Clostridium Difficile Infection
Clostridium Difficile Infection (CDI)
Treatment
1st episode, mild-moderate severity
- Treatment: Metronidazole 500 mg PO TID x 10-14 days
1st episode, severe
- Serum WBC ≥15k or creatinine > 1.5x baseline
- Treatment: Vancomycin 125 mg PO QID x 10-14 days
1st episode, severe,complicated
- Hypotension, shock ileus, or megacolon
- Treatment: Vancomycin 500 mg QID PO/NG (PR if ileus) PLUS Metronidazole 500 mg IV q8h
First recurrence
- Same as for 1st episode (because minimal resistance)
Second and more recurrences
- Treatment: Vancomycin PO in tapered or pulsed regimen. Avoid metronidazole overuse because of neurotoxicity.
Background
Definition of Clostridium difficile infection (CDI)
- Presence of diarrhea (3 unformed stools in ≤24 hours)
- Stool test positive for C. difficile or its toxins, or colonoscopic findings of pseudomembranous colitis
Epidemiology
- Accounts for 20-30% of all antibiotic-associated diarrhea
- Most common cause of infectious diarrhea in healthcare settings
Transmission
- Fecal-oral route
- Median time from exposure to C. difficile to diarrhea symptoms = 2-3 days
Risk factors to develop CDI
- Age ≥ 65 years
- Duration of hospitalization
- Exposure to antibiotics (almost every Abx has been assoc with CDI – not just clindamycin)
- 96% have received abx within 14 days before diarrhea onset
- Cancer chemotherapy
- HIV
- GI surgery or manipulation of GI tract (i.e. tube feeding)
Clinical presentation
- Diarrhea may have mucous or occult blood
Recurrence rates
Complications
- Bowel perforation
- Dehydration
- Electrolyte imbalance
- Hypoalbuminemia
- Hypotension
- Renal failure
- SIRS, sepsis
- Toxic megacolon
- Death
References
- Cohen SH, et al. Clinical practice guidelines for Clostridium difficile infection in adults: 2010 update by SHEA and IDSA. Infect Control Hosp Epidemiol. 2010; 31(5):431-55. [PubMed]
- Kelly CP, LaMont JT.Clostridium difficile--more difficult than ever.N Engl J Med. 2008 Oct 30;359(18):1932-40. doi: 10.1056/NEJMra0707500. [PubMed]
