Diagnostic Approach and Management of Clostridium difficile Infection

Fransiscus Nikodemus Hosea(1), Achmad Fauzi(2),

(1) Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia/Dr. Cipto Mangunkusumo General National Hospital, Jakarta
(2) Division of Gastroenterologi, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia/Dr. Cipto Mangunkusumo General National Hospital, Jakarta
Corresponding Author


Clostridium difficile infection (CDI) was first viewed as a nosocomial infection as it is associated with antibiotics administration. But since antibiotics are more frequently to be prescribed in the community setting, clinicians should investigate the probability of all antibiotics-associated diarrhea as CDI.

Diagnostic of CDI should be conducted cautiously as the manifestation of CDI varies from asymptomatic to fatal consequences and is associated with morbidity, mortality, recurrence risk, outbreak possibility, and low quality of life. Management of this infection should include infection prevention and control, stopping the offending antibiotics, and administration of specific antimicrobials.

Clinicians should also recognize the risk of recurrence and the higher probability of less efficacious specific antimicrobials in each episode of recurrence.


antibiotics; Clostridium difficile; diagnosis; management


Czepiel J, Dróżdż M, Pituch H, Kuijper EJ, Perucki W,

Mielimonka A, et al. Clostridium difficile infection: review.

Eur J Clin Microbiol Infect Dis. 2019;38:1211–21.

Martin JSH, Monaghan TM, Wilcox MH. Clostridium

difficile infection: epidemiology, diagnosis and understanding

transmission. Nat Rev Gastroenterol Hepatol. 2016;13:206–

Smits WK, Lyras D, Lacy DB, Wilcox MH, Kuijper EJ.

Clostridium difficile infection. Nat Rev Dis Primers.


van Prehn J, Reigadas E, Vogelzang EH, Bouza E, Hristea A,

Guery B, et al. European Society of Clinical Microbiology and

Infectious Diseases: 2021 update on the treatment guidance

document for Clostridioides difficile infection in adults. Clin

Microbiol Infect. 2021;27:S1–21.

Nelson RL, Suda KJ, Evans CT. Antibiotic treatment for

Clostridium difficile-associated diarrhoea in adults. Cochrane

Database Syst Rev. 2017;3:CD004610.

Khanna S, Pardi DS, Kelly CR, Kraft CS, Dhere T, Henn MR,

et al. A novel microbiome therapeutic increases gut microbial

diversity and prevents recurrent Clostridium difficile infection.

J Infect Dis. 2016;214:173–81.

Kee VR. Clostridium difficile infection in older adults:

a review and update on its management. Am J Geriatr

Pharmacother. 2011;10:14–24.

Gale AR, Wilson M. Clostridioides difficile. In: Graham A,

Carlberg DJ, eds. Gastrointestinal Emergencies: Evidence-

Based Answers to Key Clinical Questions. 1st ed. New York:

Springer Cham. 2019:I.p.353–6.

Sartelli M, di Bella S, McFarland LV, Khanna S, Furuya-

Kanamori L, Abuzeid N, et al. 2019 update of the WSES

guidelines for management of Clostridioides (Clostridium)

difficile infection in surgical patients. World J Emerg Surg.


Johnson S, Lavergne V, Skinner AM, Gonzales-Luna AJ,

Garey KW, Kelly CP, et al. Clinical practice guideline by the

Infectious Diseases Society of America (IDSA) and Society for

Healthcare Epidemiology of America (SHEA): 2021 focused

update guidelines on management of Clostridioides difficile

infection in adults. Clin Infect Dis. 2021;73:e1029–44.

McDonald LC, Gerding DN, Johnson S, Bakken JS, Carroll

KC, Coffin SE, et al. Clinical practice guidelines for

Clostridium difficile infection in adults and children: 2017

update by the Infectious Diseases Society of America (IDSA)

and Society for Healthcare Epidemiology of America (SHEA).

Clin Infect Dis. 2018;66:e1–48.

Simor AE. Diagnosis, management, and prevention of

Clostridium difficile infection in long-term care facilities: a

review. J Am Geriatr Soc 2010;58:1556–64.

Cleary RK. Clostridium difficile-associated diarrhea and

colitis: clinical manifestations, diagnosis, and treatment. Dis

Colon Rectum. 1998;41:1435–49.

Khan FY, Elzouki AN. Clostridium difficile infection: a review

of the literature. Asian Pac J Trop Med. 2014;7S1(S1):S6–13.

Mullish BH, Quraishi MN, Segal JP, McCune VL, Baxter M,

Marsden GL, et al. The use of faecal microbiota transplant

as treatment for recurrent or refractory Clostridium difficile

infection and other potential indications: joint British Society

of Gastroenterology (BSG) and Healthcare Infection Society

(HIS) guidelines. Gut. 2018;0:1-22

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DOI: 10.24871/2432023250


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