Clostridium diffcile is rapidly becoming the most common healthcare-acquired infection (HAI). In recent years in the U.S and other countries, C diff infection (CDI) has become more frequent, severe and difficult to treat. It is now the most common cause of diarrhea in hospitalized patients who develop diarrheal symptoms. Typically, treatment with antibiotics is considered the main cause of CDI. The increased use of antibiotics in clinical practice has resulted in an increased incidence of CDI over the past two decades. The increased incidence and severity of CDI in the U.S. as well as in other countries has been attributed to the emergence of a new more virulent strain of C diff (the 027 strain).
The diagnosis of CDI is traditionally done by a variety of methods including a review of past medical history, an examination of symptoms and laboratory-based testing. The use of laboratory tests are critical and usually necessary to make the diagnosis of CDI. A number of laboratory stool tests are commercially available for use either alone or in combination to help diagnose the infection. Several types of laboratory test methods are used to examine stool samples for certain toxins (A and B) and a specific enzyme antigen (GDH) produced by the C difficile bacteria.
Past professional guidelines for the diagnosis and treatment of CDI published in 2010 were unclear. To clarify the previously unclear recommendations and improve upon the diaagnosis and management of CDI, new updated professional practice guidelines were issued in early 2018.
For the diagnosis of CDI, the new practice guidelines now recommend a combination of stool toxin and GDH antigen and NAAT testing as part of a Multistep Algorithm Approach for performing laboratory testing. The guidelines also have laboratory guided diagnostic approaches for both adults and children.
Recommendations for treatment of CDI are also updated in the latest practice guidelines. Specific recommendations for antibiotic treatment options have been issued for initial CDI as well as for recurrent CDI and severely ill patients with or without severe complications. There are also recommendations for treatments involving fecal microbiota transplantation and surgery.
The overall objective of the new updated practice guidelines is to improve upon the care of patients with CDI.