Clostridium Difficile Infection (CDI)

Stool testing positive for toxigenic C. difficile without symptoms of C. difficile infection. This does not require any treatment – up to 10% of the population asymptomatically carries toxigenic C. difficile

Acute onset of diarrhea (3 or more loose stools in 24 hours) above patient’s baseline and not attributed to another cause.

•  Send stool for C. difficile testing

•  Consider starting empiric treatment if potentially severe disease (WBC greater than 15 or creatinine greater than 133) or fulminant disease

Acute onset diarrhea (3 or more loose stools in 24 hours) above patient’s baseline and not attributed to another cause.
AND ANY ONE OF:

• Stool testing positive for toxigenic C. difficile

• Pseudomembraneous colitis on endoscopy or histopathology

• Use Contact Precautions Plus until diarrhea is resolved for 72 hours (no need to repeat C. difficile toxin test)

• Frequent hand washing: If soap and water or hand washing sinks are not readily available, use ABHR and wash hands with soap and water as soon as possible - Use dedicated patient equipment, e.g. commodes, stethoscopes, blood pressure cuffs; clean with spore-reducing wipe after use

• Patients with confirmed CDI should be placed in private rooms or cohorted with other confirmed/active CDI cases

• Review all antibiotics and discontinue unless clearly indicated or use lower risk agents if possible (high risk antibiotics include clindamycin, carbapenems, fluoroquinolones, second and third generation cephalosporins)

• Avoid: proton pump inhibitors (e.g. omeprazole, pantoprazole), pro-motility agents (e.g. metoclopramide) and anti-peristaltic agents (e.g. loperamide)