Clostridioides (Clostridium) difficile

This chapter evaluates Clostridioides (Clostridium) difficile, a gram-positive anaerobic spore-forming bacillus found in colon flora. When C. difficile is induced to produce exotoxins (A/B) symptomatic disease (i.e., diarrhea/colitis) follows. The clinical spectrum of infection ranges from watery toxigenic diarrhea to invasive transmural colitis. C. difficile diarrhea is primarily an infection of adults. The chapter then considers the differences in pathophysiology and severity between C. difficile diarrhea and C. difficile colitis, which may be acquired in the community or hospital. Because with C. difficile diarrhea the process is intraluminal and limited to colon mucosa, the aim of therapy is to deliver high intraluminal concentrations of effective anti-C. difficile drugs. With C. difficile colitis, the pharmacokinetic aim of therapy is to achieve therapeutic colon wall levels.