From the Research
Performing a colonoscopy in a patient colonized with Clostridioides difficile (C. diff) poses significant risks, including the potential for spreading C. diff spores and triggering active infection, and therefore, elective colonoscopy should be delayed until the infection has been treated, as recommended by the most recent and highest quality study 1.
Risks Associated with Colonoscopy in C. diff Colonized Patients
The primary risks associated with performing a colonoscopy in a patient colonized with C. diff include:
- Spreading C. diff spores throughout the healthcare facility, which can contaminate endoscopic equipment and surfaces despite standard disinfection protocols 2
- Disrupting the patient's intestinal microbiome and triggering active C. diff infection in previously asymptomatic carriers, especially if antibiotics are administered perioperatively 3
- Worsening of symptoms in patients with active C. diff infection due to mechanical manipulation of the inflamed colon 4
- Increasing the risk of complications such as perforation in patients with severe colitis 5
Mitigating Risks
To mitigate these risks, the following measures can be taken:
- Schedule patients known to be colonized with C. diff at the end of the day when possible
- Perform enhanced terminal cleaning of the endoscopy suite after the procedure
- Delay elective colonoscopy until the infection has been treated, typically with oral vancomycin (125 mg four times daily for 10-14 days) or fidaxomicin (200 mg twice daily for 10 days) 1
Treatment of C. diff Infection
The treatment of C. diff infection typically involves the use of antibiotics such as vancomycin or fidaxomicin, and in some cases, fecal microbiota transplantation may be considered 1, 4. It is essential to follow the most recent and highest quality guidelines for the treatment of C. diff infection to minimize the risk of complications and transmission.