Clostridium difficile
Key Points
Key Points
- Clostridioides difficile remains the most important cause of healthcare-associated diarrhea and has become the most commonly identified cause of healthcare-associated infection in adults in the United States. Moreover, C. difficile has established itself as an important community pathogen.
- Clostridioides difficile infection (CDI) is defined by the presence of symptoms (usually diarrhea) and either a stool test positive for toxins or detection of toxigenic C. difficile or colonoscopic or histopathologic findings revealing pseudomembranous colitis.
- Recent estimates suggest the U.S. burden of CDI is close to 500,000 infections annually although the exact magnitude of burden is highly dependent upon the type of diagnostic tests used.
- Diagnosis of CDI recommendations are dependent upon institutional policy on which patients to test. See Diagnosis section.
- Treatment recommendations no longer include metronidazole as first-line treatment for CDI of any severity. See Treatment section.
Epidemiology
...emiology...
...dult...
...ease comparability between clinical se...
...onduct surveillance for healthcare facility...
...ss the rate of HO-CDI as the number of cases per...
...a by patient location in order to target c...
...diatric
...e same standardized case definitions (HO...
...surveillance for HO-CDI for inpatient pediatric...
...rveillance for CA-CDI to detect trends in the...
Diagnosis
...agnosis
...dult...
...with ≥3 unexplained and new onset unformed sto...
...se a stool toxin test as part of a...
...a NAAT alone or multiple step algor...
Do not perform repeat testing (with...
...insufficient data to recommend use of biologic...
...iatric...
...igh prevalence of asymptomatic carriage of to...
...sting should not be routinely perf...
...2 years and older, C. difficile testing...
...ure 1. CDI Laboratory Test Recommendations Base...
...mary of Available Tests for CDI in Decreasing Orde...
Infection Prevention and Control
...ction Prevention and Control...
...patients with CDI in a private room with a de...
...is required, it is recommended to coho...
...s ( S , H)705...
gowns ( S ,...
...nts with suspected CDI should be pla...
...nue contact precautions for at least...
...act precautions until discharge if...
...ine or endemic settings, perform h...
...n CDI outbreaks or hyper-endemic (sustained...
...ndwashing with soap and water is pref...
...ents to wash hands and shower to reduce the...
...se disposable patient equipment wh...
...cleaning with a sporicidal agent should be consi...
...corporate measures of cleaning effectiveness to en...
...ted data at this time to recommend u...
...cleaning with a sporicidal agent sh...
...e are insufficient data to recommend...
...quency and duration of high-risk anti...
...plement an antibiotic stewardship program....
...ntibiotics to be targeted should be based on...
...there is an epidemiologic association betw...
...ere are insufficient data at this time to recomme...
Treatment
...reatmen...
Adult
...rapy with the inciting antibiotic agent(s)...
...tibiotic therapy for CDI should be started empiri...
...h an initial CDI episode, we suggest us...
...suggest using metronidazole for an initial episod...
...epeated or prolonged courses due to r...
...administered orally is the regimen of choice. (...
...f ileus is present vancomycin can also be admini...
...in dosage is 500 mg orally 4 times per...
...rform subtotal colectomy with preser...
...g loop ileostomy with colonic lavage followed b...
...n patients with recurrent CDI episodes, we suggest...
...s with a recurrent CDI episode within...
Fecal microbiota transplantation (FMT) i...
...e are insufficient data at this time to reco...
...ediatric...
...ther metronidazole or vancomycin is recomme...
...dren with an initial episode of severe CDI, oral...
...h a second or greater episode of recurren...
...nsider fecal microbiota transplantation (FMT...
...commendations for the Treatment of Clostri...
...3. Potential Treatment Agents for Treat...
Table 4. Recommendations for the Treatment...
...Treatment: Metronidazole × 10 days (PO) Pedia...
...ded Treatment: Vancomycin x 10 days (PO) P...
...ended Treatment: Vancomycin × 10 days (PO or PR)...
...commended Treatment: Metronidazole × 1...
...atment: Metronidazole × 10 days (PO) P...
...ended Treatment: Vancomycin x 10 days (PO) Pedi...
...eatment: Vancomycin in a tapered and pulsed r...
...mended Treatment: Vancomycin for 1...
...ed Treatment: Fecal microbiota transplantat...