Recommendations for the diagnosis and treatment of Clostridioides difficile infection: an official clinical practice guideline of the Spanish Society of Chemotherapy (SEQ), Spanish Society of Internal Medicine (SEMI) and the working group of Postoperative Infection of the Spanish Society of Anesthesia and Reanimation (SEDAR)

Bouza, Emilio; Aguado, José María; Alcalá, Luis; Almirante, Benito; Alonso-Fernández, Patricia; Borges, Marcio; Cobo, Javier; Guardiola, Jordi; Horcajada Gallego, Juan Pablo; Maseda, Emilio; Mensa, Josep; Merchante, Nicolás; Muñoz-Millán, Patricia; Pérez Sáenz, José Luis; Pujol, Miquel; Reigadas, Elena; Salavert, Miguel; Barberán, José

Recommendations for the diagnosis and treatment of Clostridioides difficile infection: an official clinical practice guideline of the Spanish Society of Chemotherapy (SEQ), Spanish Society of Internal Medicine (SEMI) and the working group of Postoperative Infection of the Spanish Society of Anesthesia and Reanimation (SEDAR)

This document gathers the opinion of a multidisciplinary forum of experts on different aspects of the diagnosis and treatment of Clostridioides difficile infection (CDI) in Spain. It has been structured around a series of questions that the attendees considered relevant and in which a consensus opin...

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Autores:	Bouza, Emilio, Aguado, José María, Alcalá, Luis, Almirante, Benito, Alonso-Fernández, Patricia, Borges, Marcio, Cobo, Javier, Guardiola, Jordi, Horcajada Gallego, Juan Pablo, Maseda, Emilio, Mensa, Josep, Merchante, Nicolás, Muñoz-Millán, Patricia, Pérez Sáenz, José Luis, Pujol, Miquel, Reigadas, Elena, Salavert, Miguel, Barberán, José
Tipo de recurso:	artículo
Estado:	Versión publicada
Fecha de publicación:	2020
País:	España
Institución:	Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)
Repositorio:	Recercat. Dipósit de la Recerca de Catalunya
OAI Identifier:	oai:recercat.cat:10230/47213
Acceso en línea:	http://hdl.handle.net/10230/47213 http://dx.doi.org/10.37201/req/2065.2020
Access Level:	acceso abierto
Palabra clave:	Clostridium difficile Bezlotoxumab Clostridiodes difficile Diarrhoea associated to C. difficile Fecal Material Transplantation (FMT) Fidaxomicin Metronidazole Monoclonal antibodie Probiotics Vaccines Vancomycin

