An updated guideline for the diagnosis, management, and treatment of Clostridium difficile infection (CDI) in adults is now available. Developed by IDSA and the Society for Healthcare Epidemiology of America (SHEA), the guideline appears in the May issue of Infection Control and Hospital Epidemiology and can be found online.

Replacing guidelines published in 1995, the new document reflects an increase in the overall incidence of CDI infection, the identification of a more virulent strain responsible for more severe cases worldwide, and evidence regarding decreased effectiveness of metronidazole in treating severe CDI cases. The guideline provides recommendations regarding:

• strategies for diagnosis
• appropriate therapy
• the minimum epidemiological data that should be collected and how the data should be reported
• infection control measures for hospitals to implement routinely and during an outbreak

Several performance measures for internal performance improvement are suggested within the guideline. Infection control practices should be consistent with guideline recommendations, as should treatment of initial episodes of CDI—in particular, patients with severe CDI should be treated with vancomycin. It is also important that appropriate testing be used for diagnosis.

In addition to updated recommendations, the guideline also summarizes critical gaps where research is needed to advance clinical treatment and care of CDI. The summary is the result of a new collaboration among guideline panels, IDSA’s Research Committee, and the Society’s Standards and Practice Guidelines Committee. Research gaps are identified in four categories: epidemiology, diagnostics, management, and prevention. The project is designed to shed light on critical gaps where research funding is needed. The CDI guideline is the first to include a research gaps summary identified through this collaboration.

The guideline is available online. Other IDSA guidelines also are available on the Standards, Practice Guidelines, and Statements page of our website.

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