Adult Guidance
Clostridioides difficile Infection

Clostridioides difficile Infection

Definition

Infection of the colon caused by the bacterium Clostridioides difficile that occurs mostly in patients with current/recent antibiotic use and with regular exposure to healthcare settings

Diagnosis

Usually diarrhea (≥3 unformed/liquid stools in 24 hrs or more than normal for individual) with no other plausible cause +/- abdominal pain, cramping and fever

Severe cases (e.g. pseudomembranous colitis):

  • Severe abdominal pain, high fever, organ dysfunction
  • Toxic megacolon presents with signs of acute surgical abdomen and/or sepsis (diarrhea is often absent)
  • Consider testing symptomatic patients with no other plausible reason for diarrhea especially if recent or current exposure to antibiotics
  • Currently no single test to diagnose CDI is completely reliable and the best approach remains controversial

Two commonly used approaches:

  1. Start with highly sensitive test to detect Clostridioides difficile, if positive follow with a test to confirm toxin production
    • If toxin test negative: Consider Clostridioides difficile colonization
  2. Perform two tests simultaneously, one to detect the presence of Clostridioides difficile and one to detect toxin production
    • Concordant results can reliably confirm (both tests positive) or exclude (both tests negative) infection
    • If results conflict and patient is symptomatic, treatment should be based on the pre-test probability of Clostridioides difficile infection

Important: in case of confirmed CDI, do not repeat testing during the same episode and do not test to confirm the resolution of the infection at the end of treatment

Mild Cases:

  • Not usually needed

Severe Cases:

  • White blood cell count
  • Creatinine and electrolytes

Usually not needed unless a complication is suspected; in these cases, consider abdominal CT

Pathogen

Clostridioides difficile

  • Gram-positive spore-forming bacterium widely present in the environment that can be acquired through ingestion of spores
  • Infection can be caused by strains producing toxins when the intestinal mucosa of the colon is inflamed and disrupted

NAP1/027

  • Clostridioides difficile toxigenic strain with a particular virulence that caused outbreaks in recent years especially in North America

Treatment

  • Discontinue any other antibiotics except those treating Clostridioides difficile infection as soon as possible and adopt infection control measures to prevent transmission
  • Always recommend rehydration in patients with diarrhea; anti-diarrheal drugs not routinely necessary
  • Diarrhea may resolve slowly over days, but clinical deterioration of a patient on appropriate treatment should precipitate escalation of treatment and a surgical referral

Additional Information

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