Guidelines for Diagnosis, Treatment, and Prevention of Clostridium difficile Infections

  title={Guidelines for Diagnosis, Treatment, and Prevention of Clostridium difficile Infections},
  author={Christina M. Surawicz and Lawrence J Brandt and David G Binion and Ashwin N. Ananthakrishnan and Scott R. Curry and Peter H. Gilligan and Lynne V Mcfarland and Mark H. Mellow and Brian S Zuckerbraun},
  journal={The American Journal of Gastroenterology},
Clostridium difficile infection (CDI) is a leading cause of hospital-associated gastrointestinal illness and places a high burden on our health-care system. Patients with CDI typically have extended lengths-of-stay in hospitals, and CDI is a frequent cause of large hospital outbreaks of disease. This guideline provides recommendations for the diagnosis and management of patients with CDI as well as for the prevention and control of outbreaks while supplementing previously published guidelines… 

Rational Therapy of Clostridium difficile Infections

Current guidelines have been adapted to new pathways in diagnosing CDI and have included statements on novel therapeutic options such as fidaxomycin and faecal transplant for recurrent disease.

Clostridium difficile infection: update on diagnosis, epidemiology, and treatment strategies.

Clostridium difficile infection can range from benign diarrhea to severe disease associated with substantial morbidity and mortality, and the mainstay of medical treatment remains metronidazole and oral/rectal vancomycin.

Clostridium difficile infection: guideline-based diagnosis and treatment.

The growing clinical and epidemiological significance of CDI compels a robust implementation of multimodal diagnostic, therapeutic, and hygienic standards.

Controversies Around Epidemiology, Diagnosis and Treatment of Clostridium difficile Infection

The literature around some of the recent controversies in the field of C. difficile infection is reviewed, including the addition of a new but costly agent, fidaxomicin, which has seen some disparity between the European and North American guidelines with regard to when it should be used.

Clostridium Difficile Infection: Risk Factors, Diagnosis and Management

  • C. Surawicz
  • Medicine
    Current Treatment Options in Gastroenterology
  • 2015
Treatment should be stratified by severity of disease, with metronidazole use for mild disease cases and vancomycin for severe disease, and in patients with multiple recurrences, fecal microbiota transplant has a high rate of success.

Epidemiology, Diagnosis, and Management of Clostridium difficile Infection in Patients with Inflammatory Bowel Disease

A better understanding of the complex relationship between the gut microbiota, CDI, and IBD is needed and fecal microbiota transplantation can be successful in curing recurrent CDI when other treatments have failed, but may also trigger IBD flare and this warrants caution.

Diagnosis and management of Clostridium difficile infection.

  • T. Korman
  • Medicine, Biology
    Seminars in respiratory and critical care medicine
  • 2015
Biological therapies for the restoration of the intestinal microbiota and monoclonal antibody therapy are promising approaches for CDI management, in particular troublesome recurrent CDI.

Prevention and treatment of Clostridium difficile infection

Clostridium difficile infection is one of the most common intestinal infection often requiring hospitalization and fecal microbiota transplantation is now recommended by most guidelines for recurrent CDI obtaining extremely higher efficacy in comparison to standard treatments.

Current knowledge on the laboratory diagnosis of Clostridium difficile infection

The options for the laboratory diagnosis of CDI within the settings of the most accepted guidelines for CDI diagnosis, treatment, and prevention are reviewed.

Advances in the diagnosis and treatment of Clostridium difficile infections

While the toxigenic culture and the cell cytotoxicity neutralization assay are still recognized as the gold standard for the diagnosis of CDI, new diagnostic approaches such as nucleic acid amplification methods have become available.



Recommendations for Surveillance of Clostridium difficile–Associated Disease

An ad hoc C. difficile surveillance working group was formed to develop interim surveillance definitions and recommendations based on existing literature and expert opinion that can help to improve CDAD surveillance and prevention efforts.

Infection control measures to limit the spread of Clostridium difficile.

  • R. VonbergE. Kuijper C. Wiuff
  • Medicine
    Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases
  • 2008
A review of the literature that can be used for evidence-based guidelines to limit the spread of C. difficile is provided, including early diagnosis of CDAD, surveillance ofCDAD cases, education of staff, appropriate use of isolation precautions, hand hygiene, protective clothing, environmental cleaning and cleaning of medical equipment, good antibiotic stewardship, and specific measures during outbreaks.

Severe Clostridium difficile-associated disease in populations previously at low risk--four states, 2005.

The results of the investigation indicated the presence of severe C. difficile-associated disease in healthy persons living in the community and peripartum women, two populations previously thought to be at low risk.

Factors associated with prolonged symptoms and severe disease due to Clostridium difficile.

The proportion of patients in each category of severity and the risk factors for a more prolonged and complicated course of C. difficile-associated disease are determined to determine to limit morbidity and mortality.

Surveillance for community-associated Clostridium difficile--Connecticut, 2006.

  • Medicine, Biology
    MMWR. Morbidity and mortality weekly report
  • 2008
The findings indicated the presence of occasionally severe CDAD among healthy persons living in the community, including persons with no established risk factors for infection, and Clinicians should consider a diagnosis of CA-CDAD in outpatients with severe diarrhea, even in the absence ofestablished risk factors.

Clostridium difficile Infection in children.

Recent updates in the incidence and epidemiology of C difficile infection among children, including risk factors for infection, are discussed and the importance of CDI in special populations of children, particularly those with inflammatory bowel disease or cancer is highlighted.

Onset of Symptoms and Time to Diagnosis of Clostridium difficile–Associated Disease Following Discharge From an Acute Care Hospital

Patients with a diagnosis of Clostridium difficile–associated disease in the ambulatory care setting are identified and the relationship of symptom onset and diagnosis to prior hospitalization and exposure to antimicrobials is determined.

Vital signs: preventing Clostridium difficile infections.

  • Medicine, Political Science
    MMWR. Morbidity and mortality weekly report
  • 2012
Nearly all CDIs are related to various health-care settings where predisposing antibiotics are prescribed and C. difficile transmission occurs, and hospital-onset CDIs were prevented through an emphasis on infection control.

Recurrence rate of clostridium difficile infection in hospitalized pediatric patients with inflammatory bowel disease

CD infection in patients with IBD results in a higher rate of recurrence and is associated with higher morbidity than the general population, suggesting that CD resulted in increased severity of IBD disease.

Recurrent Clostridium Difficile Disease: Epidemiology and Clinical Characteristics

Recurrent CDAD was found to have a lengthy course involving multiple episodes of diarrhea, abdominal cramping, nausea, and fever and may result in prolonged hospital stays, additional medical costs, and rare serious complications.