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
Epidemio...
...dult
...comparability between clinical settin...
...imum, conduct surveillance for healthcare fa...
...rate of HO-CDI as the number of cases per 10,000...
...ratify data by patient location in o...
...ediatri...
...e the same standardized case definitions...
...t surveillance for HO-CDI for inpatient...
...surveillance for CA-CDI to detect trends in the...
Diagnosis
...gnosis...
...dult
...≥3 unexplained and new onset unfo...
...stool toxin test as part of a multiple step...
...e or multiple step algorithm for testing (i...
...t perform repeat testing (within 7 days) during...
...nsufficient data to recommend use o...
...diatri...
...high prevalence of asymptomatic carria...
...difficile testing should not be routinely per...
...years and older, C. difficile testing is recom...
...CDI Laboratory Test Recommendations...
...e 1. Summary of Available Tests for CDI...
Infection Prevention and Control
...tion Prevention and Contr...
...patients with CDI in a private room with...
...ohorting is required, it is recommended t...
...oves ( S , H)7...
gowns ( S , M...
...atients with suspected CDI should b...
...t precautions for at least 48 hours after diarr...
...ong contact precautions until discharge i...
...routine or endemic settings, perfo...
In CDI outbreaks or hyper-endemic (s...
...washing with soap and water is preferred if...
Encourage patients to wash hands and sh...
...e disposable patient equipment when possible and e...
...m cleaning with a sporicidal agent sho...
...e measures of cleaning effectiveness to...
...ited data at this time to recommend use of automat...
...eaning with a sporicidal agent should be consid...
...sufficient data to recommend screening fo...
...requency and duration of high-risk ant...
...tibiotic stewardship program. (G, )705...
...tibiotics to be targeted should be based on...
...ough there is an epidemiologic association be...
...ficient data at this time to recommend administ...
Treatment
...atment...
Adult
...herapy with the inciting antibiotic ag...
...ibiotic therapy for CDI should be started empiric...
...nts with an initial CDI episode, we suggest...
...gest using metronidazole for an initial...
...or prolonged courses due to risk of cu...
...in administered orally is the regim...
...sent vancomycin can also be administered per rec...
...ycin dosage is 500 mg orally 4 time...
...subtotal colectomy with preservation of the rec...
...ting loop ileostomy with colonic lavage fo...
...nts with recurrent CDI episodes, w...
...h a recurrent CDI episode within the last si...
...ota transplantation (FMT) is recommended for...
...insufficient data at this time to re...
...iatric...
...ronidazole or vancomycin is recommended for the...
...n with an initial episode of severe CDI, o...
...ren with a second or greater episode of recu...
...microbiota transplantation (FMT) for pediatr...
...le 2. Recommendations for the Treatme...
...tial Treatment Agents for Treatmen...
...endations for the Treatment of C. difficile In...
...Treatment: Metronidazole × 10 days (...
...Treatment: Vancomycin x 10 days (PO) Pediatr...
...commended Treatment: Vancomycin × 10 days (PO or...
...ecommended Treatment: Metronidazole × 10 days (I...
...ended Treatment: Metronidazole × 10 d...
...reatment: Vancomycin x 10 days (PO) Pe...
...mended Treatment: Vancomycin in a tapered...
...eatment: Vancomycin for 10 days followed by r...
...d Treatment: Fecal microbiota transplantation (...