• Clostridioides difficile
• microbiome
• recurrence
• recurrent

• Humans
• Clostridium Infections/therapy
• Clostridium Infections/drug therapy
• Fecal Microbiota Transplantation
• Clostridioides difficile/isolation & purification
• United States
• Gastrointestinal Microbiome/drug effects
• United States Food and Drug Administration
• Quality of Life
• Recurrence
• Anti-Bacterial Agents/therapeutic use
• Anti-Bacterial Agents/administration & dosage
• Microbiota/drug effects
• Drug Approval

• Clostridioides difficile
• malignancy
• molecular epidemiology
• ribotyping

Gastrointestinal complications are common in patients undergoing various forms of cancer treatments, including chemotherapy, radiation therapy, and molecular-targeted therapies. Surgical complications of oncologic therapies can occur in the upper gastrointestinal tract, small bowel, colon, and rectum. The mechanisms of action of these therapies are different. Chemotherapy includes cytotoxic drugs, which block the activity of cancer cells by targeting intracellular DNA, RNA, or proteins. Gastrointestinal symptoms are very common during chemotherapy, due to a direct effect on the intestinal mucosa resulting in edema, inflammation, ulceration, and stricture. Serious adverse events have been described as complications of molecular targeted therapies, including bowel perforation, bleeding, and pneumatosis intestinalis, which may require surgical evaluation. Radiotherapy is a local anti-cancer therapy, which uses ionizing radiation to cause inhibition of cell division and ultimately lead to cell death. Complications related to radiotherapy can be both acute and chronic. Ablative therapies, including radiofrequency, laser, microwave, cryoablation, and chemical ablation with acetic acid or ethanol, can cause thermal or chemical injuries to the nearby structures. Treatment of the different gastrointestinal complications should be tailored to the individual patient and based on the underlying pathophysiology of the complication. Furthermore, it is important to know the stage and prognosis of the disease, and a multidisciplinary approach is necessary to personalize the surgical treatment. The purpose of this narrative review is to describe complications related to different oncologic therapies that may require surgical interventions.

• Cancer
• Chemotherapy
• Radiotherapy
• Complications
• Bowel perforation
• Gastrointestinal bleeding

• Anaerobes
• Cancer
• Clostridioides difficile
• Metronidazole
• Microbiome

• Clostridioides difficile
• SARS-CoV-2
• outcomes

• bone marrow transplantation
• immunosuppression
• risk factors
• typhlitis

• Adult
• Anti-Bacterial Agents
• Bone Marrow
• Bone Marrow Transplantation/adverse effects
• Child
• Hematopoietic Stem Cell Transplantation/adverse effects
• Humans
• Male
• Mucositis/etiology
• Retrospective Studies
• Typhlitis/etiology
• Typhlitis/therapy

• Clostridioides difficile
• Crohn’s disease
• inflammatory bowel disease
• ulcerative colitis

Background: Cancer patients are at increased risk of recurrent Clostridioides difficile infection (rCDI) due to malignancy itself, cancer therapy, and frequent antibiotic use and have a lower response rate to standard oral antibiotics. There are limited data on the safety and efficacy of fecal microbiota transplantation (FMT) for treating rCDI in cancer patients. We aim to describe our experience of using FMT to treat rCDI at a tertiary cancer center.

Methods: We conducted a retrospective study of cancer patients who underwent FMT for rCDI at The University of Texas MD Anderson Cancer Center from June 2017 through January 2020. Baseline clinical data and risk factors related to rCDI and FMT were evaluated and compared between cancer types and between cases with remission and recurrence.

Results: A total of 19 patients were studied: 12 with solid malignancies and 7 with hematologic malignancies. Most patients had stage IV cancer, and 21% of patients were in cancer remission. On average, patients had 2 episodes of CDI and received 3 courses of antibiotics within 1 year before FMT. 84% of patients with rCDI responded to FMT. Compared with patients who had CDI remission following FMT, non-remission cases were more likely to have received antibiotics following FMT. There were no serious adverse events or mortality within 30 days associated with FMT.

Conclusions: FMT is safe, well-tolerated, and efficacious in treating rCDI in selected cancer patients. However, additional antibiotic use for complications from chemotherapy or immunosuppression negatively affected the efficacy of FMT in this population with advanced cancer.

