Clostridioides difficile-associated disease

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

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Última revisão: 1 Dec 2025

Última atualização: 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.

Definição

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.

História e exame físico

Principais fatores diagnósticos

diarrhea
abdominal pain

Detalhes completos

Outros fatores diagnósticos

fever
abdominal tenderness
nausea and vomiting
abdominal distension
symptoms of shock

Detalhes completos

Fatores de risco

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

Detalhes completos

Investigações diagnósticas

Primeiras investigações a serem solicitadas

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

Detalhes completos

Investigações a serem consideradas

cell culture cytotoxicity neutralization assay
CT abdomen
sigmoidoscopy or colonoscopy

Detalhes completos

Novos exames

stool lactoferrin or calprotectin

Algoritmo de tratamento

AGUDA

initial episode: nonsevere

initial episode: severe

initial episode: fulminant

CONTÍNUA

first recurrence

subsequent recurrence

Colaboradores

Autores

Ali Hassoun, MD, FACP, FIDSA, AAHIVS

Clinical Associate Professor of Medicine

Alabama Infectious Diseases Center

Huntsville

Declarações

AH declares that he has no competing interests.

Revisores

Gregory R. Madden, MD, MSDS

Assistant Professor

Division of Infectious Diseases and International Health

University of Virginia School of Medicine

Charlottesville

Declarações

GRM declares that he has no competing interests.

Satish Keshav, MBBCh, DPhil, FRCP

Consultant Gastroenterologist

Department of Gastroenterology

John Radcliffe Hospital

Oxford

Declarações

SK declares that he has no competing interests.

Ian Beales, MD, FRCP

Clinical Reader and Consultant Gastroenterologist

Norfolk and Norwich University Hospital

Norwich

Declarações

IB declares that he has no competing interests.

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Principais artigos

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 Resumo

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 Resumo

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

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 Resumo

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.

Diagnósticos diferenciais
- Antibiotic-associated diarrhea (AAD)
- Ischemic colitis
- Bacterial or viral gastroenteritis
Mais Diagnósticos diferenciais
Diretrizes
- 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
Mais Diretrizes
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Clostridioides difficile-associated disease

Resumo

Definição

História e exame físico

Principais fatores diagnósticos

Outros fatores diagnósticos

Fatores de risco

Investigações diagnósticas

Primeiras investigações a serem solicitadas

Investigações a serem consideradas

Novos exames

Algoritmo de tratamento

initial episode: nonsevere

initial episode: severe

initial episode: fulminant

first recurrence

subsequent recurrence

Colaboradores

Autores

Ali Hassoun, MD, FACP, FIDSA, AAHIVS

Declarações

Revisores

Gregory R. Madden, MD, MSDS

Declarações

Satish Keshav, MBBCh, DPhil, FRCP

Declarações

Ian Beales, MD, FRCP

Declarações

Créditos aos pareceristas

Declarações

Referências

Principais artigos

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.

Diagnósticos diferenciais

Diretrizes

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