Designed and created by Guideline Central in participation with the American Society of Colon and Rectal Surgeons
Management of Clostridioides difficile Infection
Patient Guideline Summary
Publication Date: June 1, 2021
Last Updated: March 3, 2023
Objective
Objective
This patient summary means to discuss key recommendations from the American Society of Colon and Rectal Surgeons (ASCRS) for the management of Clostridioides difficile infection. It is limited to adults 18 years of age and older and should not be used as a reference for children.
Overview
Overview
- Clostridioides difficile is a bacterium that causes a bowel infection that can be life-threatening. More severe forms are called “colitis.”
- We will use the abbreviation CDI throughout this summary to refer to Clostridioides difficile infection.
- The most common cause of CDI is antibiotics that upset the balance of bowel flora.
- Manifestations include diarrhea, fever, abdominal bloating, shock, sepsis, and kidney failure.
- This patient summary focuses on medical and surgical management of Clostridioides difficile infection.
Diagnosis
Diagnosis
- The initial evaluation should be thorough, including the severity of the condition and appropriate laboratory testing.
- Severity can range from a carrier state without symptoms to life-threatening sepsis with multiple organ failures.
Treatment
Treatment
- Probiotics may be useful in preventing CDI, but not in treating CDI.
- Hospitalized patients should be subject to isolation procedures to prevent spread.
- Oral vancomycin or fidaxomicin is considered the first-line treatment for an initial CDI.
- In cases of recurrent or refractory CDI:
- A prolonged course of vancomycin, adding bezlotoxumab, or using fidaxomicin, is an acceptable therapy for recurrent or refractory CDI in stable patients.
- Agents including other antimicrobials, binding agents, and probiotics may be added to standard treatment.
- Fecal bacteriotherapy (eg, intestinal microbiota transplantation) should be considered.
Surgery
- Surgery for C. difficile colitis should typically be reserved for patients with colonic (bowel) perforation or severity that has not improved with medical therapy.
- The usual procedure is the removal of most of the colon (large bowel) and attaching the remainder to the end of the small bowel. There are alternatives.
Abbreviations
- ASCRS: American Society Of Colon And Rectal Surgeons
- CDI: Clostridioides Difficile Infection
Source Citation
Poylin V, Hawkins AT, Bhama AR, Boutros M, Lightner AL, Khanna S, Paquette IM, Feingold DL; Prepared by the Clinical Practice Guidelines Committee of The American Society of Colon and Rectal Surgeons. The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Clostridioides difficile Infection. Dis Colon Rectum. 2021 Jun 1;64(6):650-668. doi: 10.1097/DCR.0000000000002047. PMID: 33769319.
Disclaimer
The information in this patient summary should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.