Clostridium difficile enterocolitis; C difficile-associated diarrhea (CDAD, CDD)
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Etiology
- antibiotics* (within past 6 weeks)
- odds ratio (OR) after any antibiotic (OR=3.56-6.91)
- clindamycin (OR=16.8-20.4)[41] highest risk (OR=25.4)[95]
- cephalosporins/monobactams/carbapenems (OR=4.47-5.68)[41]
- cefdinir (OR=11.0), cefuroxime (OR=9.6), cefpodoxime (OR=9.2)[95]
- fluoroquinolones (OR=5.50-5.65)[41]; ciprofloxacin (OR=6.8)[95]
- penicillins (OR=2.71-3.25);
- amoxicillin (OR=2.0), amoxicillin-clavulanate (OR=8.5)
- macrolides (OR= 2.55-2.65)
- trimethoprim/sulfamethoxazole (OR=1.81-1.84)
- tetracyclines not associated with increase risk of C difficile colitis (OR=0.91-0.92)[41]
- receipt of antibiotic by prior occupant to hospital bed increases risk for C difficile colitis (RR=1.22)[67]
- C difficile colitis may occur without recent antibiotic exposure in patients with inflammatory bowel disease[3]
- gastric acid suppression increases risk[29][73]
- proton pump inhibitors (PPI)[9][11][14][73]
- PPI may alter specific bacteria that increase risk of C difficile colitis[58]
- histamine H2 receptor antagonists[29]
- proton pump inhibitors (PPI)[9][11][14][73]
- tube feeding increases risk[3]
- recent abdominal surgery
- use of glucocorticoids[29]
- hospitalization increases risk[29]
- even without antibiotic use, patients hospitalized in a region with high antibiotic use are at increased risk for C difficile colitis[65]
- age >= 80 increases risk[29]
- severity of C difficile infection increased by
- gastric acid suppression[29]
- use of glucocorticoids[9]
- obesity may increase risk[42]
- dietary trehalose may select for emergence of 2 virulant epidemic strains of C difficile[75]
* also, prolonged or multiple antibiotics
Epidemiology
- most common cause of nosocomial diarrhea
- contamination of the hospital environment with C difficile spores[26]
- prescribing antibiotics to hospitalized patients increases risk for C difficile colitis in next bed occupant[77]
- most cases middle-age to older age
- 18% risk of developing C difficile enterocolitis in patients admitted for infections requiring antibiotics[4]
- prevalence of 0.7% in all hospitalized patients[4]
- age >= 80 years associated with increased severity of infection & increased mortality[29]
- 40-94% of cases in 2 studies community-acquired[30][56]
- 61% of cases community-acquired[87]
- community-acquired infection more common in women
- reservoirs of C. difficile spores include:
- pets, farm animals, prepared foods, newborn infants
- exposure during diaper changes ?
- pets, farm animals, prepared foods, newborn infants
- 1/3 of cases occur without exposure to identified person infected with C difficile[44]
- 39% of community-acquired cases not associated with antibiotic use
- 1.5% of community acquired diarrhea (Salmonella more likely, 1.6%)
- 95% of cases linked to healthcare exposures[31]
- family members can acquire C difficile from recently discharged patients with asymptomatic carriage of C difficile[92]
- BI strain of Clostridium difficile predisposes to relapse[35]
- NAP1/027 strain can lead to severe infection[5]
- 450,000 cases occurred in 2011 in the U.S.
- ~29,000 deaths
- incidence higher in women (RR=1.26), whites (RR=1.72), patients >= 65 years (RR=8.65)
- ~2/3 of cases were healthcare-related
- NAP1 strain more often in healthcare-related cases
- multiply recurrent C difficile colitis increasing in U.S.[74]
- see Clostridium difficile
Pathology
- occurs as a result of synthesis of enterotoxin within the intestinal lumen by specific strains of C difficile
- rarely, C difficile may directly invade the colonic mucosa
- the distal colon is usually involved
Clinical manifestations
- fever may exceed 40 C
- watery diarrhea (bloody diarrhea uncommon)
- abdominal pain, moderate to severe, may be distention*
- diarrhea may be absent in patients with severe ileus or toxic megacolon
- symptoms occur 1-10 weeks after antibiotic therapy
* indicator of severe colitis
Laboratory
- C difficile enterotoxin in stool (EIA)
- good specificity, sensitivity 75-85% (single specimen)[3]
- Clostridium difficile enterotoxin A in stool
- Clostridium difficile enterotoxin B in stool
- Clostridium difficile enterotoxin A+B in stool
- latex agglutination test
- measures glutamate dehydrogenase activity which is produced by toxigenic & non toxigenic strains of C difficile & other bacteria
- sensitive but not specific[3]
- used in conjunction with C difficile enterotoxin in stool
- positive concordant tests rule in C difficile colitis
- negative concordant tests rule out C difficile colitis
- discordant tests require rt-PCR for Clostridium difficile DNA[3]
- Clostridium difficile DNA
- Clostridium difficile toxin genes in stool (PCR)
- positive concordant Clostridium difficile DNA & C difficile enterotoxin in stool (EIA) confirm difficile colitis[3]
- Clostridium difficile culture from stool (not recommended)[3]
- anaerobic stool culture
- cytotoxic effects of enterotoxin B
- 75% sensitivity
- for patients with a high pretest probability of C difficile colitis & a confirmed negative EIA test, order stool enterotoxin B testing rather than repeating an EIA[20]
- complete blood count (CBC) to assess severity
- leukocytosis may reach 50,000 WBC/mm3
- leukocytosis > 15,000 WBC/mm3 is a indicator of severe colitis[3]
- eosinophils in blood
- eosinopenia, 0 eosinophils/uL (none), on admission associated with increased risk for mortality, colectomy, ICU admission, & vasopressor use[83]
- serum creatinine > 50% increase above baseline
- serum creatinine > 1.5 mg/dL[3] indicates severe colitis[3]
- serum albumin < 2.5 g/dL is an indicator of severe colitis[3]
- see ARUP consult[34]
