Spectrum: Local Antimicrobial Stewardship, for Prisma Health Children’s Hospital-Midlands

Clostridium difficile Infection

Clinical Evaluation

Consider the following factors prior to ordering C. difficile PCR

Signs and Symptoms
  • ≥ 3 loose, watery stools in 24hrs (required)
  • Lower abd pain/cramping
  • Low-grade fever
  • Elevated WBC
  • Radiologic evidence

Confounding Factors
  • Laxative use within 48hrs of diarrhea onset
  • Tube feeds: starting or change of rate
  • Consider stopping laxatives or modifying tube feeds prior to testing

Risk Factors
  • Recent antibiotic use
  • Recent chemotherapy
  • Recent hospitalization
  • Recent PPI use
  • Previous history of C. difficile infection

Should C. difficile or GI panel PCR be ordered?

Hard Stop on Testing

Hard stop on C. difficile PCR if:

  • ≤ 12 months of age OR

  • GI panel PCR if ≥ 72hr after admission

Order cancelled if no stool sample sent within 24hrs

Test Result Positive

Test Result Negative

Treatment

Initial Episode

First Recurrence

Recurrence/relapse is limited to 90 days from initial episode. Onset beyond this threshold should be treated as initial episode.

Second Recurrent Episode/Relapse

Recurrence/relapse is limited to 90 days from initial episode. Onset beyond this threshold should be treated as initial episode.

Third Recurrent Episode/Relapse

Recurrence/relapse is limited to 90 days from initial episode. Onset beyond this threshold should be treated as initial episode.

Critically Ill
  • Hypotension or Shock
  • Illeus
  • Megacolon