Managing C difficile: multisociety guidelines for adults and children

  • Clin Infect Dis

  • Jenny Blair, MD
  • Clinical Essentials
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Takeaway

  • 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.

Description

  • 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.

Key details

  • 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.