Nosocomial diarrhoea due to Clostridium difficile

Purpose of review The purpose of this review is to summarize recent developments in the diagnosis, epidemiology, treatment and prevention of nosocomial diarrhoea due to Clostridium difficile. Recent findings Twenty-five years after its discovery, the diagnosis of C. difficile-associated diarrhoea is still problematic with laboratories trying to reconcile the time and expense of the diagnostic process. Newer molecular techniques may offer hope. With the introduction of new antibiotics into clinical practice, confusion has arisen about the risk they pose for C. difficile-associated diarrhoea. Strains of C. difficile that fail to produce an active toxin A are an emerging problem and good molecular epidemiology is required to determine whether highly infectious clones exist. Little progress has been made in the treatment of recurrent C. difficile-associated diarrhoea; however, the development of a vaccine is imminent. More effort is being made to rid the hospital environment of C. difficile through infection-control procedures or changes in antibiotic-prescribing policies. Summary C. difficile continues to be a major nosocomial infection in many health-care institutions throughout the world. Strategies that reduce exposure to the organism or to antibiotics will have an impact on rates of C. difficile-associated diarrhoea.