Management of C. difficile Infection in Patients with Crohn's Disease

Diagnosis and Treatment

• For patients with Crohn's disease and a positive C. difficile test, oral vancomycin or fidaxomicin should be used as first-line therapy, with careful monitoring for both infection resolution and underlying IBD activity 1
• All patients with Crohn's disease who present with worsening gastrointestinal symptoms should be tested for C. difficile infection, as it may mimic or trigger an IBD flare 1
• Rule out other enteric pathogens that may be present, as Crohn's disease patients are more likely to have concurrent infections with norovirus and Campylobacter 1
• Do not escalate immunosuppressive therapy or introduce rescue therapy (infliximab or calcineurin inhibitors) in acute severe colitis associated with C. difficile infection 1
• Corticosteroid therapy for acute severe colitis can be continued during C. difficile treatment 1
• Decisions regarding continuation of immunomodulator therapy should be made on an individual basis, involving the surgical team in discussions 1

Monitoring and Follow-up

• Assess biomarkers of inflammation (fecal calprotectin >150 mg/g, CRP >5 mg/L) to differentiate between ongoing C. difficile infection and IBD flare 2, 3
• After resolution of C. difficile symptoms, evaluate for endoscopic evidence of active IBD inflammation, typically 6-12 months after treatment 4