Current status of surgical treatment for fulminant clostridium difficile colitis

Table 1 Major risk factors for the development of Clostridium difficile infection and associated disease

Risk factor	Risk	Proposed mechanism	Notes
Age (> 70 yr[10])	CDI and Severe CDAD	Diminished efficacy of immune response with aging[7]
Medical comorbidities[7]: multiple or those involving major organ systems	CDI and Severe CDAD	Diminished efficacy of immune response	Studies are conflicting with regards to which comorbid illnesses are specifically associated The evidence supporting the association with multiple/prolonged antibiotic use is controversial as this often occurs in patients with recurrent or refractory disease who are already at risk of unfavorable outcomes
Broad spectrum antibiotics Use of 3-4 antibiotics concurrently or prolonged (> 4 wk) use[12]	CDI	Alteration of normal colonic floral barrier to C. difficile colonization
	Severe CDAD
	Suppression of gastric acid production, particularly by proton pump inhibitors[6,7]			CDI	Increased survival of the acid-labile vegetative form of C. difficile while passing through the stomach[6,7]
Immunosuppression[6,13]	CDI and severe CDAD	Disruption of host ability to mount an effective response to both infection and toxemia

C. difficile: Clostridium difficile; CDI: Clostridium difficile infection; CDAD: Clostridium difficile associated disease.