Clostridioides (Clostridium) Difficile Colitis Questions & Answers

Updated: Jul 25, 2019
  • Author: Faten N Aberra, MD, MSCE; Chief Editor: BS Anand, MD  more...
  • Print
Questions & Answers

Overview

What causes Clostridium difficile (C diff) colitis?

What are common symptoms of Clostridium difficile (C diff) colitis?

What are the common physical findings in individuals with Clostridium difficile (C diff) colitis?

When should a diagnosis of Clostridium difficile (C diff) colitis be suspected?

Which lab tests should be performed in the evaluation for Clostridium difficile (C diff) infection (CDI)?

Which are the most sensitive stool assays for assessing Clostridium difficile (C diff) infection (CDI)?

Which imaging study is most useful for diagnosis of Clostridium difficile (C diff) colitis?

Is endoscopy useful for diagnosing Clostridium difficile (C diff) colitis?

What are the treatment options for Clostridium difficile (C diff) colitis?

What is the treatment for relapsed Clostridium difficile (C diff) colitis?

Is fecal microbiota transplantation effective in the treatment of Clostridium difficile (C diff) infection (CDI)?

What is Clostridium difficile (C diff)?

What is the prevalence of Clostridium difficile (C diff) colitis in hospitalized patients?

When should Clostridium difficile (C diff) colitis be suspected?

What is the rate of recurrence of Clostridium difficile (C diff) infection (CDI)?

How does Clostridium difficile (C diff) colitis develop?

What role do antibiotics have in the proliferation of Clostridium difficile (C diff)?

What is the difference between the 2 toxins produced by Clostridium difficile (C diff)?

What are the manifestations of the NAP1 strain of Clostridium difficile (C diff)?

What is the etiology of Clostridium difficile (C diff) colitis?

Which antibiotics increase the risk of developing Clostridium difficile (C diff) colitis?

Does the use of proton pump inhibitors (PPIs) increase the risk for Clostridium difficile (C diff) colitis?

Which antidepressants increase the risk for Clostridium difficile (C diff) infection (CDI)?

What are the risk factors for Clostridium difficile (C diff) colitis infection (CDI)?

Which genes increase the risk for Clostridium difficile (C diff) infection (CDI)?

What is the prevalence of Clostridium difficile (C diff) infection (CDI) in the US?

Has the incidence of reported Clostridium difficile (C diff) infection (CDI) increased over time?

What is the incidence of community-acquired Clostridium difficile (C diff) infection (CDI) compared to hospital-acquired C diff infection?

What is the global incidence of Clostridium difficile (C diff) infection (CDI)?

How does Clostridium difficile (C diff) infection (CDI) affect different age groups?

Is treatment always necessary for Clostridium difficile (C diff) colitis?

Is oral metronidazole or vancomycin effective in the treatment of Clostridium difficile (C diff) colitis?

How common is relapse of Clostridium difficile (C diff) colitis?

What are the complications and mortality rates associated with Clostridium difficile (C diff) infection (CDI)?

What is the prognosis for North American Pulsed Field type 1 and polymerase chain reaction (PCR) ribotype 027 (NAP1/027) strain of Clostridium difficile (C diff)?

What are the prognostic factors for severe outcomes in hospitalized patients with Clostridium difficile (C diff) infection (CDI) who have IBD?

What is fulminant colitis and how common is it as a complication of Clostridium difficile (C diff) infection (CDI)?

What is the prognosis of fulminant Clostridium difficile (C diff) colitis?

How is the toxic megacolon complication of Clostridium difficile (C diff) infection (CDI) diagnosed?

What are signs of colonic perforation in Clostridium difficile (C diff) infection?

Presentation

What are the symptoms of Clostridium difficile (C diff) colitis?

What are the physical findings in Clostridium difficile (C diff) colitis?

DDX

What differential diagnoses should be considered in suspected Clostridium difficile (C diff) colitis?

What are the differential diagnoses for Clostridioides (Clostridium) Difficile Colitis?

Workup

What are the roles of WBC count and serum creatinine in the evaluation of Clostridium difficile (C diff) colitis?

What are the recommendations for stool testing in Clostridium difficile (C diff) infection (CDI)?

When is retesting for Clostridium difficile (C diff) infection (CDI) recommended?

How should stool testing for Clostridium difficile (C diff) infection (CDI) be performed?

Is blood usually present in the stool of patients with Clostridium difficile (C diff) colitis?

Are stool cultures recommended for diagnosing Clostridium difficile (C diff) colitis?

Is enzyme immunoassay (EIA) used to diagnose Clostridium difficile (C diff) infection (CDI)?

What are the most sensitive stool assays for detecting Clostridium difficile (C diff) infection (CDI)?

What are the recommendations for toxin testing in stool in individuals with suspected Clostridium difficile (C diff) infection (CDI)?

Which biomarkers may be useful for distinguishing between Clostridium difficile (C diff) colonization and actual disease?

What endoscopy findings indicate Clostridium difficile (C diff) infection (CDI)?

What does biopsy of pseudomembranous plaques show in Clostridium difficile (C diff) colitis?

Why is colonoscopy more useful than sigmoidoscopy in suspected Clostridium difficile (C diff) colitis?

