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Severe disease is defined as an episode of ''C. difficile'' infection with:<ref>{{Cite journal| doi = 10.1111/1469-0691.12418| issn = 1469-0691| volume = 20 Suppl 2| pages = 1–26| last1 = Debast| first1 = S. B.| last2 = Bauer| first2 = M. P.| last3 = Kuijper| first3 = E. J.| last4 = European Society of Clinical Microbiology and Infectious Diseases| title = European Society of Clinical Microbiology and Infectious Diseases: update of the treatment guidance document for Clostridium difficile infection| journal = Clinical Microbiology and Infection: The Official Publication of the European Society of Clinical Microbiology and Infectious Diseases| date = 2014-03| pmid = 24118601}}</ref> | Severe disease is defined as an episode of ''C. difficile'' infection with:<ref>{{Cite journal| doi = 10.1111/1469-0691.12418| issn = 1469-0691| volume = 20 Suppl 2| pages = 1–26| last1 = Debast| first1 = S. B.| last2 = Bauer| first2 = M. P.| last3 = Kuijper| first3 = E. J.| last4 = European Society of Clinical Microbiology and Infectious Diseases| title = European Society of Clinical Microbiology and Infectious Diseases: update of the treatment guidance document for Clostridium difficile infection| journal = Clinical Microbiology and Infection: The Official Publication of the European Society of Clinical Microbiology and Infectious Diseases| date = 2014-03| pmid = 24118601}}</ref> | ||
* One or more specific signs and symptoms of severe colitis {{or2}} | * One or more specific signs and symptoms of severe colitis {{or2}} | ||
* A complicated course of disease, with significant systemic toxin effects and shock, resulting in need for ICU admission, colectomy or death. | * A complicated course of disease, with significant systemic toxin effects and shock, resulting in need for ICU admission, colectomy, or death. | ||
==Risk Factors== | ==Risk Factors== | ||
Revision as of 04:19, 25 April 2015
| Clostridium difficile infection |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Clostridium difficile infection is the leading cause to nosocomial diarrhea. Clinical presentation ranges across a broad spectrum from asymptomatic carriage, to diarrheal illness, to complicated disease hallmarked by pseudomembranous colitis, toxic megacolon, or bowel perforation. Diagnosis is established by the presence of diarrheal symptoms coupled with positive stool tests or endoscopic findings. Therapeutic approach and antibiotic choice should be stratified according to severity of disease and risk of recurrence.
Diagnostic Criteria
Infectious Disease Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA)
The diagnosis of C. difficile infection should be based on a combination of clinical and laboratory findings. A case definition for the usual presentation of CDI includes the following findings:[1]
- The presence of diarrhea, defined as passage of 3 or more unformed stools in 24 or fewer consecutive hours AND
- A stool test result positive for the presence of toxigenic C. difficile or its toxins OR colonoscopic or histopathologic findings demonstrating pseudomembranous colitis.
The same criteria should used to diagnose recurrent CDI.
European Society of Clinical Microbiology and Infectious Diseases (ESCMID)
Diagnosis of C. difficile infection is based on the following criteria:[2]
- A combination of signs and symptoms, confirmed by microbiological evidence of C. difficile in stools, in the absence of another cause
OR - Colonoscopic or histopathological findings demonstrating pseudomembranous colitis
Diagnostic tests for CDI include:[3]
- Enzyme immunoassay (EIA): glutamate dehydrogenase (GDH), toxins A and B
- Nucleic acid amplification tests (NAAT): 16S ribosomal RNA, GDH genes, toxin genes
- Cell culture cytoxicity assay (CCA)
- Culture of toxigenic C. difficile
Classification of Disease Severity
Infectious Disease Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA)
Initial episode of C. difficile infection may be stratified by disease severity as follows:[4]
- Mild-to-moderate disease
- Leukocytosis with WBC < 15,000 cells/mL AND Cr < 1.5 times the premorbid level
- Severe disease
- Leukocytosis with WBC ≥ 15,000 cells/mL OR Cr ≥ 1.5 times the premorbid level
- Severe, complicated disease
- Hypotension or shock, ileus, megacolon
European Society of Clinical Microbiology and Infectious Diseases (ESCMID)
Severe disease is defined as an episode of C. difficile infection with:[5]
- One or more specific signs and symptoms of severe colitis
OR - A complicated course of disease, with significant systemic toxin effects and shock, resulting in need for ICU admission, colectomy, or death.
