Clostridium difficile is the most common and important cause of healthcare infection, manifesting as a spectrum of disease ranging from mild diarrhea to toxic megacolon and pseudomembranous colitis. The causative organism, an anaerobic spore-forming bacillus, particularly affects people who have received antibiotics in the recent past; additional predispositions besides older age include immune suppressed states, gastric surgery, tube feeding, and chronic kidney disease. The geriatric population is vulnerable to complications and mortality. A variety of stool assays help in diagnosis. Prevention is the key, with infection control measures and meticulous hand hygiene important. Initial therapy includes use of metronidazole or vancomycin. Resistance and recurrence are handled differently. Newer drugs, monoclonal antibodies, and vaccines may offer better options in future.
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