In the past 5 years, C.difficile infection rates have doubled and the overall disease severity appears to be worsening.
Particularly concerning is the increase in community acquired infections in young patients without antibiotic or nosocomial exposure.
These epidemiologic changes are likely due to a new strain of C.difficile characterized by increased virulence and quinolone resistance.
Importantly, the efficacy of metronidazole has waned in recent years. In fact, > 25% of patients with moderate to severe disease do not respond to metronidazole therapy.
As a result, vancomycin has become first-line therapy for any critically ill patient with C.difficile.
References
Janka J, O'Grady NP. Clostridium difficile infection: current perspectives. Curr Opin Crit Care 2009;15:149-53.
