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Clostridium difficile



- Discussion:
    - pseudomembranous colitis & diarrhea are complications of antimicrobial therapy that have been recognized for many years;
    - over past decade many cases of these disorders have been found to be attributable to toxin-producing strains of C. difficile;
    - although clindamycin continues to be linked to diarrhea & pseudo-membranous colitis, beta-lactam antibiotics have overtaken it as the predominant causative factor, with 70% of cases in one large series being associated w/ cephalosporins;
    - syndrome occurs with nearly all antibiotics (except vancomycin and parenteral aminoglycosides), and small number of cases have been linked to antineoplastic agents;

- Treatment:
    - in severe cases or in those that do not respond to the cessation of inciting antibiotic, specific antimicrobial therapy against C. difficile has proved useful, originally with oral vancomycin, more recently w/ metronidazole, & in small number of cases w/ bacitracin



Clostridium difficile infection in orthopaedic patients.

Epidemics of Diarrhea Caused by a Clindamycin-Resistant Strain of Clostridium difficile in Four Hospitals

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