Patient P, a woman 50 years of age, has a history of rheumatoid arthritis and complicated diverticulitis. She had previously undergone a temporary colostomy and has now returned for reversal surgery. Her bowel surgery is uneventful. Because Patient P is a nurse and quite knowledgeable about the healthcare system, she is diligent in reminding staff to wash hands with soap and water, or use a hand sanitizer, before having contact with her or handling the equipment in her room.

After recovery and subsequent return to normal dietary activity, Patient P continues to have some discomfort in the lower abdomen, fails to gain weight, and develops a watery diarrhea. This persists despite multiple return visits to the surgeon's office. Eventually, the surgeon informs her that everything appears to be progressing satisfactorily from his perspective and that she should see her primary care physician or consider counseling for the symptoms. Unhappy with this assessment, she consults the infection control practitioner at the facility where she works and requests a test for C. difficile. The test is positive for C. difficile infection. Patient P is afebrile, having minimal pain, and estimates her diarrhea at 8 to 10 loose or watery stools per 24 hours. She is treated initially with metronidazole, 500 mg every eight hours for 10 days. She improves rapidly, and after one week of therapy, is now having one to 2 formed stools per 24 hours and notes improving appetite and sense of well-being. However, two weeks after the conclusion of therapy, at about the time she had planned to resume working, her diarrhea recurs and is rapidly approaching the original level of severity. She is retreated, but this time with vancomycin, 125 mg every six hours for 14 days, followed by a slow tapered dose over the subsequent three weeks. At six-weeks follow-up, she feels much improved. Her stool is formed, her bowel habits have returned to normal, and she has regained much of her lost weight. The patient and her physician are unsure whether she had been an asymptomatic carrier prior to admission (as a byproduct of her work exposure) or had acquired the infection due to hand carriage while in the hospital recovering from surgery. She wonders if earlier recognition, diagnostic consideration, and treatment might have led to a more rapid and satisfactory response to treatment, hastening her recovery and permitting a more rapid return to work.