[Clostridium difficile infections in geriatric patients].

Clostridium difficile is the main cause of nosocomial antibiotic-associated diarrhea in adults in Europe and North America. Infections with C. difficile typically occur in elderly patients with comorbidities and prior antibiotic therapy. Other risk factors are proton pump inhibitors, which are taken by many elderly patients. The main virulence factors are toxins A and B. The clinical spectrum ranges from asymptomatic colonization to severe disease with abdominal complications and sepsis. The current diagnostic gold standard is anaerobic culture but is impractical in routine use due to the long duration. Proven techniques involve glutamate dehydrogenase, toxins A and B immunoassays and PCR. First infections and recurrences can be treated with 400-500 mg metronidazole 3 times a day for 10 days. Further recurrences, serious infections or patients with more than two positive predictors should be treated orally with 125 mg vancomycin 4 times a day for at least 10 days. Fidaxomicin, rifaximin, stool transplantation and monoclonal antibodies are promising alternative therapies.