dificile

Clostridioides difficile, commonly abbreviated C. difficile, is a Gram-positive, anaerobic, spore-forming bacillus in the family Clostridiaceae. It normally resides in the human gut in small numbers but can cause disease when the intestinal microbiota is disrupted, typically after antibiotic exposure. The organism forms hardy spores that persist in the environment and spread via the fecal-oral route, especially in healthcare settings. The species epithet difficult? It is actually difficille in Latin, meaning difficult, a reflection of the pathogen’s clinical challenge.

Most clinically significant infections produce toxins TcdA and TcdB, which damage intestinal cells and trigger inflammation. Some strains also produce a binary toxin (CDT). The disease spectrum ranges from mild diarrhea to severe colitis and, in rare cases, life-threatening pseudomembranous colitis.

Diagnosis relies on detecting C. difficile or its toxins in stool, often using a combination of screening tests such as glutamate dehydrogenase (GDH), toxin immunoassays, and molecular tests for toxin genes. A clinical history of recent antibiotic exposure supports testing and interpretation.

Treatment depends on severity. First-line options for initial episodes are oral vancomycin or fidaxomicin; metronidazole is no longer the preferred option in most guidelines due to lower efficacy. Recurrent infection is common; management may include fidaxomicin retreatment or fecal microbiota transplantation after standard therapy, along with antibiotic de-escalation when possible. Prevention emphasizes antibiotic stewardship, contact precautions, hand hygiene with soap and water, and environmental cleaning with sporicidal agents.

Epidemiology and history: C. difficile was first described in 1935 and recognized as a pathogen in the 1970s. Hypervirulent strains (for example ribotype 027/NAP1) have been linked to more severe outbreaks. It remains a major cause of healthcare-associated diarrhea worldwide.