Management of Clostridioides difficile Infection
Patient Guideline Summary
- 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.
- 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.
- 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 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.
- ASCRS: American Society Of Colon And Rectal Surgeons
- CDI: Clostridioides Difficile Infection