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.
Need to Know
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.
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
Clinical Key Points
Unexplained & new‐onset diarrhea (unformed or watery stools ≥ 3 in 24 \h)
Pending C.difficile test with high clinical suspicion
Indeterminate C. difficile test
Positive C.difficile test
Endoscopic or histologic evidence of pseudomembranous colitis