Risk Factors
Complete Diagnostic Approach
Management
Dos and Don'ts
Dos
Don'ts
Guidelines
Infectious Disease Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA)
- Strategies to Prevent Clostridium difficile Infections in Acute Care Hospitals (2014)[6]
- Clinical Practice Guidelines for Clostridium difficile Infection in Adults (2010)[7]
American College of Gastroenterology (ACG)
- Guidelines for Diagnosis, Treatment, and Prevention of Clostridium difficile Infections (2013)[8]
Association for Professionals in Infection Control and Epidemiology (APIC)
- Preventing Clostridium difficile infections (2011)[9]
Eastern Association for the Surgery of Trauma (EAST)
- Timing and type of surgical treatment of Clostridium difficile-associated disease (2014)[10]
American Society of Colon and Rectal Surgeons (ASCRS)
- Practice Parameters for the Management of Clostridium difficile Infection (2015)[11]
European Society of Clinical Microbiology and Infectious Diseases (ESCMID)
- Update of the Treatment Guidance Document for Clostridium difficile Infection (2014)[12]
References
- ↑ Cohen, Stuart H.; Gerding, Dale N.; Johnson, Stuart; Kelly, Ciaran P.; Loo, Vivian G.; McDonald, L. Clifford; Pepin, Jacques; Wilcox, Mark H.; Society for Healthcare Epidemiology of America; Infectious Diseases Society of America (2010-05). "Clinical practice guidelines for Clostridium difficile infection in adults: 2010 update by the society for healthcare epidemiology of America (SHEA) and the infectious diseases society of America (IDSA)". Infection Control and Hospital Epidemiology. 31 (5): 431–455. doi:10.1086/651706. ISSN 1559-6834. PMID 20307191. Check date values in:
|date=(help) - ↑ Debast, S. B.; Bauer, M. P.; Kuijper, E. J.; European Society of Clinical Microbiology and Infectious Diseases (2014-03). "European Society of Clinical Microbiology and Infectious Diseases: update of the treatment guidance document for Clostridium difficile infection". Clinical Microbiology and Infection: The Official Publication of the European Society of Clinical Microbiology and Infectious Diseases. 20 Suppl 2: 1–26. doi:10.1111/1469-0691.12418. ISSN 1469-0691. PMID 24118601. Check date values in:
|date=(help) - ↑ Debast, S. B.; Bauer, M. P.; Kuijper, E. J.; European Society of Clinical Microbiology and Infectious Diseases (2014-03). "European Society of Clinical Microbiology and Infectious Diseases: update of the treatment guidance document for Clostridium difficile infection". Clinical Microbiology and Infection: The Official Publication of the European Society of Clinical Microbiology and Infectious Diseases. 20 Suppl 2: 1–26. doi:10.1111/1469-0691.12418. ISSN 1469-0691. PMID 24118601. Check date values in:
|date=(help) - ↑ Cohen, Stuart H.; Gerding, Dale N.; Johnson, Stuart; Kelly, Ciaran P.; Loo, Vivian G.; McDonald, L. Clifford; Pepin, Jacques; Wilcox, Mark H.; Society for Healthcare Epidemiology of America; Infectious Diseases Society of America (2010-05). "Clinical practice guidelines for Clostridium difficile infection in adults: 2010 update by the society for healthcare epidemiology of America (SHEA) and the infectious diseases society of America (IDSA)". Infection Control and Hospital Epidemiology. 31 (5): 431–455. doi:10.1086/651706. ISSN 1559-6834. PMID 20307191. Check date values in:
|date=(help) - ↑ Debast, S. B.; Bauer, M. P.; Kuijper, E. J.; European Society of Clinical Microbiology and Infectious Diseases (2014-03). "European Society of Clinical Microbiology and Infectious Diseases: update of the treatment guidance document for Clostridium difficile infection". Clinical Microbiology and Infection: The Official Publication of the European Society of Clinical Microbiology and Infectious Diseases. 20 Suppl 2: 1–26. doi:10.1111/1469-0691.12418. ISSN 1469-0691. PMID 24118601. Check date values in:
