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
...pidemiolog...
...dult...
...parability between clinical settings, use availab...
...um, conduct surveillance for health...
...e rate of HO-CDI as the number of cases per 10,...
...patient location in order to target control measu...
...iatric...
...the same standardized case definitions (HO...
...surveillance for HO-CDI for inpatie...
...eillance for CA-CDI to detect trends in the commu...
Diagnosis
...iagnos...
Adul...
...with ≥3 unexplained and new onset unfo...
...l toxin test as part of a multiple step algor...
...e or multiple step algorithm for testing...
...m repeat testing (within 7 days) dur...
...here are insufficient data to recommend use of...
...diatric...
Because of the high prevalence of asymptomati...
...sting should not be routinely performed in ch...
...en 2 years and older, C. difficile testing is...
...CDI Laboratory Test Recommendations B...
...ummary of Available Tests for CDI in Decreas...
Infection Prevention and Control
...ion Prevention and Control...
...ccommodate patients with CDI in a pr...
...rting is required, it is recommended to cohor...
...es ( S , H)7...
gowns ( S , M)70...
...s with suspected CDI should be pla...
...tact precautions for at least 48 hours af...
...ong contact precautions until discha...
...or endemic settings, perform hand hyg...
...utbreaks or hyper-endemic (sustained high rat...
...with soap and water is preferred if there is direc...
...ncourage patients to wash hands and...
...ble patient equipment when possible and...
...room cleaning with a sporicidal agent shoul...
...asures of cleaning effectiveness to...
...are limited data at this time to recommend...
...ly cleaning with a sporicidal agent...
...re are insufficient data to recommend screeni...
...the frequency and duration of high-...
...ment an antibiotic stewardship program...
...otics to be targeted should be based o...
...re is an epidemiologic association bet...
...ere are insufficient data at this time to rec...
Treatment
Treatmen...
...dult
...rapy with the inciting antibiotic agent(s) as s...
...c therapy for CDI should be started em...
...with an initial CDI episode, we suggest us...
...g metronidazole for an initial episode of non-seve...
...or prolonged courses due to risk of cumulati...
...istered orally is the regimen of choice. ( S ,...
If ileus is present vancomycin can also be admin...
...dosage is 500 mg orally 4 times per day and 500...
...rform subtotal colectomy with pres...
...leostomy with colonic lavage followed...
...with recurrent CDI episodes, we sug...
...nts with a recurrent CDI episode within t...
...ta transplantation (FMT) is recommended for pat...
...re insufficient data at this time to recommend e...
...iatric...
...onidazole or vancomycin is recommended...
...r children with an initial episode of sev...
...ldren with a second or greater episode of recurr...
...cal microbiota transplantation (FMT) for pediatr...
...le 2. Recommendations for the Treat...
...ble 3. Potential Treatment Agents for Treatment...
...le 4. Recommendations for the Treat...
...mended Treatment: Metronidazole × 10 da...
...nded Treatment: Vancomycin x 10 days (...
...nded Treatment: Vancomycin × 10 days...
...ecommended Treatment: Metronidazole × 1...
...ecommended Treatment: Metronidazole × 10 days (PO...
...tment: Vancomycin x 10 days (PO) Pediatric...
...Treatment: Vancomycin in a tapered and puls...
...mmended Treatment: Vancomycin for 10 days followed...
...eatment: Fecal microbiota transplantation ( W...