Clostridium difficile-associated disease in patients with chronic kidney disease

Abstract

As a result of radical changes in the epidemiology in the last decade Clostridium difficile becomes the most important cause of healthcare-associated diarrhea. Main risk factors for developing Clostridium difficile-associated disease include antibiotic exposure, older age, gastric acid suppression therapy, immunosuppression and prolonged hospitalization. Patients with chronic kidney disease, especially undergoing dialysis, represent a vulnerable group of patients at increased risk of disease and associated morbidities. The clinical presentation of Clostridium difficile infection spans the spectrum from asymptomatic colonization to pseudomembranous colitis, sepsis shock and death. Metronidazole and vancomycin remain the leading antibiotics in the treatment. For patients who fail to respond to antibiotics with deteriorating hemodynamics, impaired respiratory function, severe ileus or toxic megacolon surgical intervention may be required. Judicious use of antibiotics and adherence to infection control measures are vital to reduce the incidence of this serious condition.