Clostridium difficile Infection in Adults and Children

To increase comparability between clinical settings, use available standardized case definitions for surveillance of healthcare facility-onset (HO) CDI, community-onset healthcare facility-associated (CO-HCFA), and community-associated (CA) CDI. (G, )

At a minimum, conduct surveillance for healthcare facility-onset C. difficile infection (HO-CDI) in all inpatient healthcare facilities to detect elevated rates or outbreaks of CDI within the facility. ( W , L)

Express the rate of HO-CDI as the number of cases per 10,000 patient-days. Express the CO-HCFA prevalence rate as the number of cases per 1,000 patient admissions. (G, P)

Stratify data by patient location in order to target control measures when CDI incidence is above national and/or facility reduction goals or if an outbreak is noted. ( W , L)

Patients with ≥3 unexplained and new onset unformed stools in 24 h are the preferred target population for testing for CDI. ( W , VL)

Use a stool toxin test as part of a multiple step algorithm (i.e., glutamate dehydrogenase [GDH] plus toxin; GDH plus toxin, arbitrated by nucleic acid amplification test [NAAT]; or NAAT plus toxin) rather than a NAAT alone for all specimens received in the clinical laboratory when there are no pre-agreed institutional criteria for patient stool submission (see Figure 1). ( W , L)

Use a NAAT alone or multiple step algorithm for testing (i.e., GDH plus toxin; GDH plus toxin, arbitrated by NAAT; or NAAT plus toxin) rather than a toxin test alone when there are pre-agreed institutional criteria for patient stool submission (see Figure 1). ( W , L)

Do not perform repeat testing (within 7 days) during the same episode of diarrhea and do not test stool from asymptomatic patients, except for epidemiological studies. ( S , M)

There are insufficient data to recommend use of biologic markers as an adjunct to diagnosis. (K, )