• FMT
• Recurrent Clostridioides difficile infection
• cancer
• fecal microbiota transplantation
• malignancy

Diarrhea post-antibiotic use is primarily attributed to mucosal lesions induced by Clostridium (Clostridioides) difficile (C. difficile) infection (CDI). Cancer patients undergoing chemotherapy might have a higher risk of CDI even when prior antibiotics are not used. Thus far, the relationship between lung cancer chemotherapy and the incidence of diarrhea remains unclear. This prospective multicenter study aimed to determine the incidence of CDI in lung cancer patients undergoing chemotherapy.

The presence of C. difficile and its toxins was investigated in lung cancer patients experiencing diarrhea during chemotherapy including paclitaxel (PTX), nanoparticle albumin-bound paclitaxel (nab-PTX), docetaxel (DOC), tegafur-gimeracil-oteracil (S-1), or irinotecan (CPT-11). If grade 2 or higher diarrhea occurred, then a stool culture was performed to detect anaerobic organisms and C. difficile toxins A and B. Additional data were collected through patient interviews and medical chart review.

A total of 263 consecutive patients were enrolled in the study; grade 2 or higher diarrhea was observed in 22 patients (8.4%); CDI was confirmed in five of them (1.9%). The incidence of CDI was 22.7% of all diarrhea cases, and 50% of patients treated with PTX were CDI positive; the incidence of CDI was significantly higher in patients treated with PTX (P=0.039). Among the diarrhea cases, CDI patients had significantly worse ECOG performance status (PS) (P=0.043) and a significantly higher neutrophil count (P=0.028) than non-CDI patients. No CDI patients received antibiotics before cancer chemotherapy.

Although diarrhea does not always affect a large portion of lung cancer chemotherapy recipients, clinicians should consider the possibility of CDI occurrence in lung cancer patients receiving chemotherapy, particularly PTX, without prior antibiotic exposure.

• Clostridium (Clostridioides) difficile
• chemotherapy
• diarrhea
• lung cancer
• prospective multicenter study

• calicivirus
• cancer
• chronic diarrhea
• diarrhea
• gastroenteritis
• hematopoietic stem cell transplant
• immunocompromised
• norovirus

• P01 AI057788 NIAID NIH HHS
• P30 DK056338 NIDDK NIH HHS
• NIH/NIAID
• Baylor College of Medicine’s Precision Medicine and Population Health initiative
• University of Texas MD Anderson Cancer Center

• Clostridioides difficile
• FMT
• Fecal microbiota transplantation

To evaluate the safety of antimotility agents (AAs) in a population of patients with hematologic malignancies and concurrent Clostridioides difficile infection (CDI) and to describe the outcomes of AA use in a hospital setting.

We used the electronic health record to identify patients who were hospitalized in the adult malignant hematology service who had 1 or more toxin-positive C difficile stool assay between April 1, 2012, and September 21, 2017. We reviewed medical charts to obtain information on the use of AAs and any subsequent gastrointestinal complications.

There were 339 patients who were stool toxin positive for CDI during the study period. Of those, 94 patients (27%) were prescribed AAs within 14 days of CDI diagnosis. All patients received CDI antimicrobial therapy within the first 24 hours. There were 2 adverse gastrointestinal events in the group that received AAs and 6 in the group that did not receive AAs. The risk of adverse events did not differ between patients who received AAs and those who did not (adjusted odds ratio, 0.36; 95% CI, 0.06 to 2.10). The mean age of the full cohort was 52.7±15.5 years, and the mean length of stay was 26.7±22.6 days. Early AA use (<48 hours of diagnosis) was not associated with increased adverse effects.

There was no increase in the incidence of gastrointestinal events in the arm that used AAs compared with the control arm. The evidence suggests that for patients with hematologic malignancies and CDI, the addition of AAs to appropriate antimicrobial therapy poses no additional risk.

• AA, antimotility agent
• CDI, Clostridioides difficile infection
• EHR, electronic health record
• HSCT, hematopoietic stem cell transplant
• ICD-10, International Statistical Classification of Diseases, Tenth Revision
• ICD-9, International Classification of Diseases, Ninth Revision
• IDSA, Infectious Disease Society of America
• RR, relative risk
• UCSF, University of California, San Francisco

• K24 HL141354 NHLBI NIH HHS

• Acute myeloid leukemia (AML)
• differentiation syndrome
• neutropenic fever
• risk stratification

Clostridioides difficile infection (CDI) is the most common cause of hospital-acquired diarrhea. There is little available data regarding risk factors of CDI for patients who undergo cardiac surgery. The study evaluated the course of CDI in patients after cardiac surgery.

