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{| style="border: 2px solid #A8A8A8; font-size: 90%;"
'''[UNDER CONSTRUCTION]'''
! align="center" style="background: #A8A8A8; padding: 0 10px;" colspan=2 | '''Site of Infection, by Severity or Extent'''
 
! align="center" style="background: #A8A8A8; padding: 0 10px;" | '''Route of Administration'''
 
! align="center" style="background: #A8A8A8; padding: 0 10px;" | '''Setting'''
{{Clostridium difficile infection}}
! align="center" style="background: #A8A8A8; padding: 0 10px;" | '''Duration of Therapy'''
 
==Medical Therapy==
 
====Principles of Therapy====
 
* If a patient has a strong pre-test suspicion for CDI, empiric therapy for CDI should be considered regardless of the laboratory testing result.
:* ''Clostridium difficile'' infection should be suspected in any patient with diarrhea who has received antibiotics within the previous 2 months and/or whose diarrhea began 72 hours or more after hospitalization.<ref name="pmid9149180">Fekety R (1997) [http://www.ncbi.nlm.nih.gov/pubmed/9149180 Guidelines for the diagnosis and management of Clostridium difficile-associated diarrhea and colitis. American College of Gastroenterology, Practice Parameters Committee.] ''Am J Gastroenterol'' 92 (5):739-50. PMID: [http://www.ncbi.nlm.nih.gov/pubmed/9149180]</ref>
 
====Classification of Disease Severity====
 
{| style="border: 2px solid #DCDCDC; font-size: 90%; width: 80%;"
! style="background: #DCDCDC;" | Severity
! style="background: #DCDCDC;" | Definition
|-
|-
! style="background: #DCDCDC; padding: 0 10px;" rowspan=3 | '''Soft-tissue only'''
! style="background: #F5F5F5; padding: 10px 10px;" | Mild
| style="background: #DCDCDC; padding: 0 10px; font-weight: bold;" | Mild (Grade 2)
| style="background: #F5F5F5; padding: 10px 10px;" valign=top | CDI with diarrhea as the only symptom.
| style="background: #DCDCDC; padding: 0 10px;" | Oral (or topical for superficial infections)
| style="background: #DCDCDC; padding: 0 10px;" | Outpatient
| style="background: #DCDCDC; padding: 0 10px; text-align: center;" | 1–2 wk
|-
|-
| style="background: #DCDCDC; padding: 0 10px; font-weight: bold;" | Moderate (Grade 3)
! style="background: #F5F5F5; padding: 10px 10px;" | Moderate
| style="background: #DCDCDC; padding: 0 10px;" | Oral (or initial parenteral)
| style="background: #F5F5F5; padding: 10px 10px;" valign=top | CDI with diarrhea but without additional symptoms/signs meeting the definition of severe or complicated CDI.
| style="background: #DCDCDC; padding: 0 10px;" | Outpatient (or inpatient)
| style="background: #DCDCDC; padding: 0 10px; text-align: center;" | 1–3 wk
|-
|-
| style="background: #DCDCDC; padding: 0 10px; font-weight: bold;" | Severe (Grade 4)
! style="background: #F5F5F5; padding: 10px 10px;" | Severe
| style="background: #DCDCDC; padding: 0 10px;" | Initial parenteral, switch to oral when possible
| style="background: #F5F5F5; padding: 10px 10px;" valign=top | CDI that presents with or develops during the course of the disease with hypoalbuminemia (serum albumin < 3 g/dl) '''<u>and</u>''' either of the following:
| style="background: #DCDCDC; padding: 0 10px;" | Inpatient, then outpatient
* A white blood cell (WBC) count ≥15,000 cells/mm<sup>3</sup>
| style="background: #DCDCDC; padding: 0 10px; text-align: center;" | 2–4 wk
* Abdominal tenderness
|-
|-
! style="background: #F5F5F5; padding: 0 10px;" rowspan=4 | '''Bone or joint'''
! style="background: #F5F5F5; padding: 10px 10px;" | Complicated
| style="background: #DCDCDC; padding: 0 10px; font-weight: bold;" | No residual infected tissue
| style="background: #F5F5F5; padding: 10px 10px;" valign=top | CDI that presents with or develops at least one of the following signs or symptoms:
| style="background: #F5F5F5; padding: 0 10px;" | Parenteral or oral
* Admission to intensive care unit
| style="background: #F5F5F5; padding: 0 10px;" | Inpatient, then outpatient
* Hypotension with or without required use of vasopressors
| style="background: #F5F5F5; padding: 0 10px; text-align: center;" | 2–5 d
* Fever ≥38.5°C
|-
* Ileus or significant abdominal distention
| style="background: #DCDCDC; padding: 0 10px; font-weight: bold;" | Residual infected soft tissue
* Mental status changes
| style="background: #F5F5F5; padding: 0 10px;" | Parenteral or oral
* WBC ≥35,000 cells/mm<sup>3</sup> or &lt;2,000 cells/mm<sup>3</sup>
| style="background: #F5F5F5; padding: 0 10px;" | Inpatient, then outpatient
* Serum lactate levels &gt;2.2 mmol/l
| style="background: #F5F5F5; padding: 0 10px; text-align: center;" | 1–3 wk
* Any evidence of end organ failure
|-
| style="background: #DCDCDC; padding: 0 10px; font-weight: bold;" | Residual infected, viable bone
| style="background: #F5F5F5; padding: 0 10px;" | Initial parenteral, switch to oral when possible
| style="background: #F5F5F5; padding: 0 10px;" | Inpatient, then outpatient
| style="background: #F5F5F5; padding: 0 10px; text-align: center;" | 4–6 wk
|-
| style="background: #DCDCDC; padding: 0 10px; font-weight: bold;" | Residual dead bone or no surgery
| style="background: #F5F5F5; padding: 0 10px;" | Initial parenteral, switch to oral when possible
| style="background: #F5F5F5; padding: 0 10px;" | Inpatient, then outpatient
| style="background: #F5F5F5; padding: 0 10px; text-align: center;" | ≥3 mo
|}
|}
==References==
{{reflist|2}}

