- New Clostridium difficile infection (CDI) management guidelines include multistep algorithmic testing, avoiding first-line metronidazole, option to perform diverting loop ileostomy.
Why this matters
C difficile is the most commonly identified cause of healthcare-associated infection in adults, killing up to 30,000 people in the US annually.
- Literature review, guidelines, funds from Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA).
What is new
- Updates 2010 guideline, which covered adults only.
- Recommendations graded by strength, evidence quality using GRADE method.
- Consider community pediatric surveillance.
- Test if unexplained, new-onset ≥3 unformed stools in 24 hours, not asymptomatic patients.
- Do not test infants ≤1 yr old, who are frequent carriers.
- Avoid routine testing of children aged 1-2 years old with diarrhea.
- Test children ≥2 years old if prolonged/worsening diarrhea and risk factors or exposure.
- Test at-risk patients with stool toxin test as part of algorithm; test suspected cases with nucleic acid amplification test alone or algorithm.
- Consider restricting clindamycin (Cleocin), cephalosporins, fluoroquinolones.
- For initial episode, vancomycin (Vancocin) or fidaxomicin (Dificid) recommended.
- Recurrence: multiple strategies depending on situation and patient age, including fecal transplant.
- Surgical options now include diverting loop ileostomy with colonic lavage plus vancomycin flushes.