Stool testing positive without symptoms of CDI
Up to 10% of the population can carry
Can progress to clinical CDI
Does not require treatment - consider ID consult to determine if treatment necessary
Patients not meeting the definition of suspected CDI should NOT be tested
Acute onset of diarrhea (3 or more loose stools in 24 hours) above patient's baseline and not attributed to another cause
Send stool for C. difficile testing
Consider starting empiric treatment if strong suspicion or patient clinically unwell
Also test for bacterial culture, O&P
AND ANY ONE OF:
Stool testing positive for toxigenic C. difficile
Pseudomembraneous colitis on endoscopy or histopathology
Review all antibiotics and discontinue unless clearly indicated (switch to low risk antibiotics if possible)
Stop non-essential proton pump inhibitors
Stop all routine laxatives & stool softeners (ensure PRNs not given)
Stop all antidiarrheals (e.g., loperamide, diphenoxylate/atropine)
Use JBH Clostridoides difficile Infection (CDI) Order Set
IV vancomycin does NOT treat CDI - it is not secreted into the intestinal lumen
IV metronidazole is secreted into the intestinal lumen, but is not sufficient as monotherapy for CDI (used only with vancomycin PO in complicated CDI)
Do not use metronidazole PO and IV together
Usually considered for patients with multiple episodes
Consult ID
Guideline originally sourced from Island Health and adapted by Joseph Brant Hospital
McDonald LC, Gerding DN, 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 for Healthcare Epidemiology of America (SHEA). Clin Infect Dis. 2018;66(7):e1-e48.
Loo VG, Davis I, Embil J, et al. Association of Medical Microbiology and Infectious Disease Canada treatment practice guidelines for Clostridium difficile infection. JAMMI 2018;3:71–92.
The Johns Hopkins University (2020) John Hopkins ABX Guide (1.27) [Mobile App] Retrieved from: www.hopkinsguides.com
Antimicrobial Therapy Inc (2020) The Sanford Guide (4.2) [Mobile App] Retrieved from: www.sanfordguide.com/
