Last updated March 15, 2022

Management of Clostridioides difficile Infection

Recommendations

Evaluation

1. When CDI is suspected, a disease-specific history should be performed emphasizing risk factors, symptoms, underlying comorbidities, and signs of severe or fulminant disease. (1C)
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2. Patients should be evaluated to determine the severity of CDI and for the presence of peritonitis or multisystem organ failure. (1C)
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3. The diagnosis of CDI should include laboratory stool testing, and 2-step testing should be utilized to increase accuracy. (1A)
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4. Routine endoscopic evaluation to diagnose or determine the extent of CDI is not recommended. (1C)
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5. Radiologic evaluation has limited utility in the setting of CDI. (2C)
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Medical Management

6. Infection control measures should be implemented for hospitalized patients with CDI. (1B)
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7. Implementing an evidence-based antibiotic stewardship program can decrease rates of CDI. (1B)
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8. Oral vancomycin or fidaxomicin is considered first-line treatment for an initial CDI, whereas metronidazole alone is no longer considered appropriate first-line treatment. (1A)
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9. Probiotics may be useful in preventing CDI, but not in treating CDI. (2A)
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Surgical Therapy

10. Surgery for C difficile colitis should typically be reserved for patients with colonic perforation or severe colitis who do not improve with medical therapy. (1C)
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11. Subtotal colectomy with end ileostomy is typically the operative procedure recommended for severe-complicated or fulminant C difficile colitis. (1C)
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12. A diverting loop ileostomy with antegrade colonic lavage may be an alternative to subtotal colectomy for the treatment of severe-complicated or fulminant CDI. (2C)
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Recurrent and Refractory CDI

13. A prolonged course of vancomycin, adding bezlotoxumab or using fidaxomicin, is an acceptable therapy for recurrent or refractory CDI in stable patients. (1B)
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14. Patients with recurrent or refractory CDI should typically be considered for fecal bacteriotherapy (eg, intestinal microbiota transplantation) if conventional measures, including appropriate antibiotic treatment, have failed. (1B)
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15. Adjunctive agents including other antimicrobials, binding agents, and probiotics may be considered in addition to standard treatment in cases of recurrent or refractory CDI. (2C)
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Recommendation Grading

Overview

Title

Management of Clostridioides difficile Infection

Authoring Organization

Publication Month/Year

June 1, 2021

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Inclusion Criteria

Female, Male, Adult, Older adult

Health Care Settings

Ambulatory, Hospital

Intended Users

Physician, nurse practitioner, epidemiology infection prevention, nurse, physician assistant

Scope

Management

Diseases/Conditions (MeSH)

D016360 - Clostridium difficile, D003015 - Clostridium Infections

Keywords

Clostridium difficile, Clinical Practice Guidelines, Clostridioides difficile Infections

Methodology

Number of Source Documents
248
Literature Search Start Date
September 1, 2014
Literature Search End Date
September 20, 2020