Risk of diarrhoea, Clostridium difficile and cefotaxime in the elderly

Clostridium difficile diarrhoea is an increasingly important nosocomial infection. Clostridium difficile infection is associated with antibiotic use. The elderly are at greatest risk. We reported an outbreak associated with the use of cefotaxime, a third-generation cephalosporin. We review the extent of this association, putative causal mechanisms and suggest an integrated approach to the control of C difficile infection which focusses on both limiting environmental contamination and reducing patient susceptibility. Future developments are also considered, especially the potential for vaccination.