IDSA/SHEA Clostridium difficile Infection - 2018 Update

Clostridium Difficile Infection - 2018 Update

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2 Key Points • C. difficile remains the most important cause of healthcare-associated diarrhea and has become the most commonly identified cause of healthcare-associated infection in adults in the United States. Moreover, C. difficile has established itself as an important community pathogen. • C. difficile infection (CDI) is defined by the presence of symptoms (usually diarrhea) and either a stool test positive for toxins or detection of toxigenic C. difficile or colonoscopic or histopathologic findings revealing pseudomembranous colitis. • Recent estimates suggest the U.S. burden of CDI is close to 500,000 infections annually although the exact magnitude of burden is highly dependent upon the type of diagnostic tests used. • Diagnosis of CDI recommendations are dependent upon institutional policy on which patients to test. See Diagnosis section. • Treatment recommendations no longer include metronidazole as first- line treatment for CDI of any severity. See Treatment section. Adult ➤ To increase comparability between clinical settings, use available standardized case definitions for surveillance of healthcare facility- onset (HO) CDI; community-onset healthcare facility-associated (CO-HCFA); and community-associated (CA) CDI (GP). ➤ At a minimum, conduct surveillance for healthcare facility-onset C. difficile infection (HO-CDI) in all inpatient healthcare facilities to detect elevated rates or outbreaks of CDI within the facility (W-L). ➤ Express the rate of HO-CDI as the number of cases per 10,000 patient- days. Express the CO-HCFA prevalence rate as the number of cases per 1,000 patient admissions (GP). ➤ Stratify data by patient location in order to target control measures when CDI incidence is above national and/or facility reduction goals or if an outbreak is noted (W-L). Pediatric ➤ Use the same standardized case definitions (HO, CO-HCFA, CA) and rate expression (cases per 10,000 patient-days for HO, cases per 1,000 patient admissions for CO-HCFA) in pediatric patients as for adults (GP). ➤ Conduct surveillance for HO-CDI for inpatient pediatric facilities but do not include cases <2 years of age (W-L). ➤ Consider surveillance for CA-CDI to detect trends in the community (W-L). Epidemiology

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