From the Guidelines
No, you do not need to resample stool to assess for C. difficile resolution after treatment. This recommendation is based on the 2018 clinical practice guidelines for Clostridium difficile infection in adults and children by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA) 1. The guidelines advise against repeat testing for CDI in the absence of clear changes to the clinical presentation, as the diagnostic yield of repeat testing within a 7-day period is approximately 2%.
Key points to consider:
- The persistence of C. difficile toxins and organisms in stool for weeks after clinical symptoms have resolved does not indicate active infection requiring additional treatment 1.
- Resolution of CDI should be determined by the improvement of clinical symptoms, particularly the normalization of stool frequency and consistency.
- Patients should be considered clinically cured when they have fewer than three unformed stools per day.
- If symptoms recur after initial improvement, then retesting is appropriate as this may indicate a relapse or reinfection, which occurs in approximately 20-30% of cases.
- Treatment decisions should be based on clinical assessment rather than laboratory results in patients who have completed an appropriate course of therapy, as unnecessary testing can lead to overtreatment 1.
From the Research
Assessment of C. Diff Resolution
To assess for C. Diff resolution, the need for re-sampling stool is not explicitly mentioned in the provided studies. However, the studies discuss various treatment options and their effectiveness in resolving C. Diff infection.
Treatment Options
- Vancomycin is recommended as the first-line therapy for most cases of CDI 2, 3.
- Fidaxomicin is a good alternative, especially in patients at risk of relapse 2, 3.
- Metronidazole is associated with lower rates of treatment success compared to vancomycin and should no longer be used as primary therapy for the first episode of CDI or recurrent disease 3.
- Fecal microbiota transplant is effective and safe for the treatment of recurrent CDI 2, 3.
Recurrence and Resolution
- The recurrence rate of C. Diff infection remains high, up to 20% 2.
- Fidaxomicin has been shown to be superior to metronidazole, vancomycin, or their combination for a sustained clinical response and in the prevention of recurrent CDI in some studies 4, 5.
- However, fidaxomicin was inferior to metronidazole for recurrent CDI in one study 4.
Cost-Effectiveness
- The cost-effectiveness of treatment regimens for CDI has been evaluated, and the preferred treatment regimen is fidaxomicin for nonsevere CDI, vancomycin for severe CDI, fidaxomicin for first recurrence, and FMT for subsequent recurrence 6.