- hospitalized patients with diarrhea who test negative for C difficile colitis should be treated with antidiarrheal agents without further testing or treatment for C difficile[3]
- documenting clearance of C difficile in follow-up of an initial positive test is of no benefit[3], unless patient is rechallenged with antibiotic therapy & develops similar symptoms*[93]
* even if those symptoms would not otherwise suggest C difficile colitis
Diagnostic procedures
- flexible sigmoidoscopy vs colonoscopy
- may be indicated if patient has ileus & no stool is available, or
- when other colonic diseases are in the differential
- ref[3] recommends flexible sigmoidoscopy
- visualization of pseudomembranes is an indicator of severe colitis
Radiology
Complications
- toxic megacolon*
- colonic perforation*
- ileus:
- dehydration, hypovolemia, hypotension, shock*
- hypoalbuminemia
- reactive arthritis (1-4 weeks after onset)
- promotes overgrowth of vancomycin-resistent enterococci (VRE) after treatment with either vancomycin or metronidazole[17]
- relapse more common than reinfection
- 88% of 2nd episode < 8 weeks after 1st = relapse
- 65% of 2nd episode > 8 weeks after 1st = relapse[28]
- opiates increase risk for severe disease, longer hospital stay, & higher hospital readmission rates[81]
- > 75% of patients patients with C difficile colitis receive opioids when they are hospitalized[81]
- mortality ~6%
- risk factors
- age >= 80 years
- gastric acid suppression[29]
- virulent NAP1/027 strain of C difficile
- risk factors
* indicators of severe C difficile colitis
Differential diagnosis
- benign or simple antibiotic-associated diarrhea
- diarrhea caused by other enteric pathogens
- adverse reactions to non-antibiotic agents
- ischemic colitis
- inflammatory bowel disease
- intra-abdominal sepsis
Management
- stop offending agent(s) if possible
- continuation of offending antibiotics during therapy for C difficile-associated diarrhea reduces cure rate[27]
- fidaxomicin 200 mg BID may be more effective than vancomycin if offending antibiotics need to be continued for treatment of other infections[27][40]
- stop proton pump inhibitors (PPI) if possible
- use OF PPI during treatment of C difficile colitis is associated with a 42% increased risk of recurrent infection[32]
- assess severity
- leukocytosis > 15,000 WBC/mm3
- serum creatinine > 50% increase above baseline (or > 1.5 mg/dL[3])
- temperature > 38 C
- clinical or radiographic evidence of severe colitis
- supportive therapy:
- hydration, oral preferred
- correction of electrolyte imbalance
- infection control precautions
- contact isolation
- treat in rooms separated from general population[47]
- dedicated care teams[47]
- contact isolation precautions applies to visitors[55]
- maintain contact precautions for at least 48 hours after diarrhea resolves[76]
- maintain history of C difficile on medical record
- hand-washing
- alcohol-based disinfectants not effective[3][47]
- environmental cleaning with sodium hypochlorite (bleach)
- contact isolation
- avoid anti peristaltic agents
- anti-diarrheal agents
- bismuth subsalicylate (Pepto-Bismol)
- cholestyramine may abdorb enterotoxin
- metronidazole (Flagyl) 500 mg PO TID for 10-14 days[22]
- MKSAP19 no longer recommends metronidazole except for adjunctive intravenous therapy in conjunction with vancomycin for severe colitis[3]
- formerly drug of choice for patients with first episodes of mild-to-moderate C difficile infection[22]
- also used for 1st recurrence of mild-moderate C difficile colitis initially treated with metronidazole
- vancomycin or fidaxomicin rather than metronidazole for initial infection[82]
- IV metronidazole 500 mg every 6 hours if oral therapy NOT possible[7]
- possible ileus or toxic megacolon sufficient to warrant IV therapy[5]
- recurrence after metronidazole therapy is common[10] (47-58% in 2003-2004 {higher in elderly})
- avoid during pregnancy
- do NOT use metronidazole for second recurrence because of risk of neurotoxicity[22]
- vancomycin (oral)
- more effective than metronidazole[3][21]
- equally effective for mild-moderate C difficile colitis[3]
- 125 mg PO QID for 10-14 days[8][22]
- > 14 days may be needed for patients with inflammatory bowel disease[89]
- indications[3]
- first episodes
- severe first episodes[22][71]
- severe or persistent diarrhea & offending antibiotic cannot be stopped
- see Laboratory: & Clinical manifestations: for severity
- recurrent disease
- other than 1st recurrence of mild-moderate C difficile colitis initially treated with metronidazole
- prolonged course (6 weeks) of vancomycin with tapering or pulse doses at the end of treatment (see below)[3]
- fidaxomicin may be indicated in patients previously treated with vancomycin[5]
- when a delay in laboratory confirmation of > 1 day is expected[5]
- oral vancomycin + IV metronidazole for fulminant infection [82.93]
- vanocomycin enema + IV metronidazole if ileus is present[3][93]
- IV vancomycin NOT effective[7]
- more effective than metronidazole[3][21]
- fidaxomicin 200 mg BID (Dificid) FDA-approved 5/11[40]
- initial treatment of severe C difficile colitis[3]
- either vancomycin or fidaxomicin can be used 1st line[93]
- fidaxomicin is preferred agent for severe or non-severe C difficile colitis[3]
- recurrent C difficile colitis after prior treatment with vancomycin[5]
- for patients continuing to receive antibiotics, vancomycin & fidaxomicin with equal efficacy[96]
- other antibiotics: nitazoxanide, oral bacitracin
- 15-20% of patients have recurrence
- retest to confirm C difficile prior to treating relapse
- tissue culture for cytotoxic effects of enterotoxin B may be preferable to EIA[20]
- treat initial relapse of mild to moderate C difficile colitis with 2nd course of initial antibiotic[3]
- 90% respond to treatment of relapse with the initial antibiotic[5]
