Diagnosis and Management of Clostridioides difficile Infection

Epidemiology and Clinical Presentation

C. difficile is the most common identifiable cause of infectious diarrhea in healthcare settings, accounting for 10-25% of all antibiotic-associated diarrhea cases, according to the Infectious Diseases Society of America 1, 2
The Infectious Diseases Society of America states that C. difficile should be suspected in any patient with fever or leukocytosis and diarrhea who received an antibacterial agent within 60 days before onset 1, 2
One-third of patients already colonized with C. difficile will develop symptomatic infection within 2 weeks of receiving antibiotic therapy, as reported by the Journal of the American Geriatrics Society 3, 4, 5

Send a single stool specimen for C. difficile toxin testing (EIA for toxins A and B) or use a two-step algorithm (GDH screening followed by toxin testing), as recommended by Critical Care Medicine 2, 6
Testing is indicated when there are ≥3 unformed stools in 24 hours with recent antibiotic exposure (within 4-6 weeks), according to the Journal of the American Geriatrics Society 3, 4, 5, 6
Toxin assays are 60-90% sensitive and 75-100% specific, particularly when multiple specimens are tested if the first is negative, as reported by the Journal of the American Geriatrics Society 3, 4, 5

Stop the causative antibiotic immediately if clinically feasible, as continued use significantly increases recurrence risk, according to Praxis Medical Insights 6
Start oral vancomycin 125 mg four times daily for 10 days while awaiting test results if clinical suspicion is high and disease appears moderate-to-severe, as recommended by Praxis Medical Insights 6
Never use loperamide, diphenoxylate (Lomotil), or other antimotility agents if C. difficile is suspected or confirmed, as warned by Praxis Medical Insights 6, 7, 8

Use strict handwashing with soap and water after patient contact, as alcohol-based hand sanitizers do not inactivate C. difficile spores, according to the Journal of the American Geriatrics Society and Praxis Medical Insights 3, 4, 5, 6, 8
Place patient in contact isolation to prevent nosocomial transmission, as recommended by the Journal of the American Geriatrics Society 3, 4, 5