SHEA, IDSA recommend fecal transplants in updated C. diff guidelines: 7 things to know

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The Infectious Diseases Society of America and Society for Healthcare Epidemiology of America shared updated guidelines for diagnosing and treating Clostridium difficile infections Thursday.

The updated guidelines, published in Clinical Infectious Diseases, address various changes in C. diff diagnosis and treatment since SHEA and IDSA published the last guidelines in 2010.

Here are seven things to know about the 2018 guidelines.

1. Physicians should only test patients with new onset and unexplained diarrhea involving three or more unformed stools in 24 hours.

2. The medical societies recommend using a molecular test to initially check for C. diff. As these tests can be very sensitive, clinicians should also conduct a C. diff. common antigen test and a stool toxin test to avoid overdiagnosis.

3. The 2010 guidelines recommended clinicians use metronidazole as an initial treatment for C. diff. Now, the medical societies recommend using vancomycin or fidaxomicin, which demonstrate higher cure rates than metronidazole.

4. The updated guidelines also recommend use of fecal microbiota transplantation to treat patients with two or more recurrences of C. diff., along with individuals who did not respond to traditional antibiotic treatment. While the FDA has not approved fecal microbiota transplantation, the agency issued guidelines for using the therapy to treat C. diff infections.

5. To control the spread of C. diff, the medical societies recommend isolating infected patients and ensuring all medical personnel and visitors wear personal protective equipment — the same recommendations as the 2010 guidelines. However, the updated guidelines also call for heightened attention to antibiotic stewardship efforts to help limit C. diff infections.

6. The guidelines do not recommend use of probiotics to prevent C. diff.

7. Unlike the 2010 guidelines, the updated version includes recommendations regarding the surveillance, diagnosis and treatment of C. diff in children.

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