- addition of bezlotoxumab (Zinplava) to standard-of-care antibiotics is superior to antibiotics alone for preventing recurrent Clostridium difficile colitis (17% vs 28%) [[69]
- fidaxomicin 200 mg BID (Dificid) for recurrent C difficile colitis after prior treatment with vancomycin[5]
- 2nd recurrence: vancomycin taper (6-8 weeks of therapy)
- retest to confirm C difficile prior to treating relapse
- refractory C difficile colitis
- fecal transplantation via colonoscopy[33]
- repeated testing positive for C difficile enterotoxin A or enterotoxin B[6]
- may be treatment of choice for refractory C difficile colitis[48]
- fecal transplantation associated with reduced incidence of sepsis, shorter hospital stay & reduced mortality vs antiotics[88]
- oral capsules of frozen fecal material improved symptoms of C difficile colitis in a small study[53]
- repeat fecal transplantation for recurrence within 8 weeks of initial of initial fecal transplantation[91]
- coadministration of oral tolevamer (experimental)
- alternatives to fecal transplantation
- fecal transplantation superior to fidaxomicin[84]
- intravenous tigecycline may be alternative[19]
- tapering-dose schedule for 6 weeks + 5 oz of kefir with every meal (TID) for duration of antibiotic taper & for 7 weeks afterwards may be an option in patients not candidates for stool transplantation[52]
- vancomycin + rifampin 600 mg BID
- vancomycin + Saccharomyces cerevisiae (brewer's yeast) beginning 4 days prior to 10 days of vancomycin
- vancomycin + cholestyramine 4 gm BIB
- fecal transplantation via colonoscopy[33]
- do not retest, unless treating symptoms refractory to treatment
- if retesting, order tissue culture for cytotoxic effects of enterotoxin B
- surgery: total colectomy
- fulminant colitis with perforation
- toxic megacolon
- prophylaxis:
- antimicrobial stewardship
- 1/4 of Clostridium difficile infections can be prevented by reducing hospital prescriptions for high-risk antibiotics by 1/3
- fluoroquinolones
- beta-lactam/beta-lactamase inhibitors
- extended-spectrum cephalosporins
- 1/4 of Clostridium difficile infections can be prevented by reducing hospital prescriptions for high-risk antibiotics by 1/3
- probiotics
- Saccharomyces boulardii may be of benefit[5][12]
- Lactobaciilus may be useful[16]
- probiotics Bifidobacterium, Lactobacilli, Saccharomyces, & Streptococcus reduces risk of C-difficile diarrhea in patients on antibiotics by 66%[36]
- benefit uncertain in immunosuppressed patients
- Lactobacillus in combination with either Streptococcus or both Bifidobacterium & Streptococcus may be of benefit[72]
- children & hospitalized patients benefit most (NNT=12-20)[79]
- other probiotics NOT of benefit[12]
- probiotics should not be used for primary or secondary prevention[91]
- fecal transplantation effective in reducing risk among patients prescribed antibiotics[3]
- ultraviolet wavelength C germicidal irradiation appears effective in eliminating infectivity of C difficile spores from hospital rooms formerly occupied by patients with C-difficile colitis[70]
- prophylaxis with vancomycin not effective[86]
- antimicrobial stewardship
- prevention
- sodium hypochlorite for decontamination of all potentially contaminated surfaces[5]
- alcohol-based hand rubs do not eradicate C difficile spores
- wash hands with soap & water
- contact precautions
Comparative biology
- taurocholate analog CamSA inhibits C difficile spore germination & prevents disease in mice[38]
Notes
- a U.S. federal educational project helped hospital staff reduce quinolone use & C difficile infections by 20%[90]
- review article[57]
More general terms
Additional terms
References
- ↑ Fekety R Guidelines for the diagnosis and management of Clostridium difficile-associated diarrhea and colitis. American College of Gastroenterology, Practice Parameters Committee. Am J Gastroenterology 92:739-50 1997 PMID: https://www.ncbi.nlm.nih.gov/pubmed/9149180
- ↑ Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 304-305
- ↑ 3.00 3.01 3.02 3.03 3.04 3.05 3.06 3.07 3.08 3.09 3.10 3.11 3.12 3.13 3.14 3.15 3.16 3.17 3.18 3.19 3.20 3.21 3.22 3.23 3.24 3.25 3.26 3.27 Medical Knowledge Self Assessment Program (MKSAP) 14, 15, 16, 17, 18, 19. American College of Physicians, Philadelphia 2006, 2009, 2012, 2015, 2018, 2021.
Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022 - ↑ 4.0 4.1 4.2 Journal Watch 22(5):40, 2002 Kyne L et al Health care costs and mortality associated with nosocomial diarrhea due to Clostridium difficile. Clin Infect Dis 34:346, 2002 PMID: https://www.ncbi.nlm.nih.gov/pubmed/11774082
- ↑ 5.0 5.1 5.2 5.3 5.4 5.5 5.6 5.7 5.8 5.9 Geriatrics Review Syllabus, American Geriatrics Society, 5th edition, 2002-2004;
Geriatric Review Syllabus, 7th edition Parada JT et al (eds) American Geriatrics Society, 2010
Geriatric Review Syllabus, 8th edition (GRS8) Durso SC and Sullivan GN (eds) American Geriatrics Society, 2013
Geriatric Review Syllabus, 9th edition (GRS9) Medinal-Walpole A, Pacala JT, Porter JF (eds) American Geriatrics Society, 2016
Geriatric Review Syllabus, 10th edition (GRS10) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2019
Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022 - ↑ 6.0 6.1 Journal Watch 23(8):63, 2003 Aas J et al Recurrent Clostridium difficile colitis: case series involving 18 patients treated with donor stool administered via a nasogastric tube. Clin Infect Dis. 2003 Mar 1;36(5):580-5. PMID: https://www.ncbi.nlm.nih.gov/pubmed/12594638
- ↑ 7.0 7.1 7.2 Sanford Guide to Antimicrobial Therapy, 2003
- ↑ 8.0 8.1 Micromedex, WLA VA Pharmacy, UpToDate Fekety R et al Treatment of antibiotic-associated Clostridium difficile colitis with oral vancomycin: comparison of two dosage regimens. Am J Med 86:15, 1989 PMID: https://www.ncbi.nlm.nih.gov/pubmed/2910090
