Clostridioides difficile-associated disease

Clostridioides difficile-associated disease usually presents with diarrhoea, 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 diarrhoea (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. Faecal 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. Faecal microbiota-based therapies are recommended in patients with multiple recurrences. Bezlotoxumab may be considered in patients at high risk of recurrence.

Infection of the colon caused by the bacteria Clostridioides difficile. Characterised 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]Lawson PA, Citron DM, Tyrrell KL, et al. Reclassification of Clostridium difficile as Clostridioides difficile (Hall and O'Toole 1935) Prévot 1938. Anaerobe. 2016 Aug;40:95-9. http://www.ncbi.nlm.nih.gov/pubmed/27370902?tool=bestpractice.com

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