Clostridioides difficile Clinical Information

Risk Factors for CDI

• Advanced age (>65 years)
• Recent antimicrobial exposure (within previous 3 months)
  • All antibiotics increase the risk of CDI; clindamycin, beta-lactams, fluoroquinolones, and cephalosporins are most often associated with CDI
  • Even brief antibiotic exposure may result in CDI, though prolonged exposure or use of more than one antibiotic may further increase risk
• Recent hospitalization or long-term care facility admission (within previous 3 months)
• Other potential contributing factors
  • Serious underlying illness; immunocompromising conditions
  • Use of proton-pump inhibitors (causing alteration in stomach acidity)

Signs and Symptoms

• Watery liquid diarrhea 3-15 episodes per day is the most common symptom
• Other symptoms for mild-moderate disease include:
  • Fever
  • Loss of appetite
  • Nausea
  • Abdominal pain/tenderness
• Complications of severe disease
  • Pseudomembranous colitis
  • Toxic megacolon
  • Colon perforation
  • Ileus
  • Death (rare)

Transmission

• Transmission of C. difficile occurs through the fecal-oral route
• C. difficile spores can be transmitted to patients via the hands of health care personnel who have touched a contaminated surface or item
• Any environmental surface can transmit C. difficile spores which are highly resistant to cleaning and disinfection measures.
  • C. difficile is a fastidious anaerobe that dies rapidly in its vegetative state
  • C. difficile spores can remain in the environment for days to months and are highly resistant to cleaning and disinfection measures

Diagnosis

• CDI should be considered in any patient with watery diarrhea or abdominal pain following:
  • antibiotic exposure within previous 3 months
    and/or
  • exposure to a health care setting within the past 3 months
• Due to the changing epidemiology of C. difficile, consider CDI in patient with diarrhea lasting longer than 3 days with fever and/or abdominal pain in the absence of recent antibiotic use or health care exposure.
• C. difficile may also be diagnosed through the endoscopic identification of pseudomembranes.