Comparison of three current Clostridioides difficile infection guidelines: IDSA/SHEA, ESCMID, and ACG guidelines
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Clostridioides difficile infection (CDI) is a widely recognized condition associated with comorbidity and decreased patient quality of life. Certain professional medical organizations develop clinical practice guidelines for major diseases. This is done in an effort to streamline the universal clinical practice and ensure that a more accurate diagnosis and better treatments are offered to respective patients for optimal outcomes. However, as new data evolve, constant update of these guidelines becomes essential. While these guidelines provide up-to-date recommendations, they are not published around the same time; thus, their recommendations may vary depending on evidence available prior to guidelines preparation and publication.
Recommendations and corresponding justifications from three major CDI guidelines between 2013 and 2017 were pooled and compared, and notable differences were highlighted while providing an insight and a final recommendation from a clinical standpoint.
Most recommendations were consistent among all three guidelines. One notable difference was in the specification of candidates for CDI diagnosis, where it would be recommended to mainly test patients with three or more diarrheal episodes over 24 h, if they had no other clear reason for the diarrhea. Another conflicting point was regarding the treatment of non-severe CDI where vancomycin can be considered for older or sicker patients; however, metronidazole still remains a reasonable option based on recent data, some of which were not cited in the most recent guidelines of IDSA/SHEA.
Overall, it is prudent to follow these guidelines with critical appraisal to fulfill the goal of achieving optimum patient outcomes.
KeywordsClostridioides difficile Guidelines IDSA ESCMID ACG Vancomycin
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
- 4.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;66:987–94. https://doi.org/10.1093/cid/ciy149.CrossRefPubMedGoogle Scholar
- 5.Organization WH. Diarrhoea. https://www.who.int/topics/diarrhoea/en/. Accessed 16 Jan 2019.
- 9.Cohen SH, Gerding DN, Johnson S, Kelly CP, Loo VG, McDonald LC, et al. Clinical practice guidelines for Clostridium difficile infection in adults: 2010 update by the society for healthcare epidemiology of America (SHEA) and the infectious diseases society of America (IDSA). Infect Control Hosp Epidemiol. 2010;31:431–55. https://doi.org/10.1086/651706.CrossRefPubMedGoogle Scholar
- 12.Al-Nassir WN, Sethi AK, Li Y, Pultz MJ, Riggs MM, Donskey CJ. Both oral metronidazole and oral vancomycin promote persistent overgrowth of vancomycin-resistant enterococci during treatment of Clostridium difficile-associated disease. Antimicrob Agents Chemother. 2008;52:2403–6. https://doi.org/10.1128/AAC.00090-08.CrossRefPubMedPubMedCentralGoogle Scholar
- 14.Johnson S, Louie TJ, Gerding DN, Cornely OA, Chasan-Taber S, Fitts D, et al. Vancomycin, metronidazole, or tolevamer for Clostridium difficile infection: results from two multinational, randomized, controlled trials. Clin Infect Dis. 2014;59:345–54. https://doi.org/10.1093/cid/ciu313.CrossRefPubMedGoogle Scholar
- 15.Stevens VW, Nelson RE, Schwab-Daugherty EM, Khader K, Jones MM, Brown KA, et al. Comparative effectiveness of vancomycin and metronidazole for the prevention of recurrence and death in patients with Clostridium difficile infection. JAMA Internal Med. 2017;177:546–53. https://doi.org/10.1001/jamainternmed.2016.9045.CrossRefGoogle Scholar
- 18.Cornely OA, Crook DW, Esposito R, Poirier A, Somero MS, Weiss K, et al. Fidaxomicin versus vancomycin for infection with Clostridium difficile in Europe, Canada, and the USA: a double-blind, non-inferiority, randomised controlled trial. Lancet Infect Dis. 2012;12:281–9. https://doi.org/10.1016/S1473-3099(11)70374-7.CrossRefPubMedGoogle Scholar
- 19.Housman ST, Thabit AK, Kuti JL, Quintiliani R, Nicolau DP. Assessment of Clostridium difficile burden in patients over time with first episode infection following fidaxomicin or vancomycin. Infect Control Hosp Epidemiol. 2016;37:215–8. https://doi.org/10.1017/ice.2015.270.CrossRefPubMedGoogle Scholar
- 20.Thabit AK, Alam MJ, Khaleduzzaman M, Garey KW, Nicolau DP. A pilot study to assess bacterial and toxin reduction in patients with Clostridium difficile infection given fidaxomicin or vancomycin. Ann Clin Microbiol Antimicrob. 2016;15:22. https://doi.org/10.1186/s12941-016-0140-6.CrossRefPubMedPubMedCentralGoogle Scholar
- 21.Gallagher JC, Reilly JP, Navalkele B, Downham G, Haynes K, Trivedi M. Clinical and economic benefits of fidaxomicin compared to vancomycin for Clostridium difficile infection. Antimicrob Agents Chemother. 2015;59:7007–10. https://doi.org/10.1128/AAC.00939-15.CrossRefPubMedPubMedCentralGoogle Scholar
- 22.Goldenberg SD, Brown S, Edwards L, Gnanarajah D, Howard P, Jenkins D, et al. The impact of the introduction of fidaxomicin on the management of Clostridium difficile infection in seven NHS secondary care hospitals in England: a series of local service evaluations. Eur J Clin Microbiol Infect Dis. 2016;35:251–9. https://doi.org/10.1007/s10096-015-2538-z.CrossRefPubMedGoogle Scholar
- 26.Siegfried J, Dubrovskaya Y, Flagiello T, Scipione MR, Phillips M, Papadopoulos J, et al. Initial therapy for mild to moderate Clostridium difficile infection: exploring the role of oral metronidazole versus vancomycin in 168 hospitalized patients. Infect Dis Clin Pract. 2016;24:210–6.CrossRefGoogle Scholar
- 28.Al-Nassir WN, Sethi AK, Nerandzic MM, Bobulsky GS, Jump RL, Donskey CJ. Comparison of clinical and microbiological response to treatment of Clostridium difficile-associated disease with metronidazole and vancomycin. Clin Infect Dis. 2008;47:56–62. https://doi.org/10.1086/588293.CrossRefPubMedGoogle Scholar
- 33.Rokas KE, Johnson JW, Beardsley JR, Ohl CA, Luther VP, Williamson JC. The addition of intravenous metronidazole to oral vancomycin is associated with improved mortality in critically ill patients with Clostridium difficile infection. Clin Infect Dis. 2015;61:934–41. https://doi.org/10.1093/cid/civ409.CrossRefPubMedGoogle Scholar
- 37.Garey KW, Ghantoji SS, Shah DN, Habib M, Arora V, Jiang ZD, et al. A randomized, double-blind, placebo-controlled pilot study to assess the ability of rifaximin to prevent recurrent diarrhoea in patients with Clostridium difficile infection. J Antimicrob Chemother. 2011;66:2850–5. https://doi.org/10.1093/jac/dkr377.CrossRefPubMedGoogle Scholar
- 38.Thabit AK, Housman ST, Burnham CD, Nicolau DP. Association of healthcare exposure with acquisition of different Clostridium difficile strain types in patients with recurrent infection or colonization after clinical resolution of initial infection. J Hosp Infect. 2016;92:167–72. https://doi.org/10.1016/j.jhin.2015.11.009.CrossRefPubMedGoogle Scholar