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
...idemiology...
...dult...
...se comparability between clinical settings,...
...t a minimum, conduct surveillance for healt...
...press the rate of HO-CDI as the number...
...ratify data by patient location in order to ta...
...diatri...
...me standardized case definitions (HO, CO-HCFA,...
...llance for HO-CDI for inpatient pedi...
...onsider surveillance for CA-CDI to detect t...
Diagnosis
Diagnos...
...dult...
...tients with ≥3 unexplained and new onset u...
...l toxin test as part of a multiple step...
...lone or multiple step algorithm for...
...perform repeat testing (within 7 d...
...here are insufficient data to recommend use of b...
...diatric
...f the high prevalence of asymptomat...
...ting should not be routinely performed in child...
...n children 2 years and older, C. difficile...
...e 1. CDI Laboratory Test Recommendati...
...mmary of Available Tests for CDI in Decreasi...
Infection Prevention and Control
...ection Prevention and Control
...commodate patients with CDI in a private...
...required, it is recommended to cohor...
...ves ( S , H)...
...owns ( S , M)70...
...atients with suspected CDI should...
...tact precautions for at least 48 hours after diarr...
...long contact precautions until disch...
...outine or endemic settings, perform hand hygiene b...
...reaks or hyper-endemic (sustained high rates) set...
...ng with soap and water is preferred if th...
...ge patients to wash hands and shower to r...
...ble patient equipment when possible and...
...room cleaning with a sporicidal agen...
...easures of cleaning effectiveness to en...
...ere are limited data at this time to recommend us...
...cleaning with a sporicidal agent should...
...here are insufficient data to recommend screening...
...nimize the frequency and duration of high-...
...n antibiotic stewardship program. (G, )705...
...ics to be targeted should be based on the loc...
...there is an epidemiologic association betwee...
...here are insufficient data at this time to recomme...
Treatment
...reatment
Adul...
...inue therapy with the inciting antibiotic agent...
...tic therapy for CDI should be started empiric...
...or patients with an initial CDI episode, we sugge...
...ggest using metronidazole for an in...
...ated or prolonged courses due to risk...
...in administered orally is the regi...
...is present vancomycin can also be admini...
...ycin dosage is 500 mg orally 4 times per...
...rform subtotal colectomy with preservation of t...
...verting loop ileostomy with colonic lavage fol...
...ents with recurrent CDI episodes, we sugge...
...th a recurrent CDI episode within the la...
...ota transplantation (FMT) is recomm...
...fficient data at this time to recommen...
Pediatri...
Either metronidazole or vancomycin...
...ldren with an initial episode of sever...
...en with a second or greater episode of recurre...
...fecal microbiota transplantation (FMT) fo...
Table 2. Recommendations for the Treatment of Clo...
...e 3. Potential Treatment Agents for Tre...
...ecommendations for the Treatment of C. diffici...
...ecommended Treatment: Metronidazole × 10 days...
Recommended Treatment: Vancomycin x 10...
...ended Treatment: Vancomycin × 10 days (PO or...
...nded Treatment: Metronidazole × 10...
...mmended Treatment: Metronidazole × 10 days (...
...commended Treatment: Vancomycin x 10 days...
...atment: Vancomycin in a tapered and pulsed reg...
...d Treatment: Vancomycin for 10 days followed by r...
...mmended Treatment: Fecal microbiota transpla...