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المستخلص
A nosocomial, or hospital-acquired, infection is a new infection that develops in a patient during hospitalization. It is usually defined as an infection that is identified at least 48 to 72 hours following admission but not clinically apparent, at admission. With recent changes in health care delivery, the concept of ”nosocomial infections” has sometimes been expanded to include other ”health care–associated infections,” including infections acquired in institutions other than acute-care facilities (e.g. nursing homes); infections acquired during hospitalization but not identified until after discharge; and infections acquired through outpatient care such as day surgery, dialysis.
All groups of antibiotics may cause AAD, but those with broad-spectrum coverage in particular cephalosporins, extended-coverage penicillins, and clindamycin are the most common causitive antibiotics. C difficile diarrhea is largely a nosocomial disease and it is the most frequent cause of diarrhea in hospitalized patients. Its occurrence in the outpatient setting other than in patients confined to nursing homes is much less common.
Nearly 25% of antibiotic associated diarrhoeas (AAD) is caused by Clostridium difficile, making it the commonest identified and treatable pathogen. Other pathogens implicated infrequently include Clostridium perfringens, Staphylococcus aureus, Klebsiella oxytoca, Candida spp. and Salmonella spp.
Clostridium difficile is the most important cause of nosocomial diarrhea in adults. Clinical presentation of CDAD varies from diarrhea without colitis to colitis with or without pseudomembranes, and more rarely as fulminant colitis. Mild cases may present with only crampy .