Although Clostridium difficile has been recognised as the cause of antibiotic-associated PMC and diarrhoea for almost 30 years, especially in elderly patients undergoing antibiotic treatment, it is only recently that it has been acknowledged as a major hospital pathogen. It is usually acquired exogenously – in the form of resistant spores – from the contaminated hospital environment, after the normal colonisation resistance afforded by the normal colonic microflora has been disturbed. Production of at least one of two toxins causes damage to the colon wall and subsequent symptoms. Recent recognition of a hyper-virulent type that produces enhanced levels of toxins and is resistant to fluoroquinolone antibiotics is causing outbreaks of serious disease in North America and several European countries – but not yet in Scotland. Current treatment is with metronidazole or vancomycin but relapse is common. Removal of the spores – which are resistant to alcohol and most disinfectants – is crucial to controlling infection.