|date=(help) - ↑ Dubberke, Erik R.; Carling, Philip; Carrico, Ruth; Donskey, Curtis J.; Loo, Vivian G.; McDonald, L. Clifford; Maragakis, Lisa L.; Sandora, Thomas J.; Weber, David J.; Yokoe, Deborah S.; Gerding, Dale N. (2014-09). "Strategies to prevent Clostridium difficile infections in acute care hospitals: 2014 update". Infection Control and Hospital Epidemiology. 35 Suppl 2: –48-65. ISSN 1559-6834. PMID 25376069. Check date values in:
|date=(help) - ↑ Cohen, Stuart H.; Gerding, Dale N.; Johnson, Stuart; Kelly, Ciaran P.; Loo, Vivian G.; McDonald, L. Clifford; Pepin, Jacques; Wilcox, Mark H.; Society for Healthcare Epidemiology of America; Infectious Diseases Society of America (2010-05). "Clinical practice guidelines for Clostridium difficile infection in adults: 2010 update by the society for healthcare epidemiology of America (SHEA) and the infectious diseases society of America (IDSA)". Infection Control and Hospital Epidemiology. 31 (5): 431–455. doi:10.1086/651706. ISSN 1559-6834. PMID 20307191. Check date values in:
|date=(help) - ↑ Surawicz, Christina M.; Brandt, Lawrence J.; Binion, David G.; Ananthakrishnan, Ashwin N.; Curry, Scott R.; Gilligan, Peter H.; McFarland, Lynne V.; Mellow, Mark; Zuckerbraun, Brian S. (2013-04). "Guidelines for diagnosis, treatment, and prevention of Clostridium difficile infections". The American Journal of Gastroenterology. 108 (4): 478–498, quiz 499. doi:10.1038/ajg.2013.4. ISSN 1572-0241. PMID 23439232. Check date values in:
|date=(help) - ↑ Rebmann, Terri; Carrico, Ruth M.; Association for Professionals in Infection Control and Epidemiology, null (2011-04). "Preventing Clostridium difficile infections: an executive summary of the Association for Professionals in Infection Control and Epidemiology's elimination guide". American Journal of Infection Control. 39 (3): 239–242. doi:10.1016/j.ajic.2010.10.011. ISSN 1527-3296. PMID 21371783. Check date values in:
|date=(help) - ↑ Ferrada, Paula; Velopulos, Catherine G.; Sultan, Shahnaz; Haut, Elliott R.; Johnson, Emily; Praba-Egge, Anita; Enniss, Toby; Dorion, Heath; Martin, Niels D.; Bosarge, Patrick; Rushing, Amy; Duane, Therese M. (2014-06). "Timing and type of surgical treatment of Clostridium difficile-associated disease: a practice management guideline from the Eastern Association for the Surgery of Trauma". The Journal of Trauma and Acute Care Surgery. 76 (6): 1484–1493. doi:10.1097/TA.0000000000000232. ISSN 2163-0763. PMID 24854320. Check date values in:
|date=(help) - ↑ Steele, Scott R.; McCormick, James; Melton, Genevieve B.; Paquette, Ian; Rivadeneira, David E.; Stewart, David; Buie, W. Donald; Rafferty, Janice (2015-01). "Practice parameters for the management of Clostridium difficile infection". Diseases of the Colon and Rectum. 58 (1): 10–24. doi:10.1097/DCR.0000000000000289. ISSN 1530-0358. PMID 25489690. Check date values in:
|date=(help) - ↑ Debast, S. B.; Bauer, M. P.; Kuijper, E. J.; European Society of Clinical Microbiology and Infectious Diseases (2014-03). "European Society of Clinical Microbiology and Infectious Diseases: update of the treatment guidance document for Clostridium difficile infection". Clinical Microbiology and Infection: The Official Publication of the European Society of Clinical Microbiology and Infectious Diseases. 20 Suppl 2: 1–26. doi:10.1111/1469-0691.12418. ISSN 1469-0691. PMID 24118601. Check date values in:
|date=(help)