Of 6,198 patients studied, 70 (1.1%) developed CDI. The control group consisted of 73 patients in whom CDI was excluded. Perioperative data and clinical outcomes were analyzed.

Patients with CDI were significantly older in comparison to the control group (median age 73.0 vs 67.0, P = 0.005) and more frequently received proton pump inhibitors, statins, β-blockers and acetylsalicylic acid before surgery (P = 0.008, P = 0.012, P = 0.004, and P = 0.001, respectively). In addition, the presence of atherosclerosis, coronary disease and history of malignant neoplasms correlated positively with the development of CDI (P = 0.012, P = 0.036 and P = 0.05, respectively). There were no differences in the type or timing of surgery, aortic cross-clamp and cardiopulmonary bypass time, volume of postoperative drainage and administration of blood products between the studied groups. Relapse was more common among overweight patients with high postoperative plasma glucose or patients with higher C-reactive protein during the first episode of CDI, as well as those with a history of coronary disease or diabetes mellitus (P = 0.005, P = 0.030, P = 0.009, P = 0.049, and P = 0.025, respectively). Fifteen patients died (21.4%) from the CDI group and 7 (9.6%) from the control group (P = 0.050). Emergent procedures, prolonged stay in the intensive care unit, longer mechanical ventilation and high white blood cell count during the diarrhea were associated with higher mortality among patients with CDI (P = 0.05, P = 0.041, P = 0.004 and P = 0.007, respectively).

The study did not reveal any specific cardiac surgery-related risk factors for development of CDI.

• Cardiac surgery
• Clostridioides difficile infection
• Risk factors

• Clostridioides difficile infection
• Hematologic malignancy
• Hematopoietic stem cell transplantation
• Oral vancomycin prophylaxis

• Clostridium difficile
• Hematologic diseases
• Risk factors
• Tertiary care centers

• Clostridioides (Clostridium) difficile
• Graft-versus-host disease
• Hematologic malignancy
• Stem cell transplant

• Clostridioides difficile
• Clostridium Infections/therapy
• Drug Therapy
• Fecal Microbiota Transplantation
• Feces/microbiology
• Graft vs Host Disease/complications
• Graft vs Host Disease/microbiology
• Hematologic Neoplasms/complications
• Hematologic Neoplasms/microbiology
• Humans
• Microbiota
• Randomized Controlled Trials as Topic
• Risk Factors
• Stem Cell Transplantation/adverse effects
• Treatment Outcome

• DP2 AI144244 NIAID NIH HHS
• R01 HS025713 AHRQ HHS
• R01 HS026226 AHRQ HHS
• U01 AI125053 NIAID NIH HHS

• Antibiotics
• Clostridioides difficile
• Infection
• Leukemia

• immunosuppression
• infection control
• infectious disease
• prevention

• Ambulatory Care/standards
• Anti-Bacterial Agents/therapeutic use
• Antifungal Agents/therapeutic use
• Antimicrobial Stewardship
• Cancer Care Facilities/standards
• Catheter-Related Infections/prevention & control
• Cross Infection/microbiology
• Cross Infection/prevention & control
• Diet
• Drug Resistance, Multiple, Bacterial
• Food Safety
• Hand Disinfection
• Humans
• Immunocompromised Host
• Infection Control/methods
• Infection Control/standards
• Neoplasms/immunology
• Patient Isolation
• United States
• Virus Diseases/prevention & control

• Clostridium difficile infection
• Epidemiology
• Haematology patients
• Oncology patients
• Outcome

• Anticancer-drugs
• C. difficile infection
• Clostridium difficile
• Lung cancer

Clostridium difficile infection (CDI) is the leading cause of hospital-associated gastrointestinal illness. Previous studies reported that patients with active malignancy are at high risk for CDIs, and yet they are still classified as nonsevere CDI and initially treated with metronidazole. Our aim is to investigate the need for the escalation of antibiotic therapy in patients with CDI and active cancer treated with oral metronidazole versus oral vancomycin.

This is a retrospective study of adult patients admitted with CDI and any underlying active malignancy at Beaumont Hospital, Royal Oak, Michigan, from January 2008 to December 2014. Inclusion criteria included age > 18 years old, polymerase chain reaction- (PCR-) proven CDI, and active malignancy.

