Eight pearls in Clostridium difficile infection clinical management

Background

The clinical appearance of Clostridium difficile infection (CDI) has changed in the last three years in Romania, due to the emergence of the hypervirulent ribotype 027 of Clostridium difficile. It is a risk for less than optimal management of this disease, especially the severe CDI with rapidly fatal outcome.

Case report

An overview of our 2011-2013 experience retrieved several common mistakes of CDI management (e.g. almost 51% of CDI patients received combined therapy with metronidazole and vancomycin, less than 25% colectomies for cases with toxic megacolon, several secondary cases in patients hospitalized in the same room with a non-diagnosed CDI patient). We have chosen to present eight “pearls” that summarize better the difficulties of CDI clinical and microbiological diagnosis, medical and surgical treatment and control infection measures; each of these ideas is exemplified with situations from our practical experience.

Conclusion

Several common mistakes were identified in the management of CDI, even in a tertiary hospital specialized in infectious diseases. Medical continuous education based on reliable information its needed for improvement of CDI management.