Sandbox cdi

Clostridium difficile infection

Overview

Diagnostic Criteria

Classification

Risk Factors

Complete Diagnostic Approach

Management Mild Disease Moderate Disease Severe Disease Complicated Disease First Recurrence Second or Further Recurrence

Dos and Don'ts Dos Don'ts

Guidelines

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Clostridium difficile infection is the most common infectious cause of nosocomial diarrhea. Clinical presentation ranges across a broad spectrum from asymptomatic carriage, to diarrheal illness, to complicated disease hallmarked by pseudomembranous colitis, toxic megacolon, or bowel perforation. Diagnosis is established by the presence of diarrheal symptoms coupled with positive stool tests or endoscopic findings. Therapeutic approach and antibiotic choice should be stratified according to severity of disease and risk of recurrence.

Diagnostic Criteria

Each of the following criteria must be present to fulfill the case definition for C. difficile infection:

• The presence of diarrhea, defined as passage of 3 or more unformed stools in 24 or fewer consecutive hours AND
• A stool test positive for the presence of C. difficile organisms, toxins, or genes OR colonoscopic or histopathologic findings demonstrating pseudomembranous colitis

Classification

Risk Factors

Complete Diagnostic Approach

Management

Dos and Don'ts

Dos

Don'ts

Guidelines

Infectious Disease Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA)

• Strategies to Prevent Clostridium difficile Infections in Acute Care Hospitals (2014)
• Clinical Practice Guidelines for Clostridium difficile Infection in Adults (2010)

American College of Gastroenterology (ACG)

• Guidelines for Diagnosis, Treatment, and Prevention of Clostridium difficile Infections (2013)

Association for Professionals in Infection Control and Epidemiology (APIC)

• Preventing Clostridium difficile infections (2011)

Eastern Association for the Surgery of Trauma (EAST)

• Timing and type of surgical treatment of Clostridium difficile-associated disease (2014)

American Society of Colon and Rectal Surgeons (ASCRS)

• Practice Parameters for the Management of Clostridium difficile Infection (2015)

European Society of Clinical Microbiology and Infectious Diseases (ESCMID)

• Update of the Treatment Guidance Document for Clostridium difficile Infection (2014)

References