197 patients were included in the final analysis. 44.8% of the metronidazole group required escalation of therapy compared to 15.2% in the vancomycin group (p value = 0.001). 29.8% of the combination group (metronidazole and vancomycin) underwent deescalation of antibiotics, which was significantly higher compared to 2.2% of patients in the vancomycin group (p value < 0.001).

Our results support the initial use of vancomycin or a combination (metronidazole and vancomycin) versus metronidazole in patients with CDI and active malignancy.

• clostridium difficile
• clostridioides difficile
• guidelines
• cdi
• cdad

• Adult
• Child
• Clostridioides difficile/drug effects
• Clostridium Infections/drug therapy
• Diarrhea/microbiology
• Humans
• Infectious Disease Medicine
• Retrospective Studies
• Societies
• Societies, Medical

• I01 BX002449 BLRD VA

• Abdominal complications
• Cancer
• Chemotherapy
• Colitis
• Diarrhea
• Infection

• Adult
• Communicable Diseases/therapy
• Gastrointestinal Diseases/diagnosis
• Gastrointestinal Diseases/etiology
• Gastrointestinal Diseases/therapy
• Germany
• Hematology/organization & administration
• Hematology/standards
• Humans
• Medical Oncology/organization & administration
• Medical Oncology/standards
• Neoplasms/complications
• Neoplasms/diagnosis
• Neoplasms/therapy
• Practice Guidelines as Topic
• Societies, Medical/organization & administration
• Societies, Medical/standards

• no number AGIHO

• Adult
• Aged
• Aged, 80 and over
• Clostridioides difficile/isolation & purification
• Cytotoxins/therapeutic use
• Enterocolitis, Pseudomembranous/complications
• Enterocolitis, Pseudomembranous/microbiology
• Enterocolitis, Pseudomembranous/therapy
• Fecal Microbiota Transplantation/methods
• Female
• Follow-Up Studies
• Humans
• Male
• Middle Aged
• Neoplasms/complications
• Neoplasms/drug therapy
• Retrospective Studies
• Treatment Outcome
• Young Adult

To evaluate factors associated with Clostridium difficile infection (CDI) and outcomes of CDI in the myelodysplastic syndrome (MDS) and acute myeloid leukemia (AML) population.

After IRB approval, all MDS/AML patients hospitalized at the University of Maryland Greenebaum Comprehensive Cancer Center between August 2011 and December 2013 were identified. Medical charts were reviewed for demographics, clinical information, development of CDI, complications of CDI, and mortality. Patients with CDI, defined as having a positive stool PCR done for clinical suspicion of CDI, were compared to those without CDI in order to identify predictors of disease. A t-test was used for comparison of continuous variables and chi-square or Fisher’s exact tests were used for categorical variables, as appropriate.

Two hundred and twenty-three patients (60.1% male, mean age 61.3 years, 13% MDS, 87% AML) had 594 unique hospitalizations during the study period. Thirty-four patients (15.2%) were diagnosed with CDI. Factors significantly associated with CDI included lower albumin at time of hospitalization (P < 0.0001), prior diagnosis of CDI (P < 0.0001), receipt of cytarabine-based chemotherapy (P = 0.015), total days of neutropenia (P = 0.014), and total days of hospitalization (P = 0.005). Gender (P = 0.10), age (P = 0.77), proton-pump inhibitor use (P = 0.73), receipt of antibiotics (P = 0.66), and receipt of DNA hypomethylating agent-based chemotherapy (P = 0.92) were not significantly associated with CDI.

CDI is common in the MDS/AML population. Factors significantly associated with CDI in this population include low albumin, prior CDI, use of cytarabine-based chemotherapy, and prolonged neutropenia. In this study, we have identified a subset of patients in which prophylaxis studies could be targeted.

• Clostridium difficile
• Acute myeloid leukemia
• Cytarabine-based chemotherapy
• Myelodysplastic syndrome
• Neutropenia

• Abdominal Pain
• Clostridioides difficile/isolation & purification
• Combined Modality Therapy
• Comorbidity
• Diagnosis, Differential
• Enterocolitis, Pseudomembranous/diagnosis
• Enterocolitis, Pseudomembranous/therapy
• Fever
• Humans
• Male

Cancer predisposes patients to Clostridium difficile infection (CDI) due to health care exposures and medications that disrupt the gut microbiota or reduce immune response. Despite this association, the national rate of CDI among cancer patients is unknown. Furthermore, it is unclear how CDI affects clinical outcomes in cancer. The objective of this study was to describe CDI incidence and health outcomes nationally among cancer patients in the United States (U.S.).

