Guidelines
Clostridioides difficile

Clostridioides difficile

Background

  • Discontinue inciting antibiotics as soon as possible
  • Management of fluids, nutrition and diarrhea
  • Infection control
  • Alternate reasons for diarrhea (ie. laxatives, enteral feeds) or spontaneously self-resolving diarrhea should not receive treatment despite having diarrhea at time of specimen
  • No need to re-test for C. diff after a positive response to treatment as patients may continue to shed C. diff in their stool for several weeks

  • Age greater than 65
  • Prior C. difficile infection
  • Recent antibiotics within last 3 months (especially clindamycin, fluoroquinolones, cephalosporins, carbapenems)
  • Immunosuppression (e.g., chemotherapy in last 3 months, solid organ transplantation, HIV, systemic corticosteroid use)
  • Gastric acid suppression therapy (e.g., proton pump inhibitors, H2-receptor antagonists)
  • Bowel diseases and/or bowel surgery
  • Prolonged or recent hospitalization within last 3 months

Other Medications

  • Assess the necessity for new or ongoing PPI therapy against the risk of CDI
  • When assessing patients with a first or subsequent episode of C. difficile infection, actively de-prescribe unnecessary PPIs (AMMI)

  • Insufficient data to provide a recommendation for or against the use of antimotility agents but expert opinion cautions against their use because of its physiologic effect on the gut (AMMI)

  • Insufficient evident to support the use of probiotics for primary prevention of CDI

  • Saccharomyces boulardii or any other probiotics should NOT be used if patient is immunocompromised as there is potential for organisms in probiotic formulations to cause infections in hospitalized patients (IDSA)

  • Vancomycin prophylaxis may be considered for patients with a recent history of multiple recurrences or severe complicated CDI who need re-administration of systemic antimicrobials for a new infection
  • Vancomycin 125mg po BID administered during the course of their systemic antibiotic therapy and for up to 1 week after its completion is an acceptable regimen
  • Probiotics should NOT be administered as an adjunctive CDI treatment to prevent further recurrences

Clinical Approach

Up to the treating clinician's judgment as to whether a patients has mild, moderate, or severe disease

Typical manifestations:

  • Acute diarrhea (≥ 3 loose stools in 24 hours) with no obvious alternative explanation

  • Positive diagnostic laboratory assay

  • Empiric treatment is reasonable in the setting of very high clinical suspicion for CDI (e.g. patients with symptoms of severe or fulminant colitis), pending results of diagnostic testing

  • Treatment is NOT indicated in patients who have a positive diagnostic laboratory assay but do not have diarrhea or other CDI disease manifestations (asymptomatic carriage is common)

Additional Information