Guidelines
Clostridioides difficile Infection

Clostridioides difficile Infection

Risk Factors

  • Previous antibiotic exposure in last 90 days (clindamycin, fluoroquinolones and penicillins/cephalosporins = highest risk)

  • Previous hospitalization or recent healthcare exposure (last 30 days)

  • Immunocompromised

  • Advanced age (≥ 65 years old)

  • Previous CDI

  • Acid-suppressive agents (proton pump inhibitors)

  • Recent GI surgery

  • Obesity

Other Treatment Considerations

  • Discontinue antibiotics if possible

  • Discontinue anti-motility and pro-motility agents

  • Discontinue acid suppressive agents, especially proton pump inhibitors, if possible

  • Replace fluids and electrolytes as needed

  • Routine screening for C. difficile in hospitalized patients without diarrhea is NOT recommended

  • It is not recommended to perform repeat testing within 7 days during the same episode of diarrhea

More Information

  • McDonald LC, et al. Clinical Practice Guidelines for Clostridium difficile Infection in Adults: 2017 Update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA). Clinical Infectious Diseases. 2018.
  • Cohen SH, et al. Clinical Practice Guidelines for Clostridium difficile Infection in Adults: 2010 Update by the Society for Healthcare Epidemiology of America (SHEA) and the Infectious Diseases Society of America (IDSA). Infect Control Hosp Epidemiol. 2010:431-455.
  • Leffler, DA., and Lamont, JT. Clostridium difficile infection. New England Journal of Medicine. 2015:1539-1548.
  • Stevens, VW., et al. Comparative effectiveness of vancomycin and metronidazole for the prevention of recurrence and death in patients with Clostridium difficile infection. JAMA Internal Medicine. 2017:546-553.
  • Lessa, FC., et al. Burden of Clostridium difficile infection in the United States. New England Journal of Medicine. 2015.
  • Zar, FA., et al. A comparison of vancomycin and metronidazole for the treatment of Clostridium difficile–associated diarrhea, stratified by disease severity. Clinical Infectious Diseases. 2007:302-307.