Latest revision as of 10:49, 5 June 2014

[UNDER CONSTRUCTION]


C. difficile Infection Microchapters

Home

Patient Information

Overview

Historical Perspective

Pathophysiology

Causes

Classification

Differentiating Clostridium difficile infectionfrom other Diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

Abdominal X Ray

Abdominal CT Scan

Other Imaging Findings

Biopsy

Treatment

Medical Therapy

Surgery

Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Sandbox/00030 On the Web

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Most cited articles

Review articles

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Powerpoint slides

Images

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All Images
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MRI

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Sandbox/00030 in the news

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Directions to Hospitals Treating Clostridium difficile

Risk calculators and risk factors for Sandbox/00030

Medical Therapy

Principles of Therapy

  • If a patient has a strong pre-test suspicion for CDI, empiric therapy for CDI should be considered regardless of the laboratory testing result.
  • Clostridium difficile infection should be suspected in any patient with diarrhea who has received antibiotics within the previous 2 months and/or whose diarrhea began 72 hours or more after hospitalization.[1]

Classification of Disease Severity

Severity Definition
Mild CDI with diarrhea as the only symptom.
Moderate CDI with diarrhea but without additional symptoms/signs meeting the definition of severe or complicated CDI.
Severe CDI that presents with or develops during the course of the disease with hypoalbuminemia (serum albumin < 3 g/dl) and either of the following:
  • A white blood cell (WBC) count ≥15,000 cells/mm3
  • Abdominal tenderness
Complicated CDI that presents with or develops at least one of the following signs or symptoms:
  • Admission to intensive care unit
  • Hypotension with or without required use of vasopressors
  • Fever ≥38.5°C
  • Ileus or significant abdominal distention
  • Mental status changes
  • WBC ≥35,000 cells/mm3 or <2,000 cells/mm3
  • Serum lactate levels >2.2 mmol/l
  • Any evidence of end organ failure

References

  1. ↑ Fekety R (1997) Guidelines for the diagnosis and management of Clostridium difficile-associated diarrhea and colitis. American College of Gastroenterology, Practice Parameters Committee. Am J Gastroenterol 92 (5):739-50. PMID: [1]
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