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/