Data for this study were obtained from the U.S. National Hospital Discharge Surveys from 2001 to 2010. Eligible patients included those at least 18 years old with a discharge diagnosis of cancer (ICD-9-CM codes 140–165.X, 170–176.X, 179–189.X, 190–209.XX). CDI was identified using ICD-9-CM code 008.45. Data weights were applied to sampled patients to provide national estimates. CDI incidence was calculated as CDI discharges per 1000 total cancer discharges. The in-hospital mortality rate and hospital length of stay (LOS) were compared between cancer patients with and without CDI using bivariable analyses.

A total of 30,244,426 cancer discharges were included for analysis. The overall incidence of CDI was 8.6 per 1000 cancer discharges. CDI incidence increased over the study period, peaking in 2008 (17.2 per 1000 cancer discharges). Compared to patients without CDI, patients with CDI had significantly higher mortality (9.4% vs. 7.5%, p < 0.0001) and longer median LOS (9 days vs. 4 days, p < 0.0001).

CDI incidence is increasing nationally among cancer patients admitted to U.S. community hospitals. CDI was associated with significantly increased mortality and hospital LOS.

• Cancer
• Clostridium Difficile
• Epidemiology
• Mortality

• Cancer
• Chemotherapy
• Clostridium difficile colitis
• Gastrointestinal diseases
• Neutropenic enterocolitis
• Toxicity

• Hematopoietic stem cell transplantation
• antibacterial resistance
• resistant bacterial infection

• Clostridium difficile infection
• cancer
• epidemiology
• outcomes
• risks
• treatment

Evidence on risk factors for Clostridium difficile infection (CDI) in hemato-oncologic patients is conflicting. We studied risk factors for CDI in a large, well-characterized cohort of hemato-oncological patients. 144 hemato-oncological patients were identified in this retrospective, single center study with a microbiologically confirmed CDI-associated diarrhea. Patients were compared with 144 age and sex matched hemato-oncologic patients with CDI negative diarrhea. Risk factors such as prior antimicrobial therapy, type of disease, chemotherapy and survival were evaluated. CDI-positive patients received more frequently any antimicrobial agent and antimicrobial combination therapy than CDI-negative patients (79% vs. 67%; OR = 2.26, p = 0.038 and OR = 2.62, p = 0.003, respectively). CDI positive patients were treated more frequently with antimicrobial agents active against C. difficile than CDI negative ones (25% vs. 13%; OR = 2.2, p = 0.039). The interval between last chemotherapy and onset of diarrhea was significantly shorter in patients without CDI (median, 17 days vs 36 days; p < 0.001). Our study demonstrates that chemotherapy is not a significant risk factor for CDI but for early onset CDI negative diarrhea. The predominant modifiable risk factor for CDI is in hemato-oncological patients antimicrobial treatment. These findings should be taken into account in the daily clinical practice to avoid CDI associated complications and excess health care costs.

• Bacteria, Anaerobic/classification
• Bacteria, Anaerobic/isolation & purification
• Bacterial Infections/diagnosis
• Bacterial Infections/drug therapy
• Bacterial Infections/epidemiology
• Bacterial Infections/pathology
• Bacteriological Techniques/methods
• Disease Susceptibility
• Humans
• Immunocompromised Host

Identify risk factors for Clostridium difficile infection (CDI) and assess CDI outcomes among Australian patients with a haematological malignancy.

A retrospective cohort study involving all patients admitted to hospitals in Western Australia with a haematological malignancy from July 2011 to June 2012. Hospital admission data were linked with all hospital investigated CDI case data. Potential risk factors were assessed by logistic regression. The risk of death within 60 and 90 days of CDI was assessed by Cox Proportional Hazards regression.

There were 2085 patients of whom 65 had at least one CDI. Twenty percent of CDI cases were either community-acquired, indeterminate source or had only single-day admissions in the 28 days prior to CDI. Using logistic regression, having acute lymphocytic leukaemia, neutropenia and having had bacterial pneumonia or another bacterial infection were associated with CDI. CDI was associated with an increased risk of death within 60 and 90 days post CDI, but only two deaths had CDI recorded as an antecedent factor. Ribotyping information was available for 33 of the 65 CDIs. There were 19 different ribotypes identified.

