Clostridium difficile
IMPORTANT
IMPORTANT
Key Points
...Key Points...
.... difficile remains the most important ca...
Epidemiology
...Epidemiology...
...Adult...
...comparability between clinical settings, use a...
...a minimum, conduct surveillance for healthc...
...ate of HO-CDI as the number of cases per 10,000...
...a by patient location in order to targe...
...Pedia...
...same standardized case definitions (HO,...
...lance for HO-CDI for inpatient pediatric f...
...illance for CA-CDI to detect trends in the com...
Diagnosis
...D...
...Ad...
...unexplained and new onset ≥3 unformed stool...
...tool toxin test as part of a multiple step algor...
...or multiple step algorithm for testing...
...rm repeat testing (within 7 days) during the same...
...re insufficient data to recommend use o...
...Pediat...
...the high prevalence of asymptomatic carriage...
...le testing should not be routinely p...
...ears and older, C. difficile testing is...
...1. CDI Laboratory Test Recommendations...
.... Summary of Available Tests for CDI in Decreasin...
Infection Prevention and Control
...Infection Pr...
...tients with CDI in a private room with a de...
...is required, it is recommended to cohort patie...
...loves ( S ,...
...wns ( S , M)...
...suspected CDI should be placed on...
...act precautions for at least 48 hours aft...
...rolong contact precautions until dis...
...demic settings, perform hand hygiene before an...
...outbreaks or hyper-endemic (sustained h...
...washing with soap and water is preferred if ther...
...ients to wash hands and shower to reduce the burde...
...isposable patient equipment when p...
...erminal room cleaning with a sporicida...
...asures of cleaning effectiveness to...
...d data at this time to recommend use of au...
...with a sporicidal agent should be considered...
...here are insufficient data to recommend scre...
...e the frequency and duration of hi...
...ibiotic stewardship program. (G, P)70...
...tics to be targeted should be based on t...
...is an epidemiologic association between p...
...e are insufficient data at this time t...
Treatment
...Treatment...
...Adult...
...ue therapy with the inciting antibiotic...
...therapy for CDI should be started emp...
...n or fidaxomicin is recommended over metronidazole...
...e suggest using metronidazole for...
...ted dosage is metronidazole 500 mg orally 3 times...
...administered orally is the regimen of ch...
...present vancomycin can also be administered p...
...mycin dosage is 500 mg orally 4 times per day and...
...m subtotal colectomy with preservation of th...
...p ileostomy with colonic lavage followed by anteg...
...t recurrence of CDI with oral vancomyc...
...ecurrence of CDI with a 10-day course...
...first recurrence of CDI with a standard 10-day...
...otic treatment options for patients with...
...ota transplantation (FMT) is recommended f...
...re insufficient data at this time to...
...Pe...
...tronidazole or vancomycin is recommended f...
For children with an initial episode of severe CD...
...ren with a second or greater episode...
...cal microbiota transplantation (FMT)...
...ential Treatment Agents for Treatment of the Prim...
...Recommendations f...
...Initial episode...
...n 125 mg given qid for 10 days, ( S , H)...
...xomicin 200 mg given bid for 10 da...
...rnate if above agents are unavailable: Metronidaz...
...Initial episode,...
...125 mg qid PO for 10 days, ( S , H)...
...in 200 mg given bid for 10 days ( S ,...
...Initial episode, fulmin...
...potension or shock, ileus, m...
Oral vancomycin ( S , M)7...
...ancomycin ( W , L)705...
...venous metronidazole ( S...
...First recurrence ...
...mg given qid for 10 days if metronidazole w...
...tapered and pulsed vancomycin regimen i...
...daxomicin 200 mg given bid for 10 d...
...Second or subsequent recurr...
...in a tapered and pulsed regimen, ( W , L) OR7...
...comycin, 125 mg qid PO for 10 days followed...
...mg given bid for 10 days, ( W , L) OR705...
...cal microbiota transplantationc (...
...a All randomized trials have com...
...Recommendations...
...episode, non-severe...
...azole × 10 days (PO), Pediatric Dose: 7.5 mg...
...ncomycin × 10 days (PO) Pediatric Dose: 10 mg/k...
...× 10 days (PO or PR) Pediatric Dose:...
...etronidazole × 10 days (IVa) Pediatric Dose:...
...urrence, non-severe...
...× 10 days (PO) Pediatric Dose: 7.5 mg/kg/...
...omycin × 10 days (PO) Pediatric...
...subsequent recurrence...
...n in a tapered and pulsed regimenb...
...ancomycin for 10 days followed by Rifaximinc f...
...cal microbiota transplantation ( W , VL)...
...of severe or fulminant CDI associated with...