When Clostridioides difficile infection meets specific laboratory thresholds at diagnosis, it is classified as severe — a distinction that directly shapes the clinical approach and the urgency of management.
Severe CDI is identified by a white blood cell count of 15,000 cells/mm³ or higher, or a serum creatinine level above 1.5 mg/dL. These criteria are predictive of unfavorable outcomes and are applied at the time of diagnosis to guide treatment intensity.
For patients meeting severe CDI criteria, the evidence-based approach involves a microbiome-based intervention. Full indications, sequencing, and the complete structured regimen are available via the protocol below.
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 suggest FMT be considered for patients with severe and fulminant CDI refractory to antibiotic therapy, in particular, when patients are deemed poor surgical candidates (strong recommendation, low quality of evidence).
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