- ↑ 9.0 9.1 9.2 Prescriber's Letter 11(8): 2004 Proton Pump Inhibitors Associated with Increased Risk of Clostridium difficile Diarrhea Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=200804&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ 10.0 10.1 Journal Watch 25(13):102, 2005 Musher DM, Aslam S, Logan N, Nallacheru S, Bhaila I, Borchert F, Hamill RJ. Relatively poor outcome after treatment of Clostridium difficile colitis with metronidazole. Clin Infect Dis. 2005 Jun 1;40(11):1586-90. Epub 2005 Apr 25. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15889354
Pepin J, Alary ME, Valiquette L, Raiche E, Ruel J, Fulop K, Godin D, Bourassa C. Increasing risk of relapse after treatment of Clostridium difficile colitis in Quebec, Canada. Clin Infect Dis. 2005 Jun 1;40(11):1591-7. Epub 2005 Apr 25. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15889355
Gerding DN. Metronidazole for Clostridium difficile-associated disease: is it okay for mom? Clin Infect Dis. 2005 Jun 1;40(11):1598-600. Epub 2005 Apr 25. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15889356 - ↑ 11.0 11.1 Dial S et al, Use of gastric acid-suppressive agents and the risk of commumity-acquired Clostridium difficile-associated disease. JAMA 2005; 294:2989 PMID: https://www.ncbi.nlm.nih.gov/pubmed/16413249
- ↑ 12.0 12.1 12.2 The NNT: Co-Administration of Probiotics with Prescribed Antibiotics for Preventing C. Difficile Diarrhea. http://www.thennt.com/nnt/probiotics-for-preventing-c-difficile-diarrhea/
McFarland LV. Meta-analysis of probiotics for the prevention of antibiotic associated diarrhea and the treatment of Clostridium difficile disease. Am J Gastroenterol 2006; 101:812 PMID: https://www.ncbi.nlm.nih.gov/pubmed/16635227
Johnston BC, Ma SS, Goldenberg JZ et al Probiotics for the prevention of Clostridium difficile-associated diarrhea: a systematic review and meta-analysis. Ann Intern Med. 2012 Dec 18;157(12):878-88. PMID: https://www.ncbi.nlm.nih.gov/pubmed/23362517 - ↑ Musher DM, Logan N, Hamill RJ, Dupont HL, Lentnek A, Gupta A, Rossignol JF. Nitazoxanide for the treatment of Clostridium difficile colitis. Clin Infect Dis. 2006 Aug 15;43(4):421-7. Epub 2006 Jul 11. PMID: https://www.ncbi.nlm.nih.gov/pubmed/16838229
Bartlett JG. New drugs for Clostridium difficile infection. Clin Infect Dis. 2006 Aug 15;43(4):428-31. Epub 2006 Jul 11. PMID: https://www.ncbi.nlm.nih.gov/pubmed/16838230 - ↑ 14.0 14.1 Dial S et al, Proton pump inhibitor use and risk of community-acquired Clostridium difficile-associated disease defined by prescription for oral vancomycin therapy. CMAJ 2006, 175:745 PMID: https://www.ncbi.nlm.nih.gov/pubmed/17001054
Cunningham R Proton pump inhibitors and the risk of Clostridium difficile- associated disease: Further evidence from the community. CMAJ 2006, 175:757 PMID: https://www.ncbi.nlm.nih.gov/pubmed/17001056 - ↑ Bartlett JG. Narrative review: the new epidemic of Clostridium difficile- associated enteric disease. Ann Intern Med. 2006 Nov 21;145(10):758-64. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/17116920
- ↑ 16.0 16.1 Hickson M, D'Souza AL, Muthu N, Rogers TR, Want S, Rajkumar C, Bulpitt CJ. Use of probiotic Lactobacillus preparation to prevent diarrhoea associated with antibiotics: randomised double blind placebo controlled trial. BMJ. 2007 Jul 14;335(7610):80. Epub 2007 Jun 29. PMID: https://www.ncbi.nlm.nih.gov/pubmed/17604300
- ↑ 17.0 17.1 Al-Nassir WN et al, Both oral metronidazole and oral vancomycin promote persistent overgrowth of vancomycin-resistant enterococci during treatment of Clostridium difficile-associated disease. Antimicrob Agents Chemother 2008, Apr 28 PMID: https://www.ncbi.nlm.nih.gov/pubmed/18443120
Al-Nassir WN et al, Comparison of clinical and microbial response to treatment of Clostridium difficile-associated disease with metronidazole and vancomycin. Clin Infect Dis 2008, May 20 PMID: https://www.ncbi.nlm.nih.gov/pubmed/18491964 - ↑ Kelly CP CLINICIAN'S CORNER A 76-Year-Old Man With Recurrent Clostridium difficile- Associated Diarrhea. Review of C difficile Infection JAMA 2009, 301(9)March 4 PMID: https://www.ncbi.nlm.nih.gov/pubmed/19190304
- ↑ 19.0 19.1 Herpers BL et al Intravenous tigecycline as adjunctive or alternative therapy for severe refractory Clostridium difficile infection. Clin Infect Dis 2009 Jun 15; 48:1732. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19435431
- ↑ 20.0 20.1 20.2 Nemat H et al Diagnostic value of repeated enzyme immunoassays in Clostridium difficile infection. Am J Gastroenterol 2009 Aug; 104:2035. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19367273
- ↑ 21.0 21.1 Bartlett JG The case for vancomycin as the preferred drug for treatment of Clostridium difficile infection. Clin Infect Dis. 2008 May 15;46(10):1489-92. PMID: https://www.ncbi.nlm.nih.gov/pubmed/18419480
- ↑ 22.0 22.1 22.2 22.3 22.4 22.5 Cohen SH et al 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) Infect Control Hosp Epidemiol. 2010 Mar 22 PMID: https://www.ncbi.nlm.nih.gov/pubmed/20307191 DOI:http://dx.doi.org/ 10.1086/651706 http://www.journals.uchicago.edu/doi/full/10.1086/651706
- ↑ Prescriber's Letter 17(5): 2010 COMMENTARY: Prevention and Treatment of Clostridium difficile GUIDELINES: Clostridium difficile Infection in Adults (SHEA/IDSA Update, 2010) Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=260509&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ Luo RF and Banaei N. Is repeat PCR needed for diagnosis of Clostridium difficile infection? J Clin Microbiol 2010 Oct; 48:3738. PMID: https://www.ncbi.nlm.nih.gov/pubmed/20686078
- ↑ Shannon-Lowe J, Matheson NJ, Cooke FJ, Aliyu SH. Prevention and medical management of Clostridium difficile infection. BMJ 2010 Mar 12; 340:c1296. doi:10.1136/bmj.c1296. PMID: https://www.ncbi.nlm.nih.gov/pubmed/20228142.
