Recommendations for the management of Clostridioides difficile infection in adults and comparison with updated ACG, ESCMID and IDSA/SHEA guidelines

Abstract

Clostridioides difficile infection is the most common cause of antibiotic-associated diarrhea. IDSA/SHEA, ESCMID and ACG updated the clinical practice guidelines for CDI in 2021. This paper is an attempt to summarize these guidelines. The clinical presentation of Clostridioides difficile infection is varied, ranging from oligosymptomatic forms to generalized infection with sepsis. It is recommended that testing be performed only on patients with an active infection that is characterized by unexplained new-onset diarrhea. A two-stage testing algorithm should be used. The first step should be GDH or NAAT. If an initial test is positive, EIA should be performed. The first line of drugs for the treatment of Clostridioides difficile infection are vancomycin and fidaxomicin. Metronidazole should only be used if other treatment options are not available. Bezlotoxumab is a humanized monoclonal antibody that binds to and neutralizes the Clostridioides difficile toxin B. The IDSA/SHEA and ESCMID guidelines suggest adding bezlotoxumab to antibiotic therapy in patients with recurrent Clostridioides difficile infection who have had a previous episode within the last six months. Fecal microbiota transplantation (FMT) as a treatment option for second and subsequent recurrences of CDI only in patients who have been treated with the correct therapy in previous episodes. Subtotal resection of the colon with preservation of the rectum is currently considered the gold standard in the surgical treatment of Clostridioides difficile infection. According to ESCMID and ACG, vancomycin is the drug of choice for Clostridioides difficile infection in pregnancy.

Keywords

• clostridium infections
• clostridioides difficile
• toxic megacolon.