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Guidelines
Clostridium difficile Infection (CDI)

Clostridium difficile Infection (CDI)

Diagnosis

Case Definition
  • Acute onset of diarrhea (≥3 unformed stools in 24 hours)

AND

  • Documented toxigenic C. difficile or toxin presence with no other cause for diarrhea (e.g. laxatives)

Testing

  • Do not send stool for testing if diarrhea not present or ileus

    • Toxin testing cannot be reliably performed

  • Testing is restricted to one specimen within 7 days due to enhanced detection methods

  • Toxin testing is NOT a test of cure, and should not be repeated to document resolution of disease

Refer to Scripps C. difficile Testing Algorithm for more in depth explanation of diagnostic testing and interpretations

Treatment Principles

STOP all other antimicrobial agents whenever possible

  • If antibiotics required: use shortest recommended duration and most targeted therapy for the organism

  • Prolonging the duration of CDI treatment until antibiotic regimens have been completed has no known benefit

Use oral therapy whenever possible for treatment of CDI

  • Efficacy of IV metronidazole monotherapy is not well established

  • NO efficacy of IV vancomycin for CDI

Probiotics and prophylactic oral vancomycin not recommended for prevention of C. difficile based on limited evidence

Avoid anti-peristaltic agents (loperamide, Lomotil®, etc.) and anion-exchange resins (cholestyramine, colestipol)

Treatment - Initial Episodes

Asymptomatic Carriage

Non-Severe

Severe

Fulminant

Treatment - Recurrent Disease

First Recurrence

Second or Subsequent Recurrence

More Information

Reference

2017 Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA) guidelines for CDI. Clin Infect Dis 2018.