This protocol addresses Clostridioides difficile infection in patients classified as non-severe at diagnosis who have experienced a further recurrence — specifically those whose prior first-recurrence treatment did not result in sustained symptomatic cure.
White blood cell count below 15,000 cells/mm3 and serum creatinine 1.5 mg/dL or below — the thresholds that define non-severe CDI at initial presentation.
The preceding step used tapering/pulsed-dose vancomycin or fidaxomicin to manage a first CDI recurrence. This protocol is indicated when that treatment did not achieve the required outcome: sustained symptomatic cure with initial resolution of diarrhea and no evidence of further CDI recurrence.
Fecal microbiota transplantation (FMT) is the recommended intervention for patients reaching this stage of CDI recurrence. The full protocol specifies how it should be delivered and under what circumstances alternative delivery methods apply.
DOI: 10.14309/ajg.0000000000001278
We recommend the following criteria, which are predictive of unfavorable outcomes, be used to classify severe C. difficile infection at the time of diagnosis: white blood cell (WBC) ≥15,000 cells/mm3 or serum creatinine >1.5 mg/dL.
We recommend patients experiencing their second or further recurrence of CDI be treated with FMT to prevent further recurrences (strong recommendation, moderate quality of evidence).
We recommend FMT be delivered through colonoscopy (strong recommendation, moderate quality of evidence) or capsules (strong recommendation, moderate quality of evidence) for treatment of rCDI; we suggest delivery by enema if other methods are unavailable (conditional recommendation, low quality of evidence).
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