CLOSTRIDIUM-DIFFICILE IN NOSOCOMIAL DIARRHEA

Identified as the cause of pseudomembranous colitis in 1978, Clostridium difficile has emerged as the major identifiable infectious cause of nosocomial diarrhea in the U.S. Nosocomial patient-to-patient transmission has been demonstrated by epidemiologic studies of hospital outbreaks combined with molecular typing of C. difficile strains. There is evidence that both contaminated environmental surfaces and hand carriage by personnel play a role in nosocomial transmission. Appropriate glove use and handwashing by hospital personnel, improved environmental decontamination, and restriction of high-fisk antibiotics may help to reduce the incidence of C difficile infection. However, such interventions have had variable success, and the optimal strategy to control this important nosocomial pathogen remains to be determined.