Clostridium difficile-associated disease

Last reviewed: 2 Sep 2022
Last updated: 17 Aug 2021

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • diarrhoea
  • abdominal pain
More key diagnostic factors

Other diagnostic factors

  • fever
  • abdominal tenderness
  • nausea and vomiting
  • abdominal distension
  • symptoms of shock
Other diagnostic factors

Risk factors

  • antibiotic exposure
  • advanced age
  • hospitalisation or residence in a nursing home
  • exposure to infected family member
  • history of Clostridium difficile-associated disease
  • use of acid-suppressing drugs
  • inflammatory bowel disease
  • solid organ transplant recipients
  • haematopoietic stem cell transplant recipients
  • chronic kidney disease
  • HIV infection
  • immunosuppressive agents or chemotherapy
  • gastrointestinal surgery
  • vitamin D deficiency
More risk factors

Diagnostic investigations

1st investigations to order

  • FBC
  • stool guaiac (faecal occult blood test)
  • stool polymerase chain reaction (PCR)
  • stool immunoassay for glutamate dehydrogenase
  • stool immunoassay for toxins A and B
  • abdominal x-ray
More 1st investigations to order

Investigations to consider

  • cell culture cytotoxicity neutralisation assay
  • CT abdomen
  • sigmoidoscopy or colonoscopy
More investigations to consider

Emerging tests

  • stool lactoferrin or calprotectin

Treatment algorithm

ACUTE

initial episode: non-severe

initial episode: severe

initial episode: fulminant

ONGOING

first recurrence

subsequent recurrence

Contributors

Authors

Ali Hassoun, MD, FACP, FIDSA, AAHIVS

Clinical Associate Professor of Medicine

Alabama Infectious Diseases Center

Huntsville

AL

Disclosures

AH declares that he has no competing interests.

Peer reviewers

Julius Atashili, MD, MPH

Department of Epidemiology

Division of General Medicine and Epidemiology

UNC at Chapel Hill

Chapel Hill

NC

Disclosures

JA declares that he has no competing interests.

Satish Keshav, MBBCh, DPhil, FRCP

Consultant Gastroenterologist

Department of Gastroenterology

John Radcliffe Hospital

Oxford

UK

Disclosures

SK declares that he has no competing interests.

Ian Beales, MD, FRCP

Clinical Reader and Consultant Gastroenterologist

Norfolk and Norwich University Hospital

Norwich

UK

Disclosures

IB declares that he has no competing interests.

  • Clostridium difficile-associated disease images
  • Differentials

    • Antibiotic-associated diarrhoea (AAD)
    • Ischaemic colitis
    • Bacterial or viral gastroenteritis
    More Differentials
  • Guidelines

    • Clostridioides difficile infection: antimicrobial prescribing NICE guideline [NG199]
    • Healthcare Epidemiology of America (SHEA): 2021 focused update guidelines on management of Clostridioides difficile infection in adults
    More Guidelines
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