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
...pidemiolo...
...dult...
...e comparability between clinical se...
...conduct surveillance for healthca...
...the rate of HO-CDI as the number of cases per 10,...
...patient location in order to target control...
Pediat...
...the same standardized case definitions (H...
...llance for HO-CDI for inpatient pediatr...
...er surveillance for CA-CDI to detect tr...
Diagnosis
Diagnosis
Adul...
...¥3 unexplained and new onset unformed stools...
...toxin test as part of a multiple st...
...T alone or multiple step algorithm for testing (i...
...perform repeat testing (within 7 day...
...re insufficient data to recommend use...
...diatric...
...of the high prevalence of asymptomatic car...
...e testing should not be routinely per...
...ildren 2 years and older, C. difficile...
...ure 1. CDI Laboratory Test Recommendations...
...mary of Available Tests for CDI in Decreasing...
Infection Prevention and Control
...Prevention and Control...
...modate patients with CDI in a private room...
...is required, it is recommended to cohort patie...
...loves ( S , H)70...
...( S , M)705
...ients with suspected CDI should be placed...
...ct precautions for at least 48 hours after...
...ntact precautions until discharge if CDI ra...
...endemic settings, perform hand hygiene bef...
...CDI outbreaks or hyper-endemic (sustained high r...
...h soap and water is preferred if there is d...
...e patients to wash hands and shower to reduce...
...e disposable patient equipment when p...
...room cleaning with a sporicidal agent should be co...
...ures of cleaning effectiveness to ensure qu...
...imited data at this time to recommend use...
...ith a sporicidal agent should be considered in c...
...icient data to recommend screening for asymptomati...
...frequency and duration of high-risk antib...
...ment an antibiotic stewardship program. (...
...be targeted should be based on the local ep...
...is an epidemiologic association between proton pu...
...insufficient data at this time to recommend adm...
Treatment
Treatm...
Adul...
...iscontinue therapy with the inciting ant...
...tic therapy for CDI should be star...
...h an initial CDI episode, we suggest u...
...t using metronidazole for an initial episo...
...or prolonged courses due to risk of cumulati...
...nistered orally is the regimen of choice. ( S ,...
...is present vancomycin can also be adm...
...e vancomycin dosage is 500 mg orally 4 ti...
...subtotal colectomy with preservation of the r...
...ting loop ileostomy with colonic lavage followed...
...th recurrent CDI episodes, we suggest fid...
...ts with a recurrent CDI episode within...
...transplantation (FMT) is recommended for pati...
...re are insufficient data at this tim...
...iatric
...metronidazole or vancomycin is recommended fo...
...ildren with an initial episode of severe C...
...children with a second or greater episode...
...ider fecal microbiota transplantation (FMT) for p...
...mendations for the Treatment of Clostridi...
...ntial Treatment Agents for Treatment of the Prim...
...ommendations for the Treatment of C. diffic...
...tment: Metronidazole × 10 days (PO...
...ommended Treatment: Vancomycin x 10 days...
...ommended Treatment: Vancomycin × 10 day...
...ommended Treatment: Metronidazole ×...
...d Treatment: Metronidazole × 10 days (PO) Pe...
...commended Treatment: Vancomycin x 10 da...
...mmended Treatment: Vancomycin in a tapered and pul...
...reatment: Vancomycin for 10 days followed b...
...eatment: Fecal microbiota transplantation ( W ,...