Zar FA, Bakkanagari SR, Moorthi KM, Davis MB. A comparison of vancomycin and metronidazole for the treatment of Clostridium difficile-associated diarrhea, stratified by disease severity. Clin Infect Dis 2007 Aug 1; 45(3):302-307. PMID: https://www.ncbi.nlm.nih.gov/pubmed/17599306. - ↑ 26.0 26.1 Dubberke ER et al. Development and validation of a Clostridium difficile infection risk prediction model. Infect Control Hosp Epidemiol 2011 Feb 21 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/21460487 <Internet> http://www.jstor.org/stable/10.1086/658944
Shaughnessy MK et al. Evaluation of hospital room assignment and acquisition of Clostridium difficile infection. Infect Control Hosp Epidemiol 2011 Mar; 32:201. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21460503 - ↑ 27.0 27.1 27.2 Mullane KM et al. Efficacy of fidaxomicin versus vancomycin as therapy for Clostridium difficile infection in individuals taking concomitant antibiotics for other concurrent infections. Clin Infect Dis 2011 Sep 1; 53:440 PMID: https://www.ncbi.nlm.nih.gov/pubmed/21844027
- ↑ 28.0 28.1 Kamboj M et al. Relapse versus reinfection: Surveillance of Clostridium difficile infection. Clin Infect Dis 2011 Nov 15; 53:1003 PMID: https://www.ncbi.nlm.nih.gov/pubmed/21976462
- ↑ 29.0 29.1 29.2 29.3 29.4 29.5 29.6 29.7 29.8 Morrison RH et al. Risk factors associated with complications and mortality in patients with Clostridium difficile infection. Clin Infect Dis 2011 Dec 15; 53:1173. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21976459
- ↑ 30.0 30.1 Khanna S et al. The epidemiology of community-acquired Clostridium difficile infection: A population-based study. Am J Gastroenterol 2012 Jan; 107:89 PMID: https://www.ncbi.nlm.nih.gov/pubmed/22108454
Leffler DA and Lamont JT. Not so nosocomial anymore: The growing threat of community- acquired Clostridium difficile. Am J Gastroenterol 2012 Jan; 107:96. PMID: https://www.ncbi.nlm.nih.gov/pubmed/22218031 - ↑ 31.0 31.1 Centers for Disease Control and Prevention Vital Signs: Preventing Clostridium difficile Infections MMWR: March 6, 2012 / 61(Early Release);1-6 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm61e0306a1.htm
- ↑ 32.0 32.1 Linsky A, Gupta K, Lawler EV, et al. Proton pump inhibitors and risk for recurrent Clostridium difficile infection. Arch Intern Med 2010; 170(9):772-778. PMID: https://www.ncbi.nlm.nih.gov/pubmed/20458084
- ↑ 33.0 33.1 Mattila E et al. Fecal transplantation, through colonoscopy, is effective therapy for recurrent Clostridium difficile infection. Gastroenterology 2012 Mar; 142:490. PMID: https://www.ncbi.nlm.nih.gov/pubmed/22155369
- ↑ 34.0 34.1 ARUP Consult: Clostridioides (Clostridium) difficile The Physician's Guide to Laboratory Test Selection & Interpretation https://www.arupconsult.com/content/clostridium-difficile
ARUP Consult: Clostridioides (Clostridium) difficile Infection Testing Algorithm https://arupconsult.com/algorithm/clostridium-difficile-associated-disease-cdad-testing-algorithm - ↑ 35.0 35.1 Marsh JW et al. Recurrent Clostridium difficile disease: Association of relapse with BI/NAP1/027. J Clin Microbiol 2012 Oct 10; <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23052318 <Internet> http://jcm.asm.org/content/early/2012/10/03/JCM.02291-12
- ↑ 36.0 36.1 Johnston BC Probiotics for the Prevention of Clostridium difficile- Associated Diarrhea: A Systematic Review and Meta-analysis. Ann Intern Med. 13 November 2012 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23362517 <Internet> http://annals.org/article.aspx?articleid=1390418
Johnston BC et al Probiotics for the prevention of pediatric antibiotic- associated diarrhea. Cochrane Database Syst Rev. 2011 Nov 9;(11):CD004827. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/22071814
Friedman G The role of probiotics in the prevention and treatment of antibiotic-associated diarrhea and Clostridium difficile colitis. Gastroenterol Clin North Am. 2012 Dec;41(4):763-79. PMID: https://www.ncbi.nlm.nih.gov/pubmed/23101686
Islam J et al Probiotics for the prevention and treatment of Clostridium difficile in older patients. Age Ageing. 2012 Nov;41(6):706-11. PMID: https://www.ncbi.nlm.nih.gov/pubmed/22718155 - ↑ 37.0 37.1 Khanna S et al. An evaluation of repeat stool testing for Clostridium difficile infection by polymerase chain reaction. J Clin Gastroenterol 2012 Nov/Dec; 46:846. PMID: https://www.ncbi.nlm.nih.gov/pubmed/22334221
- ↑ 38.0 38.1 Howerton A et al. A new strategy for the prevention of Clostridium difficile infections. J Infect Dis. 2013 May;207(10):1498-504 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23420906 <Internet> http://jid.oxfordjournals.org/content/early/2013/02/15/infdis.jit068
Armstrong GD et al. A potential new tool for managing Clostridium difficile infection. J Infect Dis 2013 May 15; 207:1484 PMID: https://www.ncbi.nlm.nih.gov/pubmed/23420904 - ↑ Kelly CP, LaMont JT. Clostridium difficile - more difficult than ever. N Engl J Med. 2008 Oct 30;359(18):1932-40 PMID: https://www.ncbi.nlm.nih.gov/pubmed/18971494
- ↑ 40.0 40.1 40.2 Louie TJ, Miller MA, Mullane KM et al Fidaxomicin versus vancomycin for Clostridium difficile infection. N Engl J Med. 2011 Feb 3;364(5):422-31. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21288078
- ↑ 41.0 41.1 41.2 41.3 41.4 Brown KA et al. Meta-analysis of antibiotics and the risk of community- associated Clostridium difficile infection. Antimicrob Agents Chemother 2013 May; 57:2326 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23478961 <Internet> http://aac.asm.org/content/57/5/2326?ijkey=78437b9941dd0cb73b5bb17c26325e23cfd07460&keytype2=tf_ipsecsha
