Assessment and management of Clostridium difficile infection

Patients were tested for a possible CDI when a daily excessive watery diarrhoea was observed in the postoperative admission period after ileostomy closure. In our centre, diarrhoea less than 10 times a day is considered natural after ileostomy closure. Patients with less prominent diarrhoea were also tested for CDI if they experienced fever, abdominal distention, ileus, or any other combination of symptoms that are not typical of low anterior resection syndrome. The two diagnostic modalities used for CDI were direct real-time PCR and enzyme-linked fluorescent assay for detecting toxin A and B in anaerobic cultures.

Oral metronidazole (500 mg three times daily) was the treatment of choice for patients diagnosed with CDI. Although oral vancomycin is the first-choice treatment recommended by the guidelines of Infectious Diseases Society of America¹⁸, oral metronidazole is recommended first choice in South Korea for cost-related reasons. However, oral vancomycin is used in refractory CDI patients who show a poor response to metronidazole.