Table 4: Summary of Clinical Aspects of Clostridium difficile Infection (CDI).
| Risk Factors for CDI* | ||||
|---|---|---|---|---|
|
• Antibiotic or antimicrobial agent exposure (duration, and the number of antibiotics the patient has been exposed to increases the risk for CDI, but cases have been shown to results from a single course of an antibiotic) • Acid reducing medications (including histamine‐2 blockers and proton pump inhibitors) • Gastrointestinal surgery/manipulation • Longer duration of hospitalization • Underlying co-morbidities • Immunocompromising conditions (ex. cancer chemotherapy, HIV, autoimmune disease) • Advanced age (specifically > 64 years of age) |
||||
| Antibiotic Classes Associated with increased risk for CDI † | ||||
| Frequently Associated | Occasionally Associated | Rarely Associated | ||
|
Fluoroquinolones Clindamycin‡ Penicillins (broad spectrum example: ampicillin and amoxicillin) ‡ Cephalosporins (broad spectrum) ‡
|
Other Penicillins Macrolides‡ Trimethoprim Trimethoprim-sulfamethoxazole Sulfonamides
|
Aminoglycosides Bacitracin Tetracyclines‡ Chloramphenicol Metronidazole‡ Vancomycin |
||
| Laboratory tests used to diagnose CDI¶ | ||||
| Polymerase Chain Reaction (PCR): Detects one or more genes responsible for CDI as quickly as within an hour and is almost as sensitive as the CCCA. | EIA for toxin A&B: This assay tests for toxin A and B. One, or both toxins can be present with CDI, however toxin B is the most clinically relevant toxin. | EIA for glutamate dehydrogenase (GDH): Great for initial screening however this is less sensitive than PCR and cannot differentiate between toxigenic and non-toxigenic strains. | Selective Anaerobic Culture: Cultures grow Clostridium difficile, the most sensitive test however it does not differentiate between toxigenic and non-toxigenic strains. | Cell Culture Cytotoxic Assay (CCCA): This is the gold standard for testing for CDI, it takes about 2 days for the lab tests to be complete. |
Resources Used: *CDC-Clostridium difficile Infection Information for Patients (https://www.cdc.gov/hai/organisms/cdiff/cdiff-patient.html). (Archived by WebCite® at http://www.webcitation.org/archive.php); †[39], ‡[29], ¶[40].