Prevention of C. difficile infection is challenging. Established guidelines should be followed to minimize exposure to the pathogen, particularly in debilitated patients. Preventive measures include the judicious use of antibiotics, hand washing between patient contacts, rapid detection of C. difficile by immunoassays for toxins A and B, isolation of patients who have C. difficile –associated diarrhea, use of precautions when in contact with the patient and surrounding environment, proper disinfection of objects (., sodium hypochlorite, alkaline glutaraldehyde, ethylene oxide), education of staff members, and use of continued precautions until the diarrhea ceases. 1 , 6
Endoscopy is an adjunctive test that should be considered when a rapid diagnosis is required, the patient has an ileus and stool is unable to be obtained, and other colonic diseases are being considered, such as inflammatory bowel disease. 6 Sigmoidoscopy or colonoscopy is required to visualize the colonic mucosa to establish the diagnosis of pseudomembranous colitis. Pseudomembranes are 2- to 10-mm raised yellow plaques that may have areas of normal mucosa or may coalesce to form larger plaques. Flexible sigmoidoscopy can miss up to 10% of cases of pseudomembranous colitis. If pseudomembranes are not visualized on endoscopy, then the findings of C. difficile colitis may be nonspecific and biopsies should be taken. Endoscopy should be used judiciously in patients with fulminant colitis given the incumbent risk of perforation. 2
Human infection occurs through ingestion (via the mouth) and if the bacterium survives acid and bile on its passage into the bowel, it may be eradicated by the normal bowel flora. However, if the bowel flora is suppressed because of concomitant use of antibiotics, or if the bowel flora has a deficiency of Bacteroides bacteria(21),CD can colonize the flora and remain with the patient - generally for life. In some individuals it seems that antibiotics are not required for colonization to take place. This may be perhaps due to inadequate defence of the naturally occurring flora within the bowel. CD is a very hardy organism probably because it contains spores. Spores are unable to be eradicated by any known antibiotic. One way of eradicating spores is to autoclave the spore-containing specimen using a sterilizer. Of course a patient cannot be placed in a sterilizer. However some bacteria appear to be capable of inhibiting the growth of CD and even eradicating the spores and this characteristic has been used to develop 'bacteriotherapy' which will be described below.