapies, chemotherapeutic agents, and vaccinations are on the horizon. However, the most effective treatments to date are ceasing the inciting agent, reduction in the use of proton pump inhibitors, and prevention of the disease. In this chapter, we will explore the risk factors, diagnosis, treatment, and prevention of C. difficile infections (CDI) in the ICU.