Clostridium difficile

Publication Date: June 14, 2021

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...

Adult

...se comparability between clinical se...

...conduct surveillance for healthcare facility-ons...

...ress the rate of HO-CDI as the number of cases p...

...fy data by patient location in order to target c...


...iatric...

...andardized case definitions (HO, CO-HCFA, C...

...urveillance for HO-CDI for inpatient pedia...

...surveillance for CA-CDI to detect trends in the c...


Diagnosis

Diagno...

Adul...

...3 unexplained and new onset unformed stools in...

...xin test as part of a multiple step algori...

...AT alone or multiple step algorithm fo...

...perform repeat testing (within 7 day...

...insufficient data to recommend use of biologic ma...


Pediatr...

...cause of the high prevalence of asymptomat...

...fficile testing should not be routinely perfo...

...2 years and older, C. difficile testing...


...ure 1. CDI Laboratory Test Recommendatio...


...ary of Available Tests for CDI in Decr...


Infection Prevention and Control

...Prevention and Control...

...ate patients with CDI in a private...


...required, it is recommended to cohort patients i...


...( S , H)705...

...( S , M)705...


...ients with suspected CDI should be plac...


...ntact precautions for at least 48 hours after di...


...g contact precautions until discharge...


...ine or endemic settings, perform hand hygiene...


...n CDI outbreaks or hyper-endemic (...


...ith soap and water is preferred if t...


...ents to wash hands and shower to reduce t...


...isposable patient equipment when possible and en...


...erminal room cleaning with a sporicidal...


...rate measures of cleaning effectiveness to ensur...


...e limited data at this time to rec...


...y cleaning with a sporicidal agent should...


...are insufficient data to recommend screen...


...ze the frequency and duration of high-risk...


...ment an antibiotic stewardship program....


...biotics to be targeted should be based on the l...


...re is an epidemiologic association betwe...


...re are insufficient data at this time to recommen...


Treatment

Treatment

...dult

Discontinue therapy with the incit...

...rapy for CDI should be started empi...

...h an initial CDI episode, we suggest u...

we suggest using metronidazole for an initial ep...

...d or prolonged courses due to risk of cumulati...

...administered orally is the regimen of choice. (...

...eus is present vancomycin can also be admi...

...omycin dosage is 500 mg orally 4 times per...

...total colectomy with preservation of the r...

...ing loop ileostomy with colonic lavag...

In patients with recurrent CDI episodes,...

...atients with a recurrent CDI episode within the...

...cal microbiota transplantation (FMT) is...

...sufficient data at this time to recommend...


...ediatri...

...metronidazole or vancomycin is recommended...

...ren with an initial episode of severe CDI,...

...n with a second or greater episode of rec...

...al microbiota transplantation (FMT...


...able 2. Recommendations for the Treatme...


...al Treatment Agents for Treatment of the...


...ecommendations for the Treatment of C. diffic...

...ed Treatment: Metronidazole × 10 days (PO) Ped...

...d Treatment: Vancomycin x 10 days (PO)...

...commended Treatment: Vancomycin × 10 days...

...atment: Metronidazole × 10 days (IV)a...

...nded Treatment: Metronidazole × 10 d...

...Treatment: Vancomycin x 10 days (PO) Pe...

...Treatment: Vancomycin in a tapered...

...ended Treatment: Vancomycin for 10...

...ended Treatment: Fecal microbiota transplantati...