Management of Clostridioides difficile Infection
Publication Date: May 31, 2021
Last Updated: March 14, 2022
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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Title
Management of Clostridioides difficile Infection
Authoring Organization
American Society of Colon and Rectal Surgeons
Publication Month/Year
May 31, 2021
Last Updated Month/Year
September 24, 2024
External Publication Status
Published
Country of Publication
US
Inclusion Criteria
Male, Female, Adult, Older adult
Health Care Settings
Ambulatory, Hospital
Intended Users
Epidemiology infection prevention, nurse, nurse practitioner, physician, physician assistant
Diseases/Conditions (MeSH)
D016360 - Clostridium difficile, D003015 - Clostridium Infections
Keywords
Clostridium difficile, Clinical Practice Guidelines, Clostridioides difficile Infections
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.
Methodology
Number of Source Documents
248
Literature Search Start Date
August 31, 2014
Literature Search End Date
September 19, 2020