Clostridium difficile (C. difficile) is a gram positive, spore-forming, anaerobic bacillus. It is widely distributed in the environment and colonizes up to three to five percent of adults without causing symptoms. It can be acquired in both health care and community settings.
Symptoms of C. difficile can include mild diarrhea, severe cramps, high fever, explosive diarrhea, and dehydration. Severe complications include bowel perforation, septic shock, and death.
Some strains of C. difficile produce spores that are able to survive for long periods on environmental surfaces and are very hard to destroy. The spread of C. difficile occurs when there is inadequate hand hygiene and environmental cleaning.
In addition to routine practices, contact precautions should be initiated for any person who is considered to be at risk for CDI at the onset of symptoms and prior to the receipt of C. difficile testing results. Meticulous hand hygiene practices with either soap and water or an alcohol-based hand rub can reduce the risk of transmission.
If the patient is on antibiotic therapy (except for CDI treatment), it should be discontinued if the patient's condition permits.
Metronidazole is the recommended first-line therapy for mild to moderate CDI. Vancomycin is recommended for severe cases or if metronidazole is ineffective. Recurrent episodes of CDI may be treated with the same antibiotics used initially.
Recurrence of CDI is common and occurs in about 30 percent of cases.
Contact precautions can be discontinued when the client has had at least 48 hours without symptoms of diarrhea (e.g., formed or normal stool for the individual).
Retesting for C. difficile toxin is not necessary to confirm treatment success and should not be done. Toxin may be detectable long after clinical symptoms have resolved.
Revised: 02-06-2014