Clostridioides difficile

Clostridioides difficile


C. difficile stool testing:

  • Do not send C. difficile stool tests for patients not meeting criteria
  • Do not send C. difficile stool tests to document resolution of disease
  • Repeat testing within 7 days should only be considered in consultation with infectious disease

Management Considerations

Contact Precautions

Place patient in private room with C. difficile precautions

  • Probiotics: Not recommended
  • Prophylaxis: Not recommended
  • Anti-motility Agents: Generally avoid

IV vancomycin is ineffective for treatment of C. diff


Any of:

  • Hypotension/Shock
  • Perforation
  • Pancolitis
  • Toxic megacolon
  • Planned colectomy
  • Receipt of CD-20 inhibitors in previous year (e.g. rituximab, ocrelizumab)
  • Chronic, high-dose steroids (>~20mg prednisone equivalent per day)
  • Active chemotherapy
  • Hematopoietic stem cell transplant, on immunosuppressives
  • >1 risk factor for recurrent CDI (Age ≥65, severe disease on presentation, immunosuppression, episode of CDI in previous 6 months)

Additional Information

May 2023: Updated testing algorithm

These recommendations are meant to guide empiric therapeutic decision making and are not meant to replace sound clinical decision making

  • Rebekah Gass, MD
  • Kyle D. Massey, PharmD
  • Kelly Sawyer, PharmD
  • Sarah Buss, PhD

Mcdonald L, Gerding D, Johnson S, et al. Clinical Practice Guidelines for Clostridium difficile infection in adults and children: 2017 update by the Infectious Diseases Society of America (IDSA) and Society of Healthcare Epidemiology of America (SHEA). CID. 2018;XX(00):1-48. Available here

Johnson S, Lavergne V, Skinner A, et al. Clinical Practice Guideline by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA): 2021 Focused Update Guidelines on Management of Clostridioides difficile Infection in Adults. CID. 2021;73:e1029-e1044. Available Here