Clostridioides difficile Infection (CDI)

Prevention

The best method to prevent CDI is to minimize the frequency and duration of exposure to high risk antibiotics (such as clindamycin, fluoroquinolones, 3rd and 4th generation cephalosporins, and carbapenems)

Testing

Send stool for C. difficile testing if patient has 3 or more unformed or watery stools in 24 hours (NOT clearly attributable to underlying conditions or laxative use)

Management

  • Accommodate patient in a private room (if possible)

  • Gowns and gloves (masks unnecessary)

  • Perform hand hygiene with soap and water at point of care; if not available, use alcohol hand sanitizer at point of care followed immediately with soap and water at the nearest clean sink (alcohol hand sanitizer does NOT effectively remove C. difficile spores)

  • Results pending but high clinical suspicion

  • Positive C. difficile testing results

  • Colonoscopic or hisopathologic findings of pseudomembranous colitis

If discontinuation of antimicrobials is not possible, de-escalate therapy to narrowest effective spectrum of activity

For example: loperamide, diphenoxylate, opioids, metoclopramide, domperidone, etc.

The use of proton pump inhibitors (PPIs) has been associated with CDI, and may increase the risk of recurrent CDI

More Information

Formerly Clostridium difficile

Guideline content derived from:

  • NB Provincial Health Authorities Anti-Infective Stewardship Committee. Antimicrobial Therapy for Clostridioides difficile Infection (CDI) (formerly Clostridium difficile). 03-2019

  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), Clinical Infectious Diseases. 2018. cix1085, https://doi.org/10.1093/cid/cix1085
  2. Sirbu BD et al. Vancomycin Taper and Pulse Regimen with Careful Follow-up for Patients With Recurrent Clostridium difficile Infection. Clinical Infectious Diseases. 2017;65(8):1396–9
  3. Loo VG, Davis I, Embil J, et al. Association of Medical Microbiology and Infectious Disease Canada treatment practice guidelines for Clostridium difficile infection. Official Journal of the Association of Medical Microbiology and Infectious Disease Canada 3.2, 2018. doi:10.3138/jammi.2018.02.13
  4. Adapted from Vancouver Coastal Health Antimicrobial Stewardship Treatment Guidelines for Common Infections (2011)