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
...demiology...
...dult
...mparability between clinical settings, use...
...a minimum, conduct surveillance for healthcar...
...press the rate of HO-CDI as the nu...
...atify data by patient location in order to targe...
...diatric...
...standardized case definitions (HO,...
Conduct surveillance for HO-CDI for inpatient pedi...
...veillance for CA-CDI to detect tre...
Diagnosis
Diagnosis
Adult
...s with ≥3 unexplained and new onset unf...
...stool toxin test as part of a multiple step...
...alone or multiple step algorithm fo...
...repeat testing (within 7 days) during the s...
...re are insufficient data to recomme...
Pediat...
...the high prevalence of asymptomatic carriage of t...
...cile testing should not be routinely...
...years and older, C. difficile testing is recommen...
...Laboratory Test Recommendations Based o...
...of Available Tests for CDI in Decreasi...
Infection Prevention and Control
Infection Prevention a...
...commodate patients with CDI in a private...
...is required, it is recommended to cohort...
...loves ( S , H)7...
...owns ( S , M)705
...spected CDI should be placed on pre-em...
...ontact precautions for at least 48...
...rolong contact precautions until discharg...
...outine or endemic settings, perform hand hygien...
...outbreaks or hyper-endemic (sustained high rate...
...th soap and water is preferred if t...
...ncourage patients to wash hands and shower to redu...
...disposable patient equipment when possible and...
...om cleaning with a sporicidal agent should be cons...
...easures of cleaning effectiveness to ensur...
...re limited data at this time to recom...
...eaning with a sporicidal agent should be...
...nsufficient data to recommend screeni...
...requency and duration of high-risk antibiotic...
...an antibiotic stewardship program. (G,...
...s to be targeted should be based on the l...
...re is an epidemiologic association betwe...
...fficient data at this time to recommend adminis...
Treatment
...reatment...
Adul...
...therapy with the inciting antibiotic...
...apy for CDI should be started empirically for sit...
...patients with an initial CDI episode, we s...
we suggest using metronidazole for an ini...
...repeated or prolonged courses due to risk...
...nistered orally is the regimen of c...
...esent vancomycin can also be admin...
...ycin dosage is 500 mg orally 4 times per...
...btotal colectomy with preservation of the...
...iverting loop ileostomy with coloni...
...ients with recurrent CDI episodes,...
...tients with a recurrent CDI episod...
...microbiota transplantation (FMT) is re...
...insufficient data at this time to recomm...
Pediat...
...azole or vancomycin is recommended for...
...r children with an initial episode o...
...en with a second or greater episod...
...fecal microbiota transplantation (...
...mendations for the Treatment of Clostridi...
...ial Treatment Agents for Treatment of the Primar...
...mmendations for the Treatment of C. d...
...Treatment: Metronidazole × 10 days (...
...d Treatment: Vancomycin x 10 days...
...Treatment: Vancomycin × 10 days (...
...ommended Treatment: Metronidazole × 10 d...
...reatment: Metronidazole × 10 days (PO) P...
...tment: Vancomycin x 10 days (PO) Pediatric Dose:...
...ed Treatment: Vancomycin in a tapered and pul...
...mended Treatment: Vancomycin for 10 days fol...
...eatment: Fecal microbiota transplantation (...