Clostridiodes difficile

Question 1

What is Clostridioides difficile?

Answer 1

A bacterium that causes illness through toxin production

Hypervirulent strains have led to significant outbreaks in the USA and Europe, while non-toxigenic strains rarely cause illness.

Question 2

Is Clostridioides difficile notifiable?

Answer 2

No, but may be reported as an outbreak in high-risk settings

VICNISS conducts surveillance of C. difficile infections acquired in hospitals.

Question 3

How is Clostridioides difficile transmitted?

Answer 3

Ingestion of viable bacteria or spores from the environment

Bacteria are shed by symptomatic cases and are resistant to drying and many cleaning agents.

Question 4

What are the clinical features of a C. difficile infection?

Answer 4

Can be asymptomatic; symptoms include diarrhoea, fever, abdominal cramps

Severe disease can lead to pseudomembranous colitis and toxic megacolon.

Question 5

Who are high-risk groups for C. difficile infection?

Answer 5

Those on broad spectrum antibiotics, hospitalized patients, elderly, immunocompromised individuals

Longer duration of hospitalization increases risk.

Question 6

What is the incubation period for C. difficile infection?

Answer 6

Median 3 days

Question 7

What is the infectious period for C. difficile?

Answer 7

While symptomatic; spores can remain in the environment for weeks to months

Question 8

How is C. difficile diagnosed?

Answer 8

Detection of C. difficile toxin in fresh, unformed stool

Culture can be useful for strain typing during potential outbreaks.

Question 9

What is a specific screening stool test for C. difficile?

Answer 9

Clostridium-specific glutamate dehydrogenase (GDH)

This test may also be positive if colonized with a non-pathogenic strain.

Question 10

What are the outbreak definitions for C. difficile?

Answer 10

No specific definition; apply gastroenteritis outbreak definitions (2 cases in a hospital/care facility)

Question 11

What is the primary prevention strategy for C. difficile infections?

Answer 11

Avoid unnecessary antibiotics and use the narrowest spectrum agent for the shortest period

Standard IPC precautions and hand hygiene are also crucial.

Question 12

What actions should be taken for a clinical case of C. difficile?

Answer 12

Cease antibiotics and commence metronidazole; isolate the case with contact precautions

Isolation should continue until 48 hours after diarrhoea resolves.

Question 13

What cleaning agents are recommended for the environment in case of C. difficile?

Answer 13

Bleach

Rigorous clean-up procedures are essential to eradicate environmental spores.

Question 14

What should contacts of a C. difficile case practice?

Answer 14

Scrupulous hand hygiene using soap and water

Question 15

When should individuals be excluded from childcare or work due to C. difficile?

Answer 15

Until no diarrhoea for 24 hours; food handlers until no diarrhoea/vomiting for 48 hours

Question 16

What should hospital outbreaks of C. difficile trigger?

Answer 16

Reviews of cleaning and isolation measures and antimicrobial stewardship programs

Continuous surveillance of CDI in hospitals is an important quality improvement activity.