What are the complications of Clostridioides difficile (C. diff) infection?

From the Guidelines

The main complication of C. difficile infection is recurrent infection, which can lead to severe diarrhea, dehydration, and potentially life-threatening complications if left untreated, with a recurrence rate significantly lower following treatment with fidaxomicin compared to vancomycin 1. Complications of C. difficile infection include:

• Recurrent infection, with risk factors including administration of other antibiotics during or after initial treatment, defective humoral immune response, advancing age, and severe underlying disease 1
• Pseudomembranous colitis, which can lead to severe diarrhea, dehydration, and potentially life-threatening complications if left untreated
• Disruption of the intestinal microbiome diversity, leading to intestinal dysbiosis and potentially life-threatening complications Treatment recommendations:

1. Mild to moderate cases: Oral vancomycin 125 mg four times daily for 10 days
2. Severe cases: Oral vancomycin 125 mg four times daily plus intravenous metronidazole 500 mg every 8 hours for 10-14 days
3. Fulminant cases: Consider oral vancomycin 500 mg four times daily plus intravenous metronidazole 500 mg every 8 hours, with potential need for surgical intervention
4. Recurrent cases: Consider fecal microbiota transplantation, with a high degree of success in correcting intestinal dysbiosis and resolving recurrent infection 1 Additional measures:

• Discontinue the inciting antibiotic if possible
• Provide supportive care, including fluid and electrolyte replacement
• Implement contact precautions to prevent spread
• Consider probiotics, such as Saccharomyces boulardii and Lactobacillus species, for prevention of CDI recurrence, although evidence is limited 1 C. difficile produces toxins that damage the intestinal lining, leading to inflammation and diarrhea. The recommended treatments aim to eradicate the bacteria and allow the gut to heal. Vancomycin and metronidazole are effective against C. difficile, with vancomycin being the preferred first-line treatment due to its higher cure rates and lower recurrence rates. Fidaxomicin has also shown promise in reducing recurrence rates compared to vancomycin 1.

From the Research

Complications of Clostridioides difficile (C. diff) Infection

• The complications of C. diff infection include recurrence, which can occur in up to 20% of cases 2
• Other potential complications include diarrhea, leukocytosis, hypotension, and ICU admission 3, 4
• The risk of complications may be higher in certain populations, such as older adults 5
• Treatment outcomes, including cure rates and recurrence rates, can vary depending on the treatment regimen used 3, 6, 4

Treatment-Related Complications

• High-dose vancomycin may not be associated with improved treatment outcomes compared to low-dose vancomycin 3, 4
• Extended duration vancomycin regimens may be effective in reducing recurrence rates, but the optimal regimen is not well established 6
• Other treatment options, such as fidaxomicin and fecal microbiota transplantation, may also be effective in reducing recurrence rates and improving treatment outcomes 2, 5

Patient-Related Complications

• Older adults may be at increased risk of morbidity and mortality from C. diff infection 5
• Certain patient factors, such as gender, baseline albumin, and ICU admission, may be associated with treatment outcomes 4
• The presence of underlying medical conditions or immunocompromised status may also increase the risk of complications from C. diff infection 5