Clostridioides difficile-associated disease

Descripción general 
Teoría 
Diagnóstico 
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Última revisión: 25 Nov 2025

Última actualización: 06 Feb 2025

Clostridioides difficile-associated disease usually presents with diarrhea, abdominal pain, and leukocytosis, and a history of recent antibiotic use. Other common symptoms include fever, abdominal tenderness, and distension.

Testing should be limited to patients with unexplained, new-onset diarrhea (defined as 3 or more unformed stools in 24 hours). Molecular testing alone or as part of a multistep algorithm is recommended depending on local institutional protocols. May be evidence of pseudomembranes on sigmoidoscopy or colonoscopy in some patients.

Treatment is to discontinue the inciting antimicrobial agent and start therapy with oral fidaxomicin or vancomycin (metronidazole may be used as an alternative option in certain patients and some locations). Surgery may be required in fulminant disease. Fecal microbiota-based therapies may be an option in severe and fulminant disease.

Up to half of treated patients have recurrence after discontinuation of therapy but most respond to a second course of therapy. Fecal microbiota-based therapies are recommended in patients with multiple recurrences. Bezlotoxumab may be considered in patients at high risk of recurrence.

Definición

Infection of the colon caused by the bacteria Clostridioides difficile. Characterized by inflammation of the colon and the formation of pseudomembranes. Occurs in patients whose normal bowel flora has been disrupted by recent antibiotic use. Also known as pseudomembranous colitis, C difficile infection (CDI), or CDAD.

The US Clinical and Laboratory Standards Institute announced a nomenclature change of the species name from Clostridium difficile to Clostridioides difficile in 2018.[1]

This topic focuses on the diagnosis and management of C difficile infection in adults only.

Anamnesis y examen

Principales factores de diagnóstico

diarrhea
abdominal pain

Todos los datos

Otros factores de diagnóstico

fever
abdominal tenderness
nausea and vomiting
abdominal distension
symptoms of shock

Todos los datos

Factores de riesgo

antibiotic exposure
advanced age
hospitalization or residence in a nursing home
exposure to infected family member
history of Clostridioides difficile-associated disease
use of acid-suppressing drugs
inflammatory bowel disease
solid organ transplant recipients
hematopoietic stem cell transplant recipients
chronic kidney disease
HIV infection
immunosuppressive agents or chemotherapy
gastrointestinal surgery
vitamin D deficiency
consumption of C difficile contaminated food

Todos los datos

Pruebas diagnósticas

Primeras pruebas diagnósticas para solicitar

CBC
stool guaiac (fecal occult blood test)
stool polymerase chain reaction (PCR)
stool immunoassay for glutamate dehydrogenase
stool immunoassay for toxins A and B
abdominal x-ray

Todos los datos

Pruebas diagnósticas que deben considerarse

cell culture cytotoxicity neutralization assay
CT abdomen
sigmoidoscopy or colonoscopy

Todos los datos

Pruebas emergentes

stool lactoferrin or calprotectin

Algoritmo de tratamiento

Agudo

initial episode: nonsevere

initial episode: severe

initial episode: fulminant

En curso

first recurrence

subsequent recurrence

Colaboradores

Autores

Ali Hassoun, MD, FACP, FIDSA, AAHIVS

Clinical Associate Professor of Medicine

Alabama Infectious Diseases Center

Huntsville

Divulgaciones

AH declares that he has no competing interests.

Revisores por pares

Gregory R. Madden, MD, MSDS

Assistant Professor

Division of Infectious Diseases and International Health

University of Virginia School of Medicine

Charlottesville

Divulgaciones

GRM declares that he has no competing interests.

Satish Keshav, MBBCh, DPhil, FRCP

Consultant Gastroenterologist

Department of Gastroenterology

John Radcliffe Hospital

Oxford

Divulgaciones

SK declares that he has no competing interests.

Ian Beales, MD, FRCP

Clinical Reader and Consultant Gastroenterologist

Norfolk and Norwich University Hospital

Norwich

Divulgaciones

IB declares that he has no competing interests.

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Artículos principales

McDonald LC, Gerding DN, Johnson S, et al. Clinical practice guidelines for Clostridium difficile infection in adults and children: 2017 update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA). Clin Infect Dis. 2018 Mar 19;66(7):e1-48.Texto completo Resumen

Johnson S, Lavergne V, Skinner AM, et al. Clinical practice guideline by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA): 2021 focused update guidelines on Management of Clostridioides difficile infection in adults. Clin Infect Dis. 2021 Jun 24:ciab549.Texto completo Resumen

Nelson RL, Suda KJ, Evans CT. Antibiotic treatment for Clostridium difficile-associated diarrhoea in adults. Cochrane Database Syst Rev. 2017;(3):CD004610.Texto completo Resumen

van Prehn J, Reigadas E, Vogelzang EH, et al. European Society of Clinical Microbiology and Infectious Diseases: 2021 update on the treatment guidance document for Clostridioides difficile infection in adults. Clin Microbiol Infect. 2021 Dec;27 Suppl 2:S1-S21.Texto completo Resumen

Artículos de referencia

Una lista completa de las fuentes a las que se hace referencia en este tema está disponible para los usuarios con acceso a todo BMJ Best Practice.

Diferenciales
- Antibiotic-associated diarrhea (AAD)
- Ischemic colitis
- Bacterial or viral gastroenteritis
Más Diferenciales
Guías de práctica clínica
- Guideline for the management of Clostridioides difficile infection in pediatric patients with cancer and hematopoietic stem-cell transplantation recipients
- Fecal microbiota-based therapies for select gastrointestinal diseases
Más Guías de práctica clínica
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Clostridioides difficile-associated disease

Resumen

Definición

Anamnesis y examen

Principales factores de diagnóstico

Otros factores de diagnóstico

Factores de riesgo

Pruebas diagnósticas

Primeras pruebas diagnósticas para solicitar

Pruebas diagnósticas que deben considerarse

Pruebas emergentes

Algoritmo de tratamiento

initial episode: nonsevere

initial episode: severe

initial episode: fulminant

first recurrence

subsequent recurrence

Colaboradores

Autores

Ali Hassoun, MD, FACP, FIDSA, AAHIVS

Divulgaciones

Revisores por pares

Gregory R. Madden, MD, MSDS

Divulgaciones

Satish Keshav, MBBCh, DPhil, FRCP

Divulgaciones

Ian Beales, MD, FRCP

Divulgaciones

Agradecimiento de los revisores por pares

Divulgaciones

Referencias

Artículos principales

Artículos de referencia

Una lista completa de las fuentes a las que se hace referencia en este tema está disponible para los usuarios con acceso a todo BMJ Best Practice.

Diferenciales

Guías de práctica clínica

Inicie sesión o suscríbase para acceder a todo el BMJ Best Practice

Inicie sesión o suscríbase para acceder a todo el BMJ Best Practice

Inicie sesión para acceder a todo el BMJ Best Practice