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Clostridioides difficile-associated disease

Last reviewed: 5 Oct 2024
Last updated: 23 Jul 2023

Summary

Definition

History and exam

Key diagnostic factors

  • diarrhea
  • abdominal pain
Full details

Other diagnostic factors

  • fever
  • abdominal tenderness
  • nausea and vomiting
  • abdominal distension
  • symptoms of shock
Full details

Risk factors

  • 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
Full details

Diagnostic tests

1st tests to order

  • 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
Full details

Tests to consider

  • cell culture cytotoxicity neutralization assay
  • CT abdomen
  • sigmoidoscopy or colonoscopy
Full details

Emerging tests

  • stool lactoferrin or calprotectin

Treatment algorithm

ACUTE

initial episode: nonsevere

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.

  • Clostridioides difficile-associated disease images
  • Differentials

    • Antibiotic-associated diarrhea (AAD)
    • Ischemic colitis
    • Bacterial or viral gastroenteritis
    More Differentials
  • Guidelines

    • Management of Clostridioides difficile infection (CDI) in hematopoietic cell transplant patients
    • Clostridioides difficile infection: antimicrobial prescribing NICE guideline [NG199]
    More Guidelines
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