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IR Poxton
Journal Issue: 
Volume 36: Issue 3: 2006




Although Clostridium  difficile has  been  recognised  as  the  cause  of antibiotic-associated  PMC  and  diarrhoea  for  almost  30  years, especially  in  elderly patients  undergoing  antibiotic  treatment,  it  is  only  recently  that  it  has  been acknowledged as a major hospital pathogen.  It is usually acquired exogenously – in the  form  of  resistant  spores  –  from  the  contaminated  hospital  environment, after the  normal  colonisation  resistance  afforded  by  the  normal  colonic  microflora  has been disturbed. Production of at least one of two toxins causes damage to the colon wall  and  subsequent  symptoms.  Recent  recognition  of  a  hyper-virulent  type  that produces enhanced levels of toxins and is resistant to fluoroquinolone antibiotics is causing  outbreaks  of  serious  disease  in  North  America  and  several  European countries  –  but  not  yet  in  Scotland.  Current  treatment  is  with  metronidazole  or vancomycin but relapse is common.  Removal of the spores – which are resistant to alcohol and most disinfectants – is crucial to controlling infection.