Treatment Recommendations for Clostridium difficile, Treatment Failures, and Impact on Active Diarrheal Days

Abstract

ISSUE: Much like many health care facilities, the VANJHCS had experienced an increase in the incidence rate of Clostridium difficile associated diarrhea (CDAD). We had gone from an average of 3 cases per month in previous years to as high as >10 cases for one month. Current recommendations to control the spread of CDAD include contact isolation, environmental cleaning, and stopping antibiotics. Oral metronidazole for 14 days is the drug of choice for initial CDAD episode. Oral vancomycin is an option for patients who cannot take or fail treatment with metronidazole. However in a number of the patients it had been noted that they were failing these recommended antibiotic treatments, thus the adequacy of the 14 days treatment regimen was questioned. The treatment failures also are challenging for Infection Control Professionals because this prolongs the need for contact isolation and hospital stay thus increasing hospital cost.