Clostridium difficile-associated disease. Epidemiology, morbidity, mortality, and methods for control.

The incidence of Clostridium difficile-associated disease (CDAD) has increased significantly since it was first recognized in the 1970s. CDAD can occur in the outpatient setting, but most cases are nosocomial. The symptoms range from mild diarrhea to severe colitis, and although diarrhea is often considered a nuisance, CDAD is associated with significant morbidity, mortality, and human costs. Control of CDAD is a challenge for many healthcare facilities. In addition to limiting the transmission of C difficile by such measures as patient isolation, careful hand-washing, environmental disinfection, and barrier precautions, many institutions are focusing on antibiotic manipulation and biotherapy. Among the suggestions for antibiotic manipulation are decreased overall use of antibiotics and use of lower-risk antibiotics such as penicillins instead of high-risk antibiotics such as clindamycin and cephalosporins.