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
...demiolog...
Adul...
...se comparability between clinical settings,...
...minimum, conduct surveillance for h...
...ate of HO-CDI as the number of cases per 10...
...ify data by patient location in order to...
...iatric...
...standardized case definitions (HO...
...rveillance for HO-CDI for inpatient pediatric fac...
...surveillance for CA-CDI to detect...
Diagnosis
...agnosis...
...dult...
Patients with ≥3 unexplained and new...
...toxin test as part of a multiple step a...
...one or multiple step algorithm for testing (...
...epeat testing (within 7 days) during the same e...
...icient data to recommend use of bio...
...ediatr...
...igh prevalence of asymptomatic car...
...sting should not be routinely performed in childr...
...en 2 years and older, C. difficile te...
.... CDI Laboratory Test Recommendations Based o...
...mmary of Available Tests for CDI in Decreasi...
Infection Prevention and Control
...n Prevention and Control...
...te patients with CDI in a private room wi...
...orting is required, it is recommended to coh...
...oves ( S , H)70...
...s ( S , M)705...
...ts with suspected CDI should be placed o...
...e contact precautions for at least 48 hours af...
...long contact precautions until discharg...
...ndemic settings, perform hand hygiene before and a...
...I outbreaks or hyper-endemic (sustained h...
...th soap and water is preferred if there...
...ients to wash hands and shower to reduce the bur...
...e disposable patient equipment when possible and...
...cleaning with a sporicidal agent should be c...
...orporate measures of cleaning effectiveness to e...
...re are limited data at this time to recommend use...
...ith a sporicidal agent should be considered in c...
...re are insufficient data to recommend screening f...
...frequency and duration of high-risk antibioti...
...an antibiotic stewardship program. (G, )705...
...o be targeted should be based on t...
...here is an epidemiologic association betwee...
...fficient data at this time to recommend admi...
Treatment
Treatment
Adult
...apy with the inciting antibiotic agent(s) as soon...
...tic therapy for CDI should be started empiri...
...with an initial CDI episode, we suggest us...
...sing metronidazole for an initial episod...
...d repeated or prolonged courses due to risk of cu...
...comycin administered orally is the reg...
...s is present vancomycin can also be administ...
...dosage is 500 mg orally 4 times pe...
...btotal colectomy with preservation o...
...p ileostomy with colonic lavage follo...
...s with recurrent CDI episodes, we suggest f...
...r patients with a recurrent CDI epis...
...al microbiota transplantation (FMT) is rec...
...ficient data at this time to recommend ex...
Pediatr...
...ther metronidazole or vancomycin is recommended...
...th an initial episode of severe CDI...
...children with a second or greater ep...
...r fecal microbiota transplantation (FMT) for...
Table 2. Recommendations for the Treatment of...
...otential Treatment Agents for Treatm...
...ecommendations for the Treatment of C....
...mended Treatment: Metronidazole × 10 days...
...tment: Vancomycin x 10 days (PO) Pediatric Dose:...
...commended Treatment: Vancomycin × 10 day...
...ded Treatment: Metronidazole × 10...
...mmended Treatment: Metronidazole Ã...
...ded Treatment: Vancomycin x 10 days (PO) Ped...
Recommended Treatment: Vancomycin...
...ecommended Treatment: Vancomycin for 10 days follo...
...tment: Fecal microbiota transplantatio...