22 responses to “Clostridium difficile infection (CDI)”

  1. Thank you, very concise and informative. Appreciate severity based on WCC and creatinine.

  2. vanco vs metro depends on severity….good lesion

  3. Good to review CDI guidelines

  4. well written piece but disagree on two things:

    you imply that you are ordering c. diff on patients with high white counts. do you mean even if they don’t have diarrhea. our lab won’t even analyze stool for c diff unless it is loose.

    you don’t mention stool transplants. surely this is a safer and better approach than a total colectomy!

  5. Is it cost effective to use vancomycin as the first line Rx ? Any evidence on this ?

  6. Nice summary of management of this increasingly common infection. I do find that the WBC does seem to correlate with severity quite well.

  7. is there a role for feacal transplant?

  8. I have repeatedly been told by the lab at my hospital that there is no point in retesting for C Diff for at least three or four months after an infection, because the test remains positive regardless of current infective status. Retesting may on occasion convince you to look for another cause of the diarrhoea but my understanding is that it is utterly unreliable as confirmation of a recurrent infection..
    The rest of the article made very good sense and was a useful overview.

  9. Good, brief summary, useful for point of care treatment. Presentation style easy to read and assimilate

  10. I agree and is my approach

  11. Good summary. I am unsure if it will work out well in the community setting. How many family physicians will prescribe Vanco? Will surgeons accept emergent consults from community physicians without going through emergency physicians to screen severity?

  12. Further to the astounding initial evidence about the prevention of recurrences of CDI with fecal transplant, it alarms me that so little has been studied in the direction of colon flora restoration with less risky means–eg. Probiotic enemas, for instance.

  13. It is interesting to note the pathological transformation of CD from commensalism in the 1930’s to toxin producing scourge. Our study of the microbiota is sadly late on the scene, like documenting forest growth after a fire (antibiotic use). One wonders whether the Canadian Nobel discovery of bacteriophages will ever be of use as a specific therapy in infectious diseases.

  14. Thanks for your comments. I’d like to clarify a few of the issues that were raised:
    1. My article was written prior to the recent randomized control trial showing that fecal microbiota transplant outperformed 14 days of oral vancomycin [1]. Although it is recognized that stool transplant is valuable in treating recurrent CDI, it is still not available in many centers. Until it becomes more widely available, many health care providers will continue to rely on longer tapering courses of vancomycin.
    2. The comment about labs not testing formed stool is correct. As well, the comment about not doing a test of cure (repeating the test after treating the patient) is also correct.
    3. A elevated WBC in a hospitalized patient may be a clue that they have CDI. The differential for leukocytosis, however, has to be considered in the specific clinical context.
    4. Sick patients should be sent to the ER. Patients with complicated CDI (hypotension, toxic megacolon, ileus), require hospitalization. If fluids and treatment aren’t helping, surgery is consulted.
    5. The probiotics trials have been inconsistent with poor methodology, so it’s difficult to make recommendations based on them. However, there is currently a human microbiome project underway, which should shed some light on the role of “good” bacteria in human health and disease [2].

    1. Van Hood, E. et al. Duodenal Infusion of Donor Feces for Recurrent Clostridium difficile. N. Engl. J. Med. 2013;368:407-415.
    2. http://commonfund.nih.gov/hmp/

  15. nothing new here

  16. I agree with many of the correspondents. The future seems to be hopeful for widespread stool transplants even if the practice smacks of a return to leeches!!

  17. Very useful.

  18. Interesting, however I only use Vancomycin as a second line treatment for CDI

  19. Certainly interesting watching the evolution/revolution in treating c.diff and certainly the results are slowly getting much better.

  20. Thankyou for concise and good information. What does clostridium disesease symtoms are?

  21. I have found Flagyl does not work in most people.. stick to Vancomycin. If a person does not clear up on Vancomycin, immediately do a FMT

  22. Thoughts on Dificid?

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