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C. diff Prevention C. diff infection is caused by the Clostridioides difficile bacterium, which leads to gastrointestinal symptoms ranging from mild diarrhea to severe colitis, potentially causing life-threatening complications. Pathophysiology C. diff is a spore-forming, toxin-producing bacterium that disrupts normal gut flora. Antibiotic use is a major risk factor as it can diminish protective gut microbiota, allowing C. diff to proliferate. The toxins, primarily toxin A and toxin B, cause inflammation and damage to the intestinal lining. Risk Factors • Antibiotic use (especially broad-spectrum antibiotics like clindamycin, fluoroquinolones, and cephalosporins) • Advanced age • Hospitalization or long-term care facility stays • Underlying health conditions, such as inflammatory bowel disease or immunosuppression • Previous history of CDI Symptoms • Watery diarrhea (at least three bowel movements per day for two or more days) • Fever • Abdominal pain or tenderness • Nausea • Loss of appetite • Severe cases can lead to pseudomembranous colitis, toxic megacolon, bowel perforation and sepsis Diagnosis • Stool tests for toxins or C. diff DNA (PCR testing is common) • Detection of glutamate dehydrogenase (GDH) antigen, enzyme immunoassays (EIAs), or nucleic acid amplification tests (NAATs) • Clinical correlation with symptoms is necessary for accurate diagnosis Treatment • Discontinue the inciting antibiotic if possible • First-line treatment typically involves oral vancomycin or fidaxomicin • Metronidazole is less commonly used due to reduced efficacy in severe cases • For recurrent CDI, options include prolonged vancomycin taper/pulse, fidaxomicin or fecal microbiota transplantation (FMT) Prevention and Control • Implement antibiotic stewardship programs to minimize unnecessary antibiotic use • Adhere to strict infection control measures, including hand hygiene and use of personal protective equipment • Use bleach-based disinfectants to clean surfaces, as spores are resistant to many standard disinfectants. Provider Education Training Manual 7 |

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