Deshpande A et al. Community-associated Clostridium difficile infection and antibiotics: A meta-analysis. J Antimicrob Chemother 2013 Apr 25 PMID: https://www.ncbi.nlm.nih.gov/pubmed/23620467 - ↑ 42.0 42.1 Bishara J et al. Obesity as a risk factor for Clostridium difficile infection. Clin Infect Dis 2013 Aug; 57:489 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23645850 <Internet> http://cid.oxfordjournals.org/content/57/4/489
- ↑ Ananthakrishnan AN, Issa M, Binion DG. Clostridium difficile and inflammatory bowel disease. Gastroenterol Clin North Am. 2009 Dec;38(4):711-28 PMID: https://www.ncbi.nlm.nih.gov/pubmed/19913210
- ↑ 44.0 44.1 Eyre DW et al. Diverse sources of C. difficile infection identified on whole-genome sequencing. N Engl J Med 2013 Sep 26; 369:1195 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24066741 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMoa1216064
- ↑ Physician's First Watch, March 5, 2014 David G. Fairchild, MD, MPH, Editor-in-Chief Massachusetts Medical Society http://www.jwatch.org
- ↑ Simor AE. Diagnosis, management, and prevention of Clostridium difficile infection in long-term care facilities: a review. J Am Geriatr Soc. 2010 Aug;58(8):1556-64. PMID: https://www.ncbi.nlm.nih.gov/pubmed/20646106
- ↑ 47.0 47.1 47.2 47.3 Dubberke ER et al SHEA/IDSA Practice Recommendation. Strategies to Prevent Clostridium difficile Infections in Acute Care Hospitals: 2014 Update. Infection Control and Hospital Epidemiology. June 2014. 35(6) <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24799639 <Internet> http://www.jstor.org/stable/10.1086/676023
- ↑ 48.0 48.1 Konijeti GG et al. Cost-effectiveness of competing strategies for management of recurrent Clostridium difficile infection: A decision analysis. Clin Infect Dis 2014 Mar 31; PMID: https://www.ncbi.nlm.nih.gov/pubmed/24692533
Youngster I et al. Fecal microbiota transplant for relapsing Clostridium difficile infection using a frozen inoculum from unrelated donors: A randomized, open-label, controlled pilot study. Clin Infect Dis 2014 Apr 23; PMID: https://www.ncbi.nlm.nih.gov/pubmed/24762631 - ↑ Karas JA, Enoch DA, Aliyu SH. A review of mortality due to Clostridium difficile infection. J Infect. 2010 Jul;61(1):1-8. PMID: https://www.ncbi.nlm.nih.gov/pubmed/20361997
- ↑ Kee VR. Clostridium difficile infection in older adults: a review and update on its management. Am J Geriatr Pharmacother. 2012 Feb;10(1):14-24. PMID: https://www.ncbi.nlm.nih.gov/pubmed/22260856
- ↑ Krier MJ, Triadafilopoulos G. Management of severe Clostridium difficile-associated diarrhea. Dig Dis Sci. 2009 Jun;54(6):1199-202 PMID: https://www.ncbi.nlm.nih.gov/pubmed/19225882
- ↑ 52.0 52.1 Bakken JS. Staggered and tapered antibiotic withdrawal with administration of kefir for recurrent Clostridium difficile infection. Clin Infect Dis 2014 Sep 15; 59:858 PMID: https://www.ncbi.nlm.nih.gov/pubmed/24917658
- ↑ 53.0 53.1 Youngster I et al Oral, Capsulized, Frozen Fecal Microbiota Transplantation for Relapsing Clostridium difficile Infection. JAMA. Published online October 11, 2014 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25322359 <Internet> http://jama.jamanetwork.com/article.aspx?articleid=1916296
- ↑ Lessa FC et al Burden of Clostridium difficile Infection in the United States. N Engl J Med 2015; 372:825-834. February 26, 2015 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25714160 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMoa1408913
- ↑ 55.0 55.1 Orciari Herman A, Sadough S, Sofair A Guidelines Issued on Isolation Precautions for Hospital Visitors; Utility of Face Masks Reviewed Physician's First Watch, April 13, 2015 David G. Fairchild, MD, MPH, Editor-in-Chief Massachusetts Medical Society http://www.jwatch.org
Munoz-Price LS et al Isolation Precautions for Visitors. Infection Control & Hospital Epidemiology. April 10, 2015 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26017347 <Internet> http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=9641478&fileId=S0899823X15000677 - ↑ 56.0 56.1 Hensgens MP, Dekkers OM, Demeulemeester A et al Diarrhoea in general practice: when should a Clostridium difficile infection be considered? Results of a nested case-control study. Clin Microbiol Infect. 2014 Dec;20(12):O1067-74. PMID: https://www.ncbi.nlm.nih.gov/pubmed/25040463
- ↑ 57.0 57.1 Leffler DA, Lamont JT Clostridium difficile Infection. N Engl J Med 2015; 372:1539-1548. April 16, 2015 PMID: https://www.ncbi.nlm.nih.gov/pubmed/25875259
- ↑ 58.0 58.1 Freedberg DE, Toussaint NC, Chen SP et al. Proton pump inhibitors alter specific taxa in the human gastrointestinal microbiome: A crossover trial. Gastroenterology 2015 Oct; 149:883. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26164495 <Internet> http://www.gastrojournal.org/article/S0016-5085%2815%2900933-6/abstract
- ↑ Slimings C, Riley TV. Antibiotics and hospital-acquired Clostridium difficile infection: update of systematic review and meta-analysis. J Antimicrob Chemother. 2014 Apr;69(4):881-91. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/24324224 Free Article
- ↑ Alasmari F, Seiler SM, Hink T, Burnham CA, Dubberke ER. Prevalence and risk factors for asymptomatic Clostridium difficile carriage. Clin Infect Dis. 2014 Jul 15;59(2):216-22. Epub 2014 Apr 21. PMID: https://www.ncbi.nlm.nih.gov/pubmed/24755858 Free PMC Article
- ↑ Centers for Disease Control and Prevention (CDC). Vital signs: preventing Clostridium difficile infections. MMWR Morb Mortal Wkly Rep. 2012 Mar 9;61(9):157-62. PMID: https://www.ncbi.nlm.nih.gov/pubmed/22398844 Free full text
- ↑ Dupont HL. Diagnosis and management of Clostridium difficile infection. Clin Gastroenterol Hepatol. 2013 Oct;11(10):1216-23; Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/23542332
- ↑ Surawicz CM, Brandt LJ, Binion DG et al Guidelines for diagnosis, treatment, and prevention of Clostridium difficile infections. Am J Gastroenterol. 2013 Apr;108(4):478-98; Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/23439232
