Am J Obstet Gynecol 2008 Oct 17;199(4):332-7. Epub 2008 Jul 17.
Texas Medical Center, University of Houston College of Pharmacy, Houston, TX 77030, USA.
Clostridium difficile infection (CDI) in nonhospitalized patients has been reported with increased frequency. An association between CDI and pregnancy has not been stressed. This review will report 4 cases of peripartum CDI with characterization of the infecting strain and a literature review. A PubMed search identified 24 recorded cases of peripartum CDI; information was available for 14 cases. Most patients (91%) received prophylactic antibiotics during delivery or for treatment of bacterial infections (50%). All patients reported diarrhea. Two of our reported cases without known risk factors were found by polymerase chain reaction analysis to be infected with an epidemic and hypervirulent C difficile strain. These cases demonstrate the need for clinicians to consider CDI in patients with severe diarrhea, even if they do not have the traditional risk factors for CDI, such as antibiotic use or concurrent hospitalizations. Further research into the scope and risk factors for peripartum CDI is warranted.