There are a lot of missed points and misconceptions with Clostridium difficile, but probably towards the top of that list is that you can have an asymptomatic colonization. Just because you test positive for Clostridium difficile doesn't mean you have a C. diff infection. And so what are those rates?

I mean, it's going to depend on the study, but there have been some hospital studies,

according to the guidelines, where the asymptomatic colonization rate has been as high as 26%.

And then when you look at elderly patients and long-term care facilities, maybe 5% to 7% of those

patients have asymptomatic colonization. Meaning if you just tested their stools, they'd be positive

for C. diff, but they're not having diarrhea, abdominal pain, leukocytosis, all those things that we'll get into.

And when you look at a meta-analysis

that they reference in the guidelines,

they say probably when you look at all these 19 studies,

somewhere around 8.1% of patients

or people that are in a hospital have colonization.

And of course I suspect the number even within the same hospital is going to vary quite a bit from year to year, but particularly also from hospitals in different regions.

There's going to be different rates of colonization,

and so some may be very high and some may be very low. Therefore, this gram-posive

spore-forming and toxin- secreting anaerobic bacillus causes all kinds of problems like diarrhea, megacolon, severe ilias, pseudomebranes, a lot of sepsis.

And yet for some people is just hanging out as an asymptomatic colonizer.

And that's the challenge for clinicians is we need to decide who has an active infection

that needs treatment and then what treatment to give based on the scenario, and those are some

different scenarios, versus don't test and don't treat because this person does not have an infection, but they still could have

Clostridium difficile as an asymptomatic colonizer.

So let's step back and just review some of the basics about this leading cause of hospital

acquired infectious diarrhea, and I don't think it's ever going to go away in our career

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