- ↑ Agency for Healthcare Research and Quality (AHRQ) Early Diagnosis, Prevention, and Treatment of Clostridium difficile: Update. Research Review - Final - Mar. 29, 2016 https://www.effectivehealthcare.ahrq.gov/search-for-guides-reviews-and-reports/?pageaction=displayproduct&productID=2208
- ↑ 65.0 65.1 Brown KA, Jones M, Daneman N et al. Importation, antibiotics, and Clostridium difficile infection in veteran long-term care: A multilevel case-control study. Ann Intern Med 2016 Apr 19 PMID: https://www.ncbi.nlm.nih.gov/pubmed/27088642
- ↑ Knight CL, Surawicz CM. Clostridium difficile Infection. Med Clin North Am. 2013 Jul;97(4):523-36, ix. PMID: https://www.ncbi.nlm.nih.gov/pubmed/23809712
- ↑ 67.0 67.1 Freedberg DE, Salmasian H, Cohen B et al Receipt of Antibiotics in Hospitalized Patients and Risk for Clostridium difficile Infection in Subsequent Patients Who Occupy the Same Bed. JAMA Intern Med. Published online October 10, 2016 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27723860 <Internet> http://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2565687
- ↑ 68.0 68.1 68.2 Carignan A et al. Efficacy of secondary prophylaxis with vancomycin for preventing recurrent Clostridium difficile infections. Am J Gastroenterol 2016 Dec; 111:1834 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27619835 <Internet> http://www.nature.com/ajg/journal/v111/n12/full/ajg2016417a.html
- ↑ Wilcox MH, Gerding DN, Poxton IR et al Bezlotoxumab for Prevention of Recurrent Clostridium difficile Infection. N Engl J Med 2017; 376:305-317 January 26, 2017 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28121498 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMoa1602615
Bartlett JG Bezlotoxumab - A New Agent for Clostridium difficile Infection. N Engl J Med 2017; 376:305-317 January 26, 2017 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28121509 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMe1614726 - ↑ 70.0 70.1 Pegues DA, Han J, Gilmar C, McDonnell B, Gaynes S. Impact of ultraviolet germicidal irradiation for no-touch terminal room disinfection on Clostridium difficile infection incidence among hematology-oncology patients. Infect Control Hosp Epidemiol 2017 Jan; 38:39 PMID: https://www.ncbi.nlm.nih.gov/pubmed/27707423
- ↑ 71.0 71.1 Stevens VW, Nelson RE, Schwab-Daugherty EM et al Comparative Effectiveness of Vancomycin and Metronidazole for the Prevention of Recurrence and Death in Patients With Clostridium difficile Infection. JAMA Intern Med. Published online February 6, 2017 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28166328 <Internet> http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2601079
- ↑ 72.0 72.1 Shen NT, Maw A, Tmanova LL et al. Timely use of probiotics in hospitalized adults prevents clostridium difficile infection: A systematic review with meta-regression analysis. Gastroenterology 2017 Feb 10 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28192108 <Internet> http://www.gastrojournal.org/article/S0016-5085(17)30136-1/abstract
- ↑ 73.0 73.1 73.2 Tariq R, Singh S, Gupta A, Pardi DS, Khanna S. Association of gastric acid suppression with recurrent Clostridium difficile infection: A systematic review and meta-analysis. JAMA Intern Med 2017 Mar 27 PMID: https://www.ncbi.nlm.nih.gov/pubmed/28346595
- ↑ 74.0 74.1 Ma GK, Brensinger CM, Wu Q, Lewis JD Increasing Incidence of Multiply Recurrent Clostridium difficile Infection in the United States: A Cohort Study. Ann Intern Med. 2017. July 4. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28672282 <Internet> http://annals.org/aim/article/2636751/increasing-incidence-multiply-recurrent-clostridium-difficile-infection-united-states-cohort
Saini SD, Waljee AK. Fool Me Thrice: The Evolving Story of Multiply Recurrent Clostridium difficile Infection. Ann Intern Med. 2017. July 4. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28672286 <Internet> http://annals.org/aim/article/2636752/fool-me-thrice-evolving-story-multiply-recurrent-clostridium-difficile-infection - ↑ 75.0 75.1 Wilson FP Common Food Additive Promoting C. diff? MedPage Today. Jan 8, 2018 https://www.medpagetoday.com/blogs/themethodsman/70360
Collins J, Robinson C, Danhof H et al Dietary trehalose enhances virulence of epidemic Clostridium difficile. Nature. Jan 3, 2018 PMID: https://www.ncbi.nlm.nih.gov/pubmed/29310122 https://www.nature.com/articles/nature25178
Abbasi J Did a Sugar Called Trehalose Contribute to the Clostridium difficile Epidemic? JAMA. Published online March 21, 2018 PMID: https://www.ncbi.nlm.nih.gov/pubmed/29562072 https://jamanetwork.com/journals/jama/fullarticle/2675907 - ↑ 76.0 76.1 Banach DB, Bearman G, Barnden M et al Duration of Contact Precautions for Acute-Care Settings. Infection Control & Hospital Epidemiology. Jan 11, 2018 PMID: https://www.ncbi.nlm.nih.gov/pubmed/29321078 https://www.cambridge.org/core/journals/infection-control-and-hospital-epidemiology/article/duration-of-contact-precautions-for-acutecare-settings/94E38FDCE6E1823BD613ABE4E8CB5E56
- ↑ 77.0 77.1 Daneman N. Prescribing Antibiotics to Hospitalized Patients Increases the Risk of Clostridium Difficile Infection for the Next Bed Occupant. Evid Based Med. 2017;22(6):212 https://www.medscape.com/viewarticle/889419
- ↑ McDonald LC, Gerding DN, Johnson S, et al. Clinical Practice Guidelines for Clostridium difficile Infection in Adults and Children: 2017 Update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA). Clin Infect Dis. 2018 Feb 15. PMID: https://www.ncbi.nlm.nih.gov/pubmed/29462280 https://academic.oup.com/cid/advance-article/doi/10.1093/cid/cix1085/4855916
- ↑ 79.0 79.1 Goldenberg JZ, Yap C, Lytvyn L et al. Probiotics for the prevention of Clostridium difficile-associated diarrhea in adults and children. Cochrane Database Syst Rev 2017 Dec 19; 12:CD006095 PMID: https://www.ncbi.nlm.nih.gov/pubmed/29257353
