Clostridioides difficile-associated disease - Symptoms, Causes, Images, and Treatment Options

Diseases

Highlights & Basics

Key Highlights

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 transplantation is an option in severe and fulminant disease, and recurrent infections.
Up to half of treated patients have recurrence after discontinuation of therapy but most respond to a second course of therapy. Fecal microbiota transplantation is recommended in patients with multiple recurrences. Bezlotoxumab may be considered in patients at high risk of recurrence.

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History & Exam
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Definition

Epidemiology

Etiology

Pathophysiology

Images

CT scan of the abdomen showing gross thickening of the large bowel wall and obliteration of the lumen
CT scan of the abdomen showing diffuse bowel thickening suggestive of colitis

Citations

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): 1-48.[Abstract][Full Text]
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.[Abstract][Full Text]
Beinortas T, Burr NE, Wilcox MH, et al. Comparative efficacy of treatments for Clostridium difficile infection: a systematic review and network meta-analysis. Lancet Infect Dis. 2018 Sep;18(9):1035-44.[Abstract]
Nelson RL, Suda KJ, Evans CT. Antibiotic treatment for Clostridium difficile-associated diarrhoea in adults. Cochrane Database Syst Rev. 2017;(3):CD004610.[Abstract][Full Text]
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.[Abstract][Full Text]

Other Online Resources

WHO: guidelines on hand hygiene
Clostridioides difficile: diagnosis and treatments
CDC: Clostridioides difficile infection

Referenced Articles

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