Myunghan Choi and Melvin Hector
Clostridium difficile (C. difficile) is a formidable pathogen causing various symptoms ranging from asymptomatic colonization to fulminant colitis among the elderly. C. difficile associated mortality rate has quadrupled in the last five years. A recent 10 year-literature review was conducted to determine a practical approach for elderly patients with C. difficile infection (CDI) in post-acute settings (PAS). Risk factors for CDI include antibiotic use, age over 65 years old, a prior history of CDI, institutionalization, and use of protein pump inhibitors (PPIs) or H-2 blockers. Diagnostic testing to confirm CDI can be challenging because of the relatively low sensitivity of most commercially available tests. Strategies for the cost-effective management and prevention of CDI include surveillance of at-risk patients with appropriate testing, contact precaution of suspected patients, discontinuation of PPIs or H-2 blockers in selected patients, use of probiotics, and antibiotic stewardship. Treatment and management should be individualized based on risk factors, symptom severity, comorbidities, and history of prior CDI.
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