- ↑ Lewis PO, Lundberg TS, Tharp JL, Runnels CW. Implementation of Global Strategies to Prevent Hospital-Onset Clostridium difficile Infection: Targeting Proton Pump Inhibitors and Probiotics. Ann Pharmacother. 2017 Oct;51(10):848-854. Epub 2017 Aug 18. PMID: https://www.ncbi.nlm.nih.gov/pubmed/28821215
- ↑ 81.0 81.1 81.2 Salamon M Clostridium difficile Patients on Opioids Fare Much Worse. Medscape - Jun 03, 2018. https://www.medscape.com/viewarticle/897532
- ↑ 82.0 82.1 Gupta A, Cifu AS, Khanna S. Diagnosis and Treatment of Clostridium difficile Infection. JAMA. Published online August 27, 2018 PMID: https://www.ncbi.nlm.nih.gov/pubmed/30178042 https://jamanetwork.com/journals/jama/fullarticle/2698674
- ↑ 83.0 83.1 Kulaylat AS, Buonomo EL, Scully KW et al Development and Validation of a Prediction Model for Mortality and Adverse Outcomes Among Patients With Peripheral Eosinopenia on Admission for Clostridium difficile Infection. JAMA Surg. Published online September 12, 2018. PMID: https://www.ncbi.nlm.nih.gov/pubmed/30208386 https://jamanetwork.com/journals/jamasurgery/fullarticle/2698956
Wei S, Kao LS Eosinopenia and Adverse Outcomes After Clostridium Difficile Infections. Of Mice and Men. JAMA Surg. Published online September 12, 2018. PMID: https://www.ncbi.nlm.nih.gov/pubmed/30208383 https://jamanetwork.com/journals/jamasurgery/fullarticle/2698952 - ↑ 84.0 84.1 Hvas CL et al. Fecal Microbiota transplantation is superior to fidaxomicin for treatment of recurrent Clostridium difficile infection. Gastroenterology 2019 Jan 2 PMID: https://www.ncbi.nlm.nih.gov/pubmed/30610862 Free Article https://www.gastrojournal.org/article/S0016-5085(18)35434-9/pdf
- ↑ McDonald LC, Gerding DN, Johnson S et al Clinical Practice Guidelines for Clostridium difficile Infection in Adults and Children: 2017 Update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA). Clin Infect Dis. 2018 Mar 19;66(7):987-994. PMID: https://www.ncbi.nlm.nih.gov/pubmed/29562266
- ↑ 86.0 86.1 Caroff DA, Menchaca JT, Zhang Z et al. Oral vancomycin prophylaxis during systemic antibiotic exposure to prevent Clostridiodes difficile infection relapses. Infect Control Hosp Epidemiol 2019 Apr 29 PMID: https://www.ncbi.nlm.nih.gov/pubmed/31030679
- ↑ 87.0 87.1 Turner NA, Grambow SC, Woods CW et al Epidemiologic Trends in Clostridioides difficile Infections in a Regional Community Hospital Network. JAMA Netw Open. 2019;2(10):e1914149. PMID: https://www.ncbi.nlm.nih.gov/pubmed/31664443 https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2753662
- ↑ 88.0 88.1 Ianiro G, Murri R, Sciume GD et al. Incidence of bloodstream infections, length of hospital stay, and survival in patients with recurrent Clostridioides difficile infection treated with fecal microbiota transplantation or antibiotics: A prospective cohort study. Ann Intern Med 2019 Nov 19; 171:695 PMID: https://www.ncbi.nlm.nih.gov/pubmed/31683278 https://annals.org/aim/article-abstract/2754174/incidence-bloodstream-infections-length-hospital-stay-survival-patients-recurrent-clostridioides
- ↑ 89.0 89.1 Lei D, Ollech JE, Andersen M et al. Long-duration oral vancomycin to treat Clostridioides difficile in patients with inflammatory bowel disease is associated with a low rate of recurrence. Am J Gastroenterol 2019 Dec; 114:1904 PMID: https://www.ncbi.nlm.nih.gov/pubmed/31714359
- ↑ 90.0 90.1 Tamma PD et al. Association of a safety program for improving antibiotic use with antibiotic use and hospital-onset Clostridioides difficile infection rates among US hospitals. JAMA Netw Open 2021 Feb 1; 4:e210235 PMID: https://www.ncbi.nlm.nih.gov/pubmed/33635327 Free article https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2776911
- ↑ 91.0 91.1 91.2 Splete H New ACG Guideline for Prevention, Diagnosis, and Treatment of C difficile Medscape - Jun 24, 2021. https://www.medscape.com/viewarticle/953726
Kelly CR et al. ACG Clinical Guidelines: Prevention, diagnosis, and treatment of Clostridioides difficile infections. Am J Gastroenterol 2021 Jun; 116:1124. PMID: https://www.ncbi.nlm.nih.gov/pubmed/34003176 https://journals.lww.com/ajg/Fulltext/2021/06000/ACG_Clinical_Guidelines__Prevention,_Diagnosis,.12.aspx - ↑ 92.0 92.1 Miller AC, Arakkal AT, Sewell DK et al. Risk for asymptomatic household transmission of Clostridioides difficile infection associated with recently hospitalized family members. Emerg Infect Dis 2022 May; 28:932-939 PMID: https://www.ncbi.nlm.nih.gov/pubmed/35447064 PMCID: PMC9045444 Free PMC article https://wwwnc.cdc.gov/eid/article/28/5/21-2023_article
- ↑ 93.0 93.1 93.2 93.3 NEJM Knowledge+ Gastroenterology
- ↑ Johnson S, Lavergne V, Skinner AM, et al. Clinical practice guideline by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA): 2021 focused update guidelines on management of Clostridioides difficile infection in adults. Clin Infect Dis. 2021;73:755-757. PMID: https://www.ncbi.nlm.nih.gov/pubmed/34492699
- ↑ 95.0 95.1 95.2 95.3 Miller AC, Arakkal AT, Sewell DK et al. Comparison of different antibiotics and the risk for community-associated Clostridioides difficile infection: A case-control study. Open Forum Infect Dis 2023 Aug 5; 10:ofad413. PMID: https://www.ncbi.nlm.nih.gov/pubmed/37622034 PMCID: PMC10444966 Free PMC article https://academic.oup.com/ofid/article/10/8/ofad413/7237811
- ↑ 96.0 96.1 Rao K et al. An open-label, randomized trial comparing fidaxomicin to oral vancomycin for the treatment of Clostridioides difficile infection in hospitalized patients receiving concomitant antibiotics for concurrent infections. Clin Infect Dis 2023 Oct 5; [e-pub]. PMID: https://www.ncbi.nlm.nih.gov/pubmed/37797310 https://academic.oup.com/cid/advance-article-abstract/doi/10.1093/cid/ciad606/7292896