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Guidelines
C. difficile Infection (CDI)

C. difficile Infection (CDI)

Definitions

  • 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
  • Acute onset of diarrhea (3 or more loose stools in 24 hours) above patient's baseline and not attributed to another cause

AND ANY ONE OF:

  • Stool testing positive for toxigenic C. difficile
  • Pseudomembraneous colitis on endoscopy or histopathology

Management

  • 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)

Notes

  • 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

Additional Information

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/

Approved: May 2020