Am J Emerg Med. 2020 Oct;38(10):2203-2208. doi: 10.1016/j.ajem.2020.06.083. Epub 2020 Jul 4.
BACKGROUND: Clostridioides difficile infection (CDI), characterized primarily by diffuse diarrhea in the setting of recent healthcare and antibiotic exposure, maintains significantly high rates of diagnosis in the U.S., even in the emergency department (ED). Recent updates in the literature concerning CDI should be considered for effective clinical practice in the ED setting.
OBJECTIVE: This narrative review provides an evidence-based summary of current data for the ED-based evaluation and management of CDI.
DISCUSSION: Substantial literature on the risk factors, diagnostic criteria, and treatment regimens have recently published concerning CDI. These studies include evaluation of risks associated with specific antibiotic classes, demonstrating that even single doses of antibiotics pose significant risk of CDI. Disproportional increases in elderly CDI rates show particular vulnerability in this population. Updated literature reveals presenting symptoms with wide ranges in rates of diarrhea, abdominal pain, fever, and nausea with vomiting. In some patients diarrhea may be altogether absent, clouding clinical suspicion. Classification primarily centers on a non-severe/severe division from the IDSA. Treatment has largely shifted away from metronidazole as a first-line antibiotic, instead focusing on oral vancomycin and fidaxomicin, even for an initial episode of CDI in an uncomplicated patient. Attention to hand hygiene and adherence to contact precautions are key to infection prevention.
CONCLUSIONS: CDI cause significant illness throughout the U.S. Successful CDI diagnosis and management in the ED require current knowledge of risk, presentation, diagnosis, and proper antibiotic treatment.