For activities outside of the submitted work, K. C. has received research grants from GenePOC, Accelerate, and BD Diagnostics; has received royalties from McGraw-Hill and ASM Press; and has received travel expenses as board member with ASM. The panel met face-to-face on 3 occasions and conducted numerous monthly subgroup and full panel conference calls to complete the work of the guideline. CDI Treatment Guidelines for SHC Indexed by Severity Clinical Severity/Stage First Line Regimen Alternative Regimen Non-Severe Vancomycin 125mg PO q6h x 10- 14 days Fidaxomicin 200mg PO BID x 10 days Additional isolation techniques (contact precautions, private rooms, and cohorting of patients with active CDI) have been used for control of outbreaks, with variable success [207, 214, 215]. More recently, an alternative procedure has been proposed (loop ileostomy with antegrade vancomycin lavage) as a colon-preserving, less invasive (usually laparoscopic), and less morbid approach that warrants further investigation as it may lead to improved outcomes as well as colon salvage [340]. XXI. Literature searches were originally implemented on 4 December 2012, updated on 3 March 2014, and further extended to 31 December 2016. There was no statistically significant difference in the clinical presentations at the onset of infection and severity of disease between patients positive by NAAT alone compared with those concordant for both NAAT and 2-step algorithm assays [183]. There are insufficient data to recommend use of biologic markers as an adjunct to diagnosis, Because of the high prevalence of asymptomatic carriage of toxigenic, Accommodate patients with CDI in a private room with a dedicated toilet to decrease transmission to other patients. The period between initial colonization with C. difficile and the occurrence of CDI (ie, incubation period) was estimated in 3 earlier studies to be a median of 2–3 days [66, 68]. Mayfield et al reported that the introduction of disinfection with a hypochlorite-based solution (5000 ppm available chlorine) was associated with reduced incidence of CDI in a bone marrow transplant unit where there was a relatively high incidence of CDI [86]. Assuming an effective vaccine is developed, what population should be targeted? This may involve periodic chart review in a series of patients to assess for clinical risk factors, signs, and symptoms suggestive of CDI. Virtually every antibiotic has been associated with CDI through the years, but certain classes—third-/fourth-generation cephalosporins [99], fluoroquinolones [36, 37, 100], carbapenems [99], and clindamycin [101, 102]—have been found to be high risk. Antibiotic restriction may be one of the most useful control measures for a CDI outbreak. For example, evidence of emergence of a virulent strain, ribotype 078, has been reported from the Netherlands [57]. XII. Daily sporicidal disinfection can be effective at reducing C. difficile environmental contamination and has been associated with reductions in CDI in outbreak settings in conjunction with other interventions to prevent CDI. Use of multiple antibiotics (mean number used, 4.2 vs 1.4 antibiotics) was found to be an important risk factor for developing CDI and the incidence of CDI increases with the number of antibiotics prescribed (relative risk, 1.49; 95% CI, 1.23–1.81) [102, 287]. There are no studies that demonstrate further extending contact precautions results in reductions in CDI incidence. XXXV. 1 The comprehensive clinical practice guideline addressing the epidemiology, diagnosis, treatment, and prevention of CDI was written by a multinational expert panel of physicians and was endorsed … There was also a high degree of genetic relatedness between 078 isolates found in humans and pigs, an association also noted in the United States [58]. Using a quasi-experimental design and time series analysis, the effect of detecting and isolating asymptomatic carriers was evaluated. They convened a group of experts to publish an update to their 2010 C.difficile infection (CDI) guidelines. The data base of the recent phase 3 fidaxomicin vs vancomycin treatment trials has been used to develop [319, 320] and validate [321] factors that might predict treatment failure [319] or cure [320]. The authors examined the results of the 2 reference assays (TC and CCNA) along with 4 commercial methods—2 toxin A/B enzyme EIAs, GDH, and a NAAT [185]. Khanna et al [125] performed a population-based cohort study of CDI epidemiology in children 0–18 years of age. What is the role of anti-CDI agents in secondary CDI prevention of CDI (patients successfully treated for CDI but who receive subsequent oral, intravenous, or intramuscular antibiotics)? Judged by the published literature, FMT appears to be safe in the short term [359, 367, 372, 373] and mild to moderate posttreatment adverse events are for the most part self-limited [374]. While toxin EIAs remain insensitive in the detection of toxigenic C. difficile when compared with these successive technologies, sensitivities vary among available toxin EIA tests. Furthermore, use of an inappropriate comparative reference method is a recurring issue (eg, using TC to assess the accuracy of a toxin test when the correct comparator is CCNA). Measuring the effect of environmental agents with sporicidal activity on the incidence of CDI is complicated by data that indicate that most patients with CDI do not directly acquire C. difficile from the environment, the existence of different methods to apply these agents, and the record of inconsistent impact of sporicidal agents on reducing CDI incidence in nonoutbreak settings. The majority of pediatric studies have evaluated the incidence of CDI-related hospitalizations among multicenter cohorts of hospitalized children [126–128]. Compared with toxigenic culture, the toxin EIA had a sensitivity of 66.7% and specificity of 91.8% and the values for the PCR assay were 94.4% and 96.8%, respectively [172]. What is the best-performing method (ie, in use positive and negative predictive value) for detecting patients at increased risk for clinically significant C. difficile infection in commonly submitted stool specimens? Continue contact precautions in patients with C. difficile infection for at least 48 hours after diarrhea is resolved. Antibiotic treatment is rec… Twenty of these 100 patients (20%) were diagnosed with CDI but the test results were not available for 2.07 days. For both time periods, CDI cases were defined as having clinical symptoms including diarrhea (84%), fever and abdominal pain (4%), nausea and vomiting (2%), abdominal pain, leukocytosis, or sepsis (2% each), and fever alone (1%) with a positive NAAT or a positive CCNA [183]. Patients who were CCNA positive/PCR positive had higher all-cause 30-day mortality compared with CCNA-negative/PCR-positive patients. Other risk factors for CDI include gastrointestinal surgery [102] or manipulation of the gastrointestinal tract, including tube feeding [110]. Although occupying a room where a prior occupant had CDI is a significant risk factor for CDI acquisition, this accounts for approximately 10% of CDI cases, indicating other vectors are more common [89].