ABSTRACT
The culprit was thought to be a Staphylococcus species, but it was not until 1977 that Clostridium difficile was correctly identified as the cause with the demonstration of neutralization of stool filtrate-induced cytotoxicity by Clostridial anti-toxin. The production of cytotoxins A and B has been considered as the sine qua non of C. difficile infection (CDI). With the recognition of C. difficile as the pathogen responsible for pseudomembranous colitis, metronidazole and vancomycin were recognized as effective antimicrobial agents. Risk factors for CDI were also identified, and included antibiotic exposure, age, prior hospitalization, prior stay at a long-term care facility, abdominal surgery, immunosuppression, and chronic kidney disease. By far the most significant addition to the medical armamentarium for CDI since 2000 has been the use of fecal microbiota transplant. Indications for operative intervention for CDI include toxic megacolon, perforation, and septic shock with multiorgan failure unresponsive to medical therapy.
