Clostridioides difficile Infection Risk and Prevention in Immunocompetent Persons

Risk Assessment and Key Factors

The European Society of Clinical Microbiology and Infectious Diseases recommends that immunocompetent individuals with inflammatory bowel disease (IBD) be considered at higher risk for Clostridioides difficile infection (CDI), with most cases occurring in the presence of specific risk factors such as recent antibiotic exposure or hospitalization 1, 2
The American Gastroenterological Association notes that community-acquired CDI has been increasingly reported, with an estimated 159,000 cases in the USA in 2011, representing 35% of the total CDI burden, and is often associated with outpatient antibiotic prescriptions and acid-suppression medications 3

The Infectious Diseases Society of America recommends antimicrobial stewardship as critical for preventing CDI in all populations, and hand hygiene with soap is recommended for CDI prevention 4, 6
The American College of Gastroenterology suggests a two-step algorithm for diagnosis: first using a highly sensitive test (GDH antigen or nucleic acid amplification), followed by a highly specific test (toxin A/B enzyme immunoassay) 1, 2

The European Society for Clinical Microbiology and Infectious Diseases suggests that for recurrent CDI in immunocompetent adults, fecal microbiota-based therapies are a reasonable option upon completion of standard-of-care antibiotics, and vancomycin taper or fidaxomicin are alternative therapies to prevent recurrent CDI 7, 8
The American Gastroenterological Association recommends that in immunocompetent individuals with a first episode of CDI, standard antibiotic therapy with oral vancomycin or fidaxomicin is typically effective 7, 8