Introduction to Clostridioides difficile infection

Clostridioides difficile (formerly known as Clostridium difficile) causes the most severe cases of antibiotic-associated diarrhoea. Infection can occur at any time during, or some months after, a course of antibiotics.

C. difficile is most commonly associated with or after antibiotic use. Antibiotics with the greatest risk of causing C. difficile infection includeMiller 2023Slimings 2021:

• broad-spectrum cephalosporins
• carbapenems
• clindamycin
• fluoroquinolones
• penicillin+beta-lactamase inhibitors.

Other risk factors associated with C. difficile infection include:

• hospitalisation
• previous C. difficile infection
• use of proton pump inhibitors (PPIs)
• cancer chemotherapy.

However, in studies of risk factors, it is difficult to dissociate these risk factors from antibiotic use and other potential confoundersEze 2017. Community-acquired C. difficile infection can also occur in people without risk factors.

Outbreaks of hypervirulent strains (including PCR ribotype 027 and 078) have been reported worldwide, including in Australia. Some outbreaks of these hypervirulent strains have been associated with use of broad-spectrum quinolones (eg moxifloxacin).

Antimicrobial stewardship and infection control measures (additional contact precautions) in hospitals have reduced nosocomial spread, particularly in outbreaks.