Updated guidelines on the management of Clostridium difficile infection (CDI), with a focus on the use of faecal microbiota transplant, have been published by the British Society of Gastroenterology and Healthcare Infection Society.
The guidelines support the use of faecal microbiota transplant (FMT) as a second-line treatment option in patients with recurrent or refractory CDI, after considering first-line options including antimicrobial therapy and/or antitoxin therapy.
For recurrent infection, the guidelines recommend FMT in patients who have had at least 2 recurrences, or patients with one recurrence and risk factors for further episodes (e.g., severe/complicated infection). FMT should used with caution in immunosuppressed patients.
These recommendations support US guidelines published earlier in the year by the Infectious Diseases Society of America/Society for Healthcare Epidemiology of America.See Management: approach
Patients usually present 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 vancomycin or fidaxomicin. Surgery may be required in fulminant disease.
About 5% to 50% of treated patients have recurrence after discontinuation of therapy, but most respond to a second course of therapy. Faecal microbiota transplantation may be recommended in patients with multiple recurrences.
Infection of the colon caused by the bacteria Clostridium 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, CDI, or CDAD. This topic covers the diagnosis and management of adults only.
The US Clinical and Laboratory Standards Institute announced a nomenclature change of the species name from Clostridium difficile to Clostridioides difficile in 2018; however, this name change has not been widely adopted yet. 
This topic focuses on the diagnosis and management of C difficile infection in adults only.
Clinical Associate Professor of Medicine
Alabama Infectious Diseases Center
AH declares that he has no competing interests.
Department of Epidemiology
Division of General Medicine and Epidemiology
UNC at Chapel Hill
JA declares that he has no competing interests.
Department of Gastroenterology
John Radcliffe Hospital
SK declares that he has no competing interests.
Clinical Reader and Consultant Gastroenterologist
Norfolk and Norwich University Hospital
IB declares that he has no competing interests.
Use of this content is subject to our disclaimer