Neutropenia was strongly associated with CDI. While having CDI is a risk factor for death, in many cases it may not be a direct contributor to death but may reflect patients having higher morbidity. A wide variety of C. difficile ribotypes were found and community-acquired infection may be under-estimated in these patients.

• Aged
• Australia
• Clostridioides difficile/isolation & purification
• Clostridioides difficile/pathogenicity
• Clostridium Infections/complications
• Clostridium Infections/epidemiology
• Clostridium Infections/microbiology
• Clostridium Infections/pathology
• Cross Infection/epidemiology
• Cross Infection/microbiology
• Cross Infection/pathology
• Female
• Hematologic Neoplasms/complications
• Hematologic Neoplasms/epidemiology
• Hematologic Neoplasms/microbiology
• Hematologic Neoplasms/pathology
• Hospitals
• Humans
• Information Storage and Retrieval
• Male
• Middle Aged
• Proportional Hazards Models
• Retrospective Studies
• Risk Factors

• Sanofi Pasteur

• fluoroquinolone prophylaxis
• haematology
• healthcare-associated infection
• multiresistant gram negatives
• vancomycin-resistant enterococci (VRE)

Patients submitted to hematopoietic stem cell transplantation have an increased risk of Clostridium difficile infection and multiple risk factors have been identified. Published reports have indicated an incidence from 9% to 30% of transplant patients however to date there is no information about infection in these patients in Chile.

A retrospective analysis was performed of patients who developed C. difficile infection after hematopoietic stem cell transplantations from 2000 to 2013. Statistical analysis used the Statistical Package for the Social Sciences software.

Two hundred and fifty patients were studied (mean age: 39 years; range: 17–69), with 147 (59%) receiving allogeneic transplants and 103 (41%) receiving autologous transplants. One hundred and ninety-two (77%) patients had diarrhea, with 25 (10%) cases of C. difficile infection being confirmed. Twenty infected patients had undergone allogeneic transplants, of which ten had acute lymphoblastic leukemia, three had acute myeloid leukemia and seven had other diseases (myelodysplastic syndrome, chronic myeloid leukemia, severe aplastic anemia). In the autologous transplant group, five patients had C. difficile infection; two had multiple myeloma, one had amyloidosis, one had acute myeloid leukemia and one had germinal carcinoma. The overall incidence of C. difficile infection was 4% within the first week, 6.4% in the first month and 10% in one year, with no difference in overall survival between infected and non-infected groups (72.0% vs. 67.6%, respectively; p-value = 0.56). Patients infected after allogeneic transplants had a slower time to neutrophil engraftment compared to non-infected patients (17.5 vs. 14.9 days, respectively; p-value = 0.008). In the autologous transplant group there was no significant difference in the neutrophil engraftment time between infected and non-infected patients (12.5 days vs. 11.8 days, respectively; p-value = 0.71). In the allogeneic transplant group, the median time to acute graft-versus-host disease was similar between the two groups (p-value = 0.08), as was the incidence of grades 1–4 acute graft-versus-host disease (40% vs. 48%; p-value >0.05).

The incidence of C. difficile infection after hematopoietic stem cell transplantation was low, with a significant number of cases occurring shortly after transplantation. Allogeneic transplants had a three-time higher risk of infection compared to autologous transplants, but this was not associated with increased mortality, decreased overall survival or higher risk of acute graft-versus-host disease.

• Clostridium difficile
• Hematopoietic stem cell transplantation
• Infection
• Outcomes

• Clostridioides difficile
• Enterocolitis, Pseudomembranous/mortality
• Enterocolitis, Pseudomembranous/physiopathology
• Humans
• Severity of Illness Index
• Stem Cell Transplantation
• Transplantation, Homologous

• UR8/CCU715087-03 PHS HHS

• Adult
• Clostridioides difficile/drug effects
• Clostridium Infections/diagnosis
• Clostridium Infections/drug therapy
• Clostridium Infections/epidemiology
• Cross Infection/diagnosis
• Cross Infection/drug therapy
• Cross Infection/epidemiology
• Enterocolitis, Pseudomembranous/diagnosis
• Enterocolitis, Pseudomembranous/drug therapy
• Enterocolitis, Pseudomembranous/epidemiology
• Humans
• Infection Control/methods