Can endoscopic exam findings be normal in patients with Clostridium difficile (C diff) infection (CDI)?

Are sigmoidoscopy and colonoscopy indicated in fulminant Clostridium difficile (C diff) colitis?

Which imaging modality does the ACR recommend in suspected Clostridium difficile (C diff) colitis?

What are the common findings of CT scanning in Clostridium difficile (C diff) colitis?

Treatment

What should be considered in making treatment decisions in Clostridium difficile (C diff) infection (CDI)?

What are the ESCMI guidelines for the treatment of Clostridium difficile (C diff) infection (CDI)?

What are the CDC recommendations regarding antibiotic prescribing in hospitalized patients to reduce Clostridium difficile (C diff) infection (CDI)?

Does Clostridium difficile (C diff) infection (CDI) increase the risk of colectomy in patients with IBD?

Do patients with fulminant Clostridium difficile (C diff) colitis and toxic megacolon require surgery?

What are the outcomes of emergency colectomy in Clostridium difficile (C diff) colitis?

When should consultations be considered in Clostridium difficile (C diff) colitis?

Does cessation of antibiotics that cause Clostridium difficile (C diff) colitis lower the risk of recurrence?

How is mild diarrhea treated in Clostridium difficile (C diff) infection (CDI)?

How is severe or complicated Clostridium difficile (C diff) colitis treated?

How is Clostridium difficile (C diff) infection (CDI) treated in patients with IBD?

How are fulminant cases of Clostridium difficile (C diff) colitis treated?

Is oral fidaxomicin effective in the treatment of Clostridium difficile (C diff) colitis?

How common is relapse of Clostridium difficile (C diff) colitis?

Is bezlotoxumab effective in reducing the recurrence of Clostridium difficile (C diff) colitis?

Are probiotics recommended in the treatment of Clostridium difficile (C diff) infection (CDI)?

How effective is fecal microbiota transplantation (FMT) in the treatment of recurrent Clostridium difficile (C diff) colitis?

Is fecal microbiota transplantation (FMT) an effective treatment of recurrent Clostridium difficile (C diff) colitis in children?

Is fecal microbiota transplantation (FMT) an effective cure for recurring Clostridium difficile (C diff) colitis?

What risks are associated with fecal microbiota transplantation (FMT) in Clostridium difficile (C diff) colitis?

Is intestinal microbiota transplantation (IMT) effective as treatment for recurrent Clostridium difficile (C diff) colitis?

What are the guidelines for preventing nosocomial transmission of Clostridium difficile (C diff)?

How is Clostridium difficile (C diff) infection (CDI) prevented?

Guidelines

What are IDSA/SHEA and the WSES diagnostic and treatment guidelines for Clostridium difficile infection (CDI)?

What are the BSG/HIS guidelines on best practices for fecal microbiota transplantation (FMT) to treat Clostridium difficile infection (CDI)?

Medications

When should medication therapy be considered in the treatment of Clostridium difficile (C diff) infection (CDI)?

Which medications are recommended in the treatment of Clostridium difficile (C diff) colitis?

What are the recommended metronidazole regimens in the treatment of Clostridium difficile (C diff) colitis?

Is fidaxomicin effective as a treatment for the North American Pulsed Field type 1 (NAP1) strains of Clostridium difficile (C diff)?

Is metronidazole more effective than other agents in the initial treatment of Clostridium difficile (C diff) infection?

What is the recommended medication treatment for severe cases of Clostridium difficile (C diff) colitis?

Is fidaxomicin as effective as vancomycin in the treatment of Clostridium difficile (C diff) infection (CDI)?

Which medications are most effective in treating Clostridium difficile (C diff) colitis in patients with cancer?

What is the prevalence of relapse in patients treated with metronidazole or vancomycin for Clostridium difficile (C diff) colitis?

What is bezlotoxumab?

What are risk factors for recurrence of Clostridium difficile (C diff) infection (CDI)?

What are the determining factors in choosing an antibiotic for Clostridium difficile colitis (C diff) recurrence?

Are probiotics beneficial in the treatment of Clostridium difficile (C diff) colitis?

Is rifaximin FDA approved for prevention of Clostridium difficile (C diff) colitis relapse?

Is nitazoxanide an effective treatment for Clostridium difficile (C diff) colitis?

Is IVIG an effective adjunctive treatment for Clostridium difficile (C diff) colitis?

Is cholestyramine an effective treatment for Clostridium difficile (C diff) colitis?

What therapies are being investigated for the treatment of Clostridium difficile (C diff) colitis?

Which medications in the drug class Bile Acid Sequestrants are used in the treatment of Clostridioides (Clostridium) Difficile Colitis?

Which medications in the drug class Monoclonal Antibodies are used in the treatment of Clostridioides (Clostridium) Difficile Colitis?

Which medications in the drug class Macrolides are used in the treatment of Clostridioides (Clostridium) Difficile Colitis?

Which medications in the drug class Glycopeptides are used in the treatment of Clostridioides (Clostridium) Difficile Colitis?

Which medications in the drug class Antibiotics, Other are used in the treatment of Clostridioides (Clostridium) Difficile Colitis?