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spelling	Recommendations for the diagnosis and treatment of Clostridioides difficile infection: an official clinical practice guideline of the Spanish Society of Chemotherapy (SEQ), Spanish Society of Internal Medicine (SEMI) and the working group of Postoperative Infection of the Spanish Society of Anesthesia and Reanimation (SEDAR)Bouza, EmilioAguado, José MaríaAlcalá, LuisAlmirante, BenitoAlonso-Fernández, PatriciaBorges, MarcioCobo, JavierGuardiola, JordiHorcajada Gallego, Juan PabloMaseda, EmilioMensa, JosepMerchante, NicolásMuñoz-Millán, PatriciaPérez Sáenz, José LuisPujol, MiquelReigadas, ElenaSalavert, MiguelBarberán, JoséClostridium difficileBezlotoxumabClostridiodes difficileDiarrhoea associated to C. difficileFecal Material Transplantation (FMT)FidaxomicinMetronidazoleMonoclonal antibodieProbioticsVaccinesVancomycinThis document gathers the opinion of a multidisciplinary forum of experts on different aspects of the diagnosis and treatment of Clostridioides difficile infection (CDI) in Spain. It has been structured around a series of questions that the attendees considered relevant and in which a consensus opinion was reached. The main messages were as follows: CDI should be suspected in patients older than 2 years of age in the presence of diarrhea, paralytic ileus and unexplained leukocytosis, even in the absence of classical risk factors. With a few exceptions, a single stool sample is sufficient for diagnosis, which can be sent to the laboratory with or without transportation media for enteropathogenic bacteria. In the absence of diarrhoea, rectal swabs may be valid. The microbiology laboratory should include C. difficile among the pathogens routinely searched in patients with diarrhoea. Laboratory tests in different order and sequence schemes include GDH detection, presence of toxins, molecular tests and toxigenic culture. Immediate determination of sensitivity to drugs such as vancomycin, metronidazole or fidaxomycin is not required. The evolution of toxin persistence is not a suitable test for follow up. Laboratory diagnosis of CDI should be rapid and results reported and interpreted to clinicians immediately. In addition to the basic support of all diarrheic episodes, CDI treatment requires the suppression of antiperistaltic agents, proton pump inhibitors and antibiotics, where possible. Oral vancomycin and fidaxomycin are the antibacterials of choice in treatment, intravenous metronidazole being restricted for patients in whom the presence of the above drugs in the intestinal lumen cannot be assured. Fecal material transplantation is the treatment of choice for patients with multiple recurrences but uncertainties persist regarding its standardization and safety. Bezlotoxumab is a monoclonal antibody to C. difficile toxin B that should be administered to patients at high risk of recurrence. Surgery is becoming less and less necessary and prevention with vaccines is under research. Probiotics have so far not been shown to be therapeutically or preventively effective. The therapeutic strategy should be based, rather than on the number of episodes, on the severity of the episodes and on their potential to recur. Some data point to the efficacy of oral vancomycin prophylaxis in patients who reccur CDI when systemic antibiotics are required again.Sociedad Española de Quimioterapia202120212020info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionapplication/pdfapplication/pdfhttp://hdl.handle.net/10230/47213http://dx.doi.org/10.37201/req/2065.2020reponame:Recercat. Dipósit de la Recerca de Catalunyainstname:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)InglésCopyright © The Author 2020. This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)(https://creativecommons.org/licenses/by-nc/4.0/).http://creativecommons.org/licenses/by-nc/4.0/info:eu-repo/semantics/openAccessoai:recercat.cat:10230/472132026-05-29T05:05:01Z
dc.title.none.fl_str_mv	Recommendations for the diagnosis and treatment of Clostridioides difficile infection: an official clinical practice guideline of the Spanish Society of Chemotherapy (SEQ), Spanish Society of Internal Medicine (SEMI) and the working group of Postoperative Infection of the Spanish Society of Anesthesia and Reanimation (SEDAR)
title	Recommendations for the diagnosis and treatment of Clostridioides difficile infection: an official clinical practice guideline of the Spanish Society of Chemotherapy (SEQ), Spanish Society of Internal Medicine (SEMI) and the working group of Postoperative Infection of the Spanish Society of Anesthesia and Reanimation (SEDAR)
