From the Guidelines
Clostridioides difficile (C. diff) colonization can resolve spontaneously in many cases without requiring treatment. Approximately 10 to 52% of defined populations are asymptomatic carriers of C. difficile, and asymptomatic fecal shedding of C. difficile may be transient 1. Asymptomatic colonization does not increase the risk of symptomatic CDI, and may protect against later development of symptomatic disease 1.
Key Factors Influencing Spontaneous Resolution
- The robustness of the individual's gut microbiome
- Absence of ongoing antibiotic exposure
- The person's immune status
Treating asymptomatic colonization with antibiotics like vancomycin is generally discouraged as it may temporarily interrupt shedding, but increase the risk of C. difficile carriage following therapy completion 1. The best approach for colonized individuals is to practice good hand hygiene, avoid unnecessary antibiotics, and monitor for development of symptoms such as diarrhea, which would indicate progression from colonization to active infection requiring treatment.
Recommendations for Asymptomatic Carriers
- No treatment is recommended for asymptomatic C. diff colonization
- Practice good hand hygiene
- Avoid unnecessary antibiotics
- Monitor for development of symptoms such as diarrhea
From the Research
Spontaneous Resolution of C. diff Colonization
- There is limited evidence to suggest that C. diff colonization will resolve spontaneously 2, 3.
- The available studies focus on the treatment and prevention of C. diff infection, rather than the spontaneous resolution of colonization.
- However, it is known that C. diff infection can recur in up to 20% of cases, suggesting that colonization may persist in some individuals 2.
Treatment and Prevention of C. diff Infection
- Vancomycin and fidaxomicin are recommended as first-line therapies for C. diff infection 2, 3, 4.
- Fecal microbiota transplantation is also an effective treatment for recurrent C. diff infection 5, 6.
- Bezlotoxumab has been shown to prevent recurrent C. diff infection, but its use may be limited by cost 3.
Factors Influencing Spontaneous Resolution
- The spontaneous resolution of C. diff colonization may be influenced by various factors, including the individual's immune status, the presence of underlying medical conditions, and the use of antibiotics 3, 4.
- However, there is currently limited evidence to support the idea that C. diff colonization will resolve spontaneously in the absence of treatment.