Clostridium difficile
IMPORTANT
IMPORTANT
Key Points
...Ke...
...mains the most important cause of heal...
Epidemiology
...Epidemiology...
...Adult...
...comparability between clinical settings, us...
...minimum, conduct surveillance for healthcare...
...ess the rate of HO-CDI as the number of case...
...tify data by patient location in order to tar...
Pediatri...
...e standardized case definitions (HO, CO-HCFA, CA...
...ance for HO-CDI for inpatient pediatric fac...
...illance for CA-CDI to detect trends i...
Diagnosis
...Diagnos...
...Adult...
...s with unexplained and new onset ≥3 unf...
...ol toxin test as part of a multiple step algor...
...lone or multiple step algorithm for testi...
...erform repeat testing (within 7 days) d...
There are insufficient data to recommend us...
...Pediatric...
...ecause of the high prevalence of as...
...ile testing should not be routinely...
...ears and older, C. difficile testing is rec...
...igure 1. CDI Laboratory Test Recommend...
...mmary of Available Tests for CDI in...
Infection Prevention and Control
...Infection Preventio...
...ccommodate patients with CDI in a...
...orting is required, it is recommend...
...es ( S , H)705...
...wns ( S , M)705
...h suspected CDI should be placed on pre-emptive c...
...ontact precautions for at least 48 hours...
...ng contact precautions until dischar...
...or endemic settings, perform hand hygiene bef...
...DI outbreaks or hyper-endemic (sus...
...shing with soap and water is preferred if there...
...patients to wash hands and shower to...
...sable patient equipment when possibl...
...inal room cleaning with a sporicidal a...
...measures of cleaning effectiveness to ensure qual...
...limited data at this time to recommend...
...ith a sporicidal agent should be considere...
...are insufficient data to recommend screening...
...imize the frequency and duration of h...
...lement an antibiotic stewardship prog...
...to be targeted should be based on the...
...h there is an epidemiologic association betw...
...are insufficient data at this time to recommend...
Treatment
...Treat...
...scontinue therapy with the inciting antibiot...
...ntibiotic therapy for CDI should be sta...
...n or fidaxomicin is recommended over metro...
...t using metronidazole for an initial episode...
...d dosage is metronidazole 500 mg orally 3 times...
...n administered orally is the regimen...
...us is present vancomycin can also be administ...
...ancomycin dosage is 500 mg orally 4 tim...
...rform subtotal colectomy with preservation of th...
...verting loop ileostomy with colonic l...
...reat a first recurrence of CDI with oral...
...first recurrence of CDI with a 10-day course of...
...irst recurrence of CDI with a stan...
...otic treatment options for patients with mor...
...ecal microbiota transplantation (FMT)...
...sufficient data at this time to recommend extendin...
...Pediatr...
...ither metronidazole or vancomycin i...
...hildren with an initial episode of severe CD...
...ldren with a second or greater epis...
...onsider fecal microbiota transplantation (F...
...ble 2. Potential Treatment Agents for Treat...
...Recommenda...
...Initial...
...cin 125 mg given qid for 10 days, ( S , H) OR705...
...0 mg given bid for 10 days ( S , H)70...
...lternate if above agents are unavai...
...Initial episode,...
...125 mg qid PO for 10 days, ( S , H) OR705...
...200 mg given bid for 10 days ( S , H)705...
...Initial episode, fulm...
...tension or shock, ileus, megacolon...
...ancomycin ( S , M)70...
...l vancomycin ( W , L)7...
...metronidazole ( S , M)705...
...First re...
...125 mg given qid for 10 days if metronidazole...
...nged tapered and pulsed vancomycin regimen...
...mg given bid for 10 days if vancomycin was...
...Second or subsequent...
...comycin in a tapered and pulsed regimen, ( W , L)...
...cin, 125 mg qid PO for 10 days fol...
...omicin 200 mg given bid for 10 days, (...
...microbiota transplantationc ( S...
...All randomized trials have compared 10 day...
...Recommenda...
...l episode, non-seve...
...× 10 days (PO), Pediatric Dose: 7.5 mg/kg/d...
...days (PO) Pediatric Dose: 10 mg/kg/...
...× 10 days (PO or PR) Pediatric Dose:...
...10 days (IVa) Pediatric Dose: 10 mg/kg/dose...
...recurrence, non-severe...
...ole × 10 days (PO) Pediatric Dose: 7.5 mg/kg/...
...× 10 days (PO) Pediatric Dose: 10 mg/kg/do...
...or subsequent recurren...
...in a tapered and pulsed regimenb Pediat...
...in for 10 days followed by Rifaximinc fo...
...robiota transplantation ( W , VL)7...
...n cases of severe or fulminant CDI associa...