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)

Cohen, Stuart H.; Gerding, Dale N.; Johnson, Stuart; Kelly, Ciarán P.; Loo, Vivian G.; McDonald, L. Clifford; Pépin, Jacques; Wilcox, Mark H.

doi:10.1086/651706

Cited by 2,736 publications

(3,453 citation statements)

References 214 publications

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“…It is non-invasive and produces toxins A and B that cause disease, ranging from asymptomatic carriage, to mild diarrhea, to colitis, or pseudomembranous colitis. CDI is defi ned as the acute onset of diarrhea with documented toxigenic C. diffi cile or its toxin and no other documented cause for diarrhea ( 3 ).…”

Section: Epidemiology and Risk Factorsmentioning

confidence: 99%

“…Because C. diffi cile carriage is increased in patients on antimicrobial therapy, only diarrheal stools warrant testing ( 3,14 ). Very occasionally, a patient with ileus and complicated disease will have a formed stool ( 3 ), in which case the laboratory should be made aware of this special clinical situation. Rectal swabs can be used for PCR 26.…”

Section: Microbiology and Diagnosismentioning

confidence: 99%

“…Th is guideline provides recommendations for the diagnosis and management of patients with CDI as well as for the prevention and control of outbreaks. It supplements previously published Infectious Disease Society of America (IDSA)/Society of Hospital Epidemiologists of America (SHEA) and European Society of Clinical Microbiology and Infectious Diseases (ESCMID) guidelines ( 3,4 ) and an evidence-based review ( 5 ).…”

Section: Introductionmentioning

confidence: 99%

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Guidelines for Diagnosis, Treatment, and Prevention of Clostridium difficile Infections

Surawicz

Brandt

Binion

et al. 2013

American Journal of Gastroenterology

1,477

1,408

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Clostridium diffi cile infection (CDI) is a leading cause of hospital-associated gastrointestinal illness and places a high burden on our health-care system. Patients with CDI typically have extended lengths-of-stay in hospitals, and CDI is a frequent cause of large hospital outbreaks of disease. This guideline provides recommendations for the diagnosis and management of patients with CDI as well as for the prevention and control of outbreaks while supplementing previously published guidelines. New molecular diagnostic stool tests will likely replace current enzyme immunoassay tests. We suggest treatment of patients be stratifi ed depending on whether they have mild-to-moderate, severe, or complicated disease. Therapy with metronidazole remains the choice for mildto-moderate disease but may not be adequate for patients with severe or complicated disease. We propose a classifi cation of disease severity to guide therapy that is useful for clinicians. We review current treatment options for patients with recurrent CDI and recommendations for the control and prevention of outbreaks of CDI. Am J Gastroenterol 2013; 108:478-498; doi: 10.1038/ajg.2013 12. In patients in whom oral antibiotics cannot reach a segment of the colon, such as with Hartman's pouch, ileostomy, or colon diversion, vancomycin therapy delivered via enema should be added to treatments above until the patient improves. (Conditional recommendation, low-quality evidence)13. The use of anti-peristaltic agents to control diarrhea from confi rmed or suspected CDI should be limited or avoided, as they may obscure symptoms and precipitate complicated disease. Use of anti-peristaltic agents in the setting of CDI must always be accompanied by medical therapy for CDI. (Strong recommendation, low-quality evidence) Management of severe and complicated CDI14. Supportive care should be delivered to all patients and includes intravenous fl uid resuscitation, electrolyte replacement, and pharmacological venous thromboembolism prophylaxis. Furthermore, in the absence of ileus or signifi cant abdominal distention, oral or enteral feeding should be continued. 17. Vancomycin delivered orally (500 mg four times per day) and per rectum (500 mg in a volume of 500 ml four times a day) plus intravenous metronidazole (500 mg three times a day) is the treatment of choice for patients with complicated CDI with ileus or toxic colon and / or signifi cant abdominal distention. (Strong recommendation, low-quality evidence)18. Surgical consult should be obtained in all patients with complicated CDI. Surgical therapy should be considered in patients with any one of the following attributed to CDI: hypotension requiring vasopressor therapy; clinical signs of sepsis and organ dysfunction (renal and pulmonary); mental status changes; white blood cell count ≥ 50,000 cells / μ l, lactate ≥ 5 mmol / l; or failure to improve on medical therapy after 5 days. (Strong recommendation, moderate-quality evidence) Management of recurrent CDI (RCDI)19. The fi rst recurrence of CDI can be treated ...

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Section: Epidemiology and Risk Factorsmentioning

confidence: 99%

Section: Microbiology and Diagnosismentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Guidelines for Diagnosis, Treatment, and Prevention of Clostridium difficile Infections

Surawicz

Brandt

Binion

et al. 2013

American Journal of Gastroenterology

1,477

1,408

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“…In practice, many labs perform the rapid and easy to perform EIA for toxin A and B detection, though this test lacks sensitivity and is considered a suboptimal approach by current clinical practice guidelines [6]. More recently, nucleic acid amplification tests including real-time PCR and LAMP have been developed for diagnosis of CDI.…”

Section: Accepted M Manuscriptmentioning

confidence: 99%

“…can be implemented for routine use [6]. We performed a meta-analysis to assess the capabilities of LAMP in the diagnosis of CDI.…”

Section: Accepted M Manuscriptmentioning

confidence: 99%

Accuracy of loop-mediated isothermal amplification for the diagnosis of Clostridium difficile infection: a systematic review

Lloyd

Pasupuleti

Thota

et al. 2015

Diagnostic Microbiology and Infectious Disease

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CitationLloyd A, Pasupuleti V, Thota P, Pant C, Rolston DDK, Hernandez A V., et al. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. A C C E P T E D M A N U S C R I P T ACCEPTED MANUSCRIPT

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Oral, Capsulized, Frozen Fecal Microbiota Transplantation for RelapsingClostridium difficileInfection

Youngster

Russell

Pindar

et al. 2014

JAMA

578

435

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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)

Cited by 2,736 publications

References 214 publications

Guidelines for Diagnosis, Treatment, and Prevention of Clostridium difficile Infections

Guidelines for Diagnosis, Treatment, and Prevention of Clostridium difficile Infections

Accuracy of loop-mediated isothermal amplification for the diagnosis of Clostridium difficile infection: a systematic review

Oral, Capsulized, Frozen Fecal Microbiota Transplantation for RelapsingClostridium difficileInfection

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