UMEM Educational Pearls

New Perspectives on Clostridium difficile

  • In the past 5 years, C.difficile infection rates have doubled and the overall disease severity appears to be worsening.
  • Particularly concerning is the increase in community acquired infections in young patients without antibiotic or nosocomial exposure.
  • These epidemiologic changes are likely due to a new strain of C.difficile characterized by increased virulence and quinolone resistance.
  • Importantly, the efficacy of metronidazole has waned in recent years.  In fact, > 25% of patients with moderate to severe disease do not respond to metronidazole therapy.
  • As a result, vancomycin has become first-line therapy for any critically ill patient with C.difficile.


Janka J, O'Grady NP. Clostridium difficile infection: current perspectives. Curr Opin Crit Care 2009;15:149-53.