Management of Clostridioides difficile Infection

Diagnosis and Treatment Assessment

Routine testing for C. difficile toxin after treatment is not recommended, as stool tests can remain positive for up to 6 weeks after successful treatment, even when patients are clinically cured, as stated by the American Medical Association and the British Society of Gastroenterology and Healthcare Infection Society 1, 2
The definition of cure/remission from CDI should be based on clinical assessment rather than laboratory testing, as recommended by the British Society of Gastroenterology and Healthcare Infection Society 2
Treatment failure or recurrence should be defined on a case-by-case basis, primarily using clinical symptoms, as suggested by the British Society of Gastroenterology and Healthcare Infection Society 2

Testing should only be considered in specific circumstances, such as persistent CDI symptoms despite appropriate treatment or suspected relapse with new onset of symptoms, as recommended by the British Society of Gastroenterology and Healthcare Infection Society and the American Medical Association 1, 2
The choice of test should be based on the clinical scenario, with Nucleic Acid Amplification Tests (NAATs)/PCR having the highest sensitivity, but unable to distinguish between active infection and colonization, and Toxin EIA being more specific for active disease 3
Multi-step Algorithms, combining GDH plus toxin testing, are recommended as they provide better clinical correlation than PCR alone 3

Clinicians should follow patients for at least 8 weeks after treatment to fully establish efficacy and monitor for adverse events, as recommended by the British Society of Gastroenterology and Healthcare Infection Society 2
Clinical response should be assessed based on resolution of diarrhea, improvement in other symptoms, and return to baseline bowel function, as suggested by the British Society of Gastroenterology and Healthcare Infection Society 2
The Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA) recommend against repeat testing within 7 days during the same episode of diarrhea, as Stool C. difficile PCR can remain positive for up to 6 weeks after successful treatment 3, 1

Patients with Clostridioides difficile infection should be isolated with contact precautions for at least 48 hours after diarrhea has resolved, and consider prolonged isolation precautions until patient discharge in facilities with high CDI rates 3, 4
Implement contact precautions immediately upon suspicion of CDI, including placing the patient in a private room with a dedicated toilet, and prioritize patients with stool incontinence if private rooms are limited 3
Healthcare personnel must use gloves and gowns when entering the room and while caring for CDI patients, and hand hygiene with soap and water or alcohol-based hand hygiene products should be performed before and after patient contact 3
Daily cleaning with a sporicidal agent should be implemented during outbreaks or in high-prevalence settings, and consider sporicidal cleaning if there are repeated cases of CDI in the same room 3
Place patients with suspected CDI on preemptive contact precautions while awaiting test results if results cannot be obtained on the same day, as the frequency of C. difficile acquisition on gloved hands of healthcare personnel after skin contact with infected patients is approximately 69% 3