Clostridium Difficile Infection

Background

Clostridium difficile is the commonest cause of infectious diarrhea in hospitals.

Implement Contact Plus precautions for suspected or confirmed C.difficile infection (CDI).

For all patients with CDI, discontinue concurrent antibiotics, proton pump inhibitors (PPIs), anti-peristaltic and promotability agents unless these are required. The reason for continuing these medications should be documented.

Medical and surgical management of CDI is based on severity of illness.

It is essential that:

  • Treatment for CDI be initiated promptly and stratified appropriately, as patients/clients (particularly the elderly) can deteriorate rapidly.
  • Asymptomatic patients with positive stool tests (e.g. colonization) or those whose symptoms have spontaneously resolved should generally not be treated
  • C. difficile testing should not be used as a “test of cure” or “treatment endpoint,” as tests may remain positive several months after the episode.
    • For indeterminate test results, repeat testing is not indicated. Consult ASP team

  • At a minimum, daily vital signs (temperature, heart rate, blood pressure).
  • Daily assessment for presence and number of diarrheal episodes, volume of ostomy (where applicable), and consistency.
  • Clinical status should be improving within 4-6 days

Select All That Apply

  1. McDonald LC, Gerding DN, Johnson S, Bakken JS, Carroll KC, Coffin SE, Dubberke ER, Garey KW, Gould CV, Kelly C, Loo V, Sammons JS, Sandora TJ, Wilcox MH. 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). CID 2018;66(1 April):e1- 48.
  2. Loo VG, Davis I, Embil J, Evans GA, Hota S, Lee C, Lee TC, Longtin Y, Louie T, Moayyedi P, Poutanen S, Simor AE, Steiner T, Thampi N, Valiquette L. Association of Medical Microbiology and Infectious Disease Canada treatment practice guidelines for Clostridium difficile infection. JAMMI 2018;3(2):71- 92.
  3. Debast SB, Bauer MP, Kuijper EJ, et al. European Society of Clinical Microbiology and Infectious Diseases: update of the treatment guidance document for Clostridium difficile infection. Clin Microbiol Infect 2014;20(Suppl s2):1–26.