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Doença associada ao Clostridioides difficile

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Last reviewed: 10 Dec 2025
Last updated: 06 Feb 2025

Summary

Definition

History and exam

Key diagnostic factors

  • presença de fatores de risco
  • diarreia
  • dor abdominal
Full details

Other diagnostic factors

  • febre
  • desconforto abdominal
  • náuseas e vômitos
  • distensão abdominal
  • sintomas de choque
Full details

Risk factors

  • exposição a antibióticos
  • idade avançada
  • hospitalização ou permanência em instituição asilar
  • exposição a familiares infectados
  • história de doença associada ao Clostridioides difficile
  • uso de medicamentos supressores de ácido
  • doença inflamatória intestinal
  • receptores de transplante de órgão sólido
  • receptores de transplante de células-tronco hematopoéticas
  • doença renal crônica
  • Infecção pelo vírus da imunodeficiência humana (HIV)
  • agentes imunossupressores ou quimioterapia
  • cirurgia gastrointestinal
  • deficiência de vitamina D
  • consumo de alimentos contaminados com C difficile
Full details

Diagnostic tests

1st tests to order

  • Hemograma completo
  • teste de guáiaco (exame de sangue oculto nas fezes)
  • reação em cadeia da polimerase das fezes
  • imunoensaio de fezes para glutamato desidrogenase
  • imunoensaio de fezes para toxinas A e B
  • radiografia abdominal
Full details

Tests to consider

  • ensaio de neutralização de citotoxicidade da cultura celular
  • tomografia computadorizada (TC) abdominal
  • sigmoidoscopia ou colonoscopia
Full details

Emerging tests

  • lactoferrina ou calprotectina nas fezes

Treatment algorithm

ACUTE

episódio inicial: não grave

episódio inicial: grave

episódio inicial: fulminante

ONGOING

primeira recorrência

recorrência subsequente

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

Gregory R. Madden, MD, MSDS

Assistant Professor

Division of Infectious Diseases and International Health

University of Virginia School of Medicine

Charlottesville

VA

Disclosures

GRM 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.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

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.Full text  Abstract

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.Full text  Abstract

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.Full text  Abstract

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

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
  • Doença associada ao Clostridioides difficile images

  • Differentials

    • Diarreia associada a antibióticos (DAA)
    • Colite isquêmica
    • Gastroenterite bacteriana ou viral
    More Differentials

  • Guidelines

    • Clinical guidance for C. diff prevention in acute care facilities
    • Clostridioides difficile infection: antimicrobial prescribing NICE guideline
    More Guidelines
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