Infectious Diseases I
Antibiotic therapy is the most important risk factor.
All antibiotic classes have been associated with CDI.
Highest-risk (listed by decreasing risk) antibiotic classes include clindamycin, fluoroquinolones,
cephalosporins/carbapenems, and penicillins.
antagonists
Age older than 65 years
Duration of hospitalization
Cancer chemotherapy
GI surgery
Previous CDI
Decrease the risk of acquiring C. difficile.
Staff, patient, family, caregiver education
Hand hygiene to remove C. difficile spores through nonβalcohol-based handwashing using soap or
chlorhexidine gluconate and water
Contact isolation, including full-barrier precautions (gown and gloves), single-occupancy room,
and the cohorting of patients with a CDI
| d. | Limit reuse or between-patient sharing, and terminal clean patient careβrelated equipment (e.g., |
|---|
digital thermometers, point-of-care blood glucose machines, dietary trays, intravenous infusion
pumps) and rooms (previous antibiotic use by the previous bed occupant may increase the risk of
CDI in the current occupying patient).
Environmental decontamination using bleach-containing cleaning solution
Limit overuse of, and discontinue unnecessary, antibiotic therapy.
Decrease duration of hospital stay.
Discontinue unnecessary gastric acidβreducing pharmacotherapy.
Diagnosis of CDI is based on clinical and laboratory findings.
within 24 consecutive hours.
Rarely, a symptomatic patient will present with ileus and colonic distension with minimal or no
diarrhea.
Patients with cecal CDI or right-sided CDI colitis may have formed stools.
Laboratory findings include stool sample positive for toxigenic C. difficile, C. difficile toxin, or
colonoscopic or histopathologic findings showing pseudomembranous colitis. Available strategies for
detecting toxin-producing C. difficile include:
Testing for C. difficile should only be performed on unformed stool unless patients have ileus.
Identifying the ideal testing strategy remains difficult. Institution-specific decisions for which
test(s) to use should be evidence based and collaborative across interested parties. Moreover,
institutions should consider creating local interdisciplinary guidelines for C. difficile testing to
avoid positive results in colonized patients without infection.
Stool culture with detection of a toxigenic isolate through identification of neutralizable toxin
activity is considered the gold standard test. However, this process could take up to 9 days, limiting
its clinical utility.