1. Background
Clostridium difficile infection (CDI) was first described in 1978
[1]. Since then CDI has emerged as a common complication of
antibiotic usage, and a leading cause of antibiotic-associated diarrhea,
especially in institutional settings [2e7]. CDI was the leading
cause of nosocomial infections in US community hospitals in 2010
[8]. The severity of C. difficile infection ranges from mild cases,
requiring little more than the discontinuation of antibiotics and
supportive measures, to severe illness with intractable diarrhea,
fever, leukocytosis, sepsis syndrome, toxic megacolon, and death.
Fatality rates as high as 58% have been reported in case series of
critically ill patients with CDI [9e11] .