Clinical Guideline Highlights for the Hospitalist: Diagnosis and Management of Clostridium difficile in Adults
GUIDELINE TITLE: 2018 Infectious Disease Society of America (IDSA)/Society for Healthcare Epidemiology of America (SHEA) Clostridium difficile infection (CDI) clinical practice guideline
RELEASE DATE: February 15, 2018
PRIOR VERSION: 2010 Infectious Disease Society of America (IDSA)/Society for Healthcare Epidemiology of America (SHEA) Clostridium difficile infection (CDI) clinical practice guideline
DEVELOPER: A panel of 14 multidisciplinary experts
FUNDING SOURCE: IDSA and SHEA
TARGET POPULATION: Adult and pediatric patients at risk for or diagnosed with Clostridium difficile infection based on a literature review with a defined search period of 2009–2016. This review will focus on adult patients.
© 2019 Society of Hospital Medicine
CRITIQUE
Methods in Preparing Guidelines
The guideline committee consisted of an interdisciplinary team of healthcare providers with extensive experience in the diagnosis, infection control, treatment, and management of C. difficile. The literature search accessed five different databases (Medline, Embase, Cochrane, Health Technology Assessment, and Database of Abstracts of Reviews and Effects), relevant journals, conference proceedings, and regulatory websites published over the search period of 2009-2016.
A major strength of these guidelines is the extensive work that went into their preparation. The committee reviewed over 14,000 pieces of literature and performed a detailed analysis of each one to determine the quality of evidence in support of each recommendation.
Sources of Potential Conflict of Interest or Bias
To reduce bias, the committee’s work was funded by Infectious Disease Society of America and Society for Healthcare Epidemiology of America. Some authors received funding for work outside of this guideline by companies that manufacture diagnostic assays, vancomycin, and fidaxomicin. These potential conflicts were listed at the end of the article.
Generalizability of the Guideline
Not all studies included in the guideline contain exclusively hospitalized patients, but much of the guideline content is applicable to hospitalized patients. Because C. difficile infection is such a widespread public health problem and these guidelines represent a significant update in knowledge since 2010, the specific recommendations highlighted in this review will impact numerous hospitalists, regardless of the practice setting.
Areas in Need of Future Study
Based on the current literature, as well as statements in the guideline, we expect future guidance around potential screening for and isolation of asymptomatic carriers, including closer guidance on stool transplantation focusing on timing and route, as further data emerge in these areas.
Other Resources
- Grading of Recommendations Assessment, Development, and Evaluation system (https://www.gradeworkinggroup.org)
- Universal Screening for C. difficile in a Tertiary Hospital: risk factors for carriage and clinical disease (Color/Blackhttps://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(19)30048-5/fulltext)
- Effectiveness of Isolating Clostridium Difficile Asymptomatic Carriers on the Incidence of Infections (Color/Blackhttps://clinicaltrials.gov/ct2/show/NCT03223415)
- Effect of Detecting and Isolating Clostridium difficile Carriers at Hospital Admission on the Incidence of C difficile Infections (Color/Blackhttps://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2516765)
- Clinical Trial Testing Fecal Microbiota Transplant for Recurrent Diarrheal Disease Begins (Color/Blackhttps://www.nih.gov/news-events/news-releases/clinical-trial-testing-fecal-microbiota-transplant-recurrent-diarrheal-disease-begins)
