There are two kinds of diarrhea in medicine: the kind that passes, and the kind that makes the whole ward smell like a biohazard zone 🚨. If you’ve worked a week in inpatient medicine, you already know which one Clostridium difficile falls into.
At Sheikh Khalifa Hospital, I’ve seen patients from Awaran, Chaghi, and even Washuk, brought in with a history of recent antibiotics and a new onset of explosive diarrhea. Sometimes the chart just screams “C. diff” before the PCR even comes back.
And if you’re prepping for exams (or rounding with someone like Dr. Basit Khan, who questions harder than most MRCP stations), you better have a sharp mnemonic ready.
🧠 Mnemonic: ABCDEF — Risk Factors for Clostridium difficile
| Letter | Risk Factor | Explanation |
|---|---|---|
| A | Antibiotic use | Especially clindamycin, cephalosporins, fluoroquinolones — gut flora gets nuked. 💣 |
| B | Bowel surgery | Post-op patients have disrupted microbiota and motility changes. 🏥🔪 |
| C | Chemotherapy | Immunosuppression + mucosal damage = perfect C. diff storm. ☢️ |
| D | Diabetes mellitus | Poor gut motility, altered immunity, and frequent antibiotics. 🍬💉 |
| E | Elderly age | >65 years = decreased immune defense, polypharmacy, hospital exposure. 👴 |
| F | Fecal transplant needed | The Hail Mary for recurrent cases. (The name sounds gross, but it’s 💯 effective!) 💩➡️💩 |
🚽 A Real Case from the Quetta Wards
A few weeks ago, a sweet 72-year-old retired schoolteacher from Panjgur was admitted under our unit. She had just finished a 10-day course of ciprofloxacin for a UTI, and now came in with fever, abdominal cramps, and around 12 episodes of watery diarrhea per day. You could practically hear Dr. Behroz Rahim mutter, “Here comes the C. diff.”
Stool toxin was positive, WBC count was high, creatinine had bumped. Classic Clostridium difficile colitis.
We held antibiotics, started oral vancomycin, and initiated isolation. Her recovery was slow but steady — and luckily, no need for fecal transplant (though we did keep the gastro team on speed dial 👨⚕️💩).
💡 Clinical Pearls
- Always think C. diff in any hospitalized patient with new-onset diarrhea — especially post-antibiotics.Start with oral vancomycin or fidaxomicin. Metronidazole is now a second-string player 🧴.
- For recurrent cases, fecal microbiota transplant (FMT) is gold-standard. Yes, it works — and no, don’t ask where the sample comes from if you’re eating lunch.
- Watch for toxic megacolon — particularly in older, immunocompromised patients. CT abdomen is your friend.
- Infection control is crucial. Gloves, gowns, and that one overzealous nurse who douses everything in Dettol. 🧼🧤
Here’s a quick summary for C. Difficile Risk Factors:
| Mnemonic | Risk Factor | Why It Matters |
|---|---|---|
| A | Antibiotic use | Destroys normal gut flora, allows C. diff overgrowth |
| B | Bowel surgery | Alters motility, mucosal defenses disrupted |
| C | Chemotherapy | Immunosuppression and mucosal injury |
| D | Diabetes mellitus | Increased susceptibility, common antibiotic use |
| E | Elderly age | Frailty + multiple comorbidities = higher risk |
| F | Fecal transplant need | Used in recurrent or refractory cases |
That’s all for today, folks! We hope that you find this blog post useful in your studies/clinical practice. 🙂
Happy learning!
Authored by :
Dr. Aurangzaib Qambrani
MBBS | PLAB | MRCP (UK)
Sheikh Khalifa Bin Zayed Hospital, Quetta
Discover more from Bibliobazar Digi Books
Subscribe to get the latest posts sent to your email.