spellingShingle	Recommendations for the diagnosis and treatment of Clostridioides difficile infection: an official clinical practice guideline of the Spanish Society of Chemotherapy (SEQ), Spanish Society of Internal Medicine (SEMI) and the working group of Postoperative Infection of the Spanish Society of Anesthesia and Reanimation (SEDAR) Bouza, Emilio Clostridium difficile Bezlotoxumab Clostridiodes difficile Diarrhoea associated to C. difficile Fecal Material Transplantation (FMT) Fidaxomicin Metronidazole Monoclonal antibodie Probiotics Vaccines Vancomycin
title_short	Recommendations for the diagnosis and treatment of Clostridioides difficile infection: an official clinical practice guideline of the Spanish Society of Chemotherapy (SEQ), Spanish Society of Internal Medicine (SEMI) and the working group of Postoperative Infection of the Spanish Society of Anesthesia and Reanimation (SEDAR)
title_full	Recommendations for the diagnosis and treatment of Clostridioides difficile infection: an official clinical practice guideline of the Spanish Society of Chemotherapy (SEQ), Spanish Society of Internal Medicine (SEMI) and the working group of Postoperative Infection of the Spanish Society of Anesthesia and Reanimation (SEDAR)
title_fullStr	Recommendations for the diagnosis and treatment of Clostridioides difficile infection: an official clinical practice guideline of the Spanish Society of Chemotherapy (SEQ), Spanish Society of Internal Medicine (SEMI) and the working group of Postoperative Infection of the Spanish Society of Anesthesia and Reanimation (SEDAR)
title_full_unstemmed	Recommendations for the diagnosis and treatment of Clostridioides difficile infection: an official clinical practice guideline of the Spanish Society of Chemotherapy (SEQ), Spanish Society of Internal Medicine (SEMI) and the working group of Postoperative Infection of the Spanish Society of Anesthesia and Reanimation (SEDAR)
title_sort	Recommendations for the diagnosis and treatment of Clostridioides difficile infection: an official clinical practice guideline of the Spanish Society of Chemotherapy (SEQ), Spanish Society of Internal Medicine (SEMI) and the working group of Postoperative Infection of the Spanish Society of Anesthesia and Reanimation (SEDAR)
dc.creator.none.fl_str_mv	Bouza, Emilio Aguado, José María Alcalá, Luis Almirante, Benito Alonso-Fernández, Patricia Borges, Marcio Cobo, Javier Guardiola, Jordi Horcajada Gallego, Juan Pablo Maseda, Emilio Mensa, Josep Merchante, Nicolás Muñoz-Millán, Patricia Pérez Sáenz, José Luis Pujol, Miquel Reigadas, Elena Salavert, Miguel Barberán, José
author	Bouza, Emilio
author_facet	Bouza, Emilio Aguado, José María Alcalá, Luis Almirante, Benito Alonso-Fernández, Patricia Borges, Marcio Cobo, Javier Guardiola, Jordi Horcajada Gallego, Juan Pablo Maseda, Emilio Mensa, Josep Merchante, Nicolás Muñoz-Millán, Patricia Pérez Sáenz, José Luis Pujol, Miquel Reigadas, Elena Salavert, Miguel Barberán, José
author_role	author
author2	Aguado, José María Alcalá, Luis Almirante, Benito Alonso-Fernández, Patricia Borges, Marcio Cobo, Javier Guardiola, Jordi Horcajada Gallego, Juan Pablo Maseda, Emilio Mensa, Josep Merchante, Nicolás Muñoz-Millán, Patricia Pérez Sáenz, José Luis Pujol, Miquel Reigadas, Elena Salavert, Miguel Barberán, José
author2_role	author author author author author author author author author author author author author author author author author
dc.subject.none.fl_str_mv	Clostridium difficile Bezlotoxumab Clostridiodes difficile Diarrhoea associated to C. difficile Fecal Material Transplantation (FMT) Fidaxomicin Metronidazole Monoclonal antibodie Probiotics Vaccines Vancomycin
topic	Clostridium difficile Bezlotoxumab Clostridiodes difficile Diarrhoea associated to C. difficile Fecal Material Transplantation (FMT) Fidaxomicin Metronidazole Monoclonal antibodie Probiotics Vaccines Vancomycin
description	This document gathers the opinion of a multidisciplinary forum of experts on different aspects of the diagnosis and treatment of Clostridioides difficile infection (CDI) in Spain. It has been structured around a series of questions that the attendees considered relevant and in which a consensus opinion was reached. The main messages were as follows: CDI should be suspected in patients older than 2 years of age in the presence of diarrhea, paralytic ileus and unexplained leukocytosis, even in the absence of classical risk factors. With a few exceptions, a single stool sample is sufficient for diagnosis, which can be sent to the laboratory with or without transportation media for enteropathogenic bacteria. In the absence of diarrhoea, rectal swabs may be valid. The microbiology laboratory should include C. difficile among the pathogens routinely searched in patients with diarrhoea. Laboratory tests in different order and sequence schemes include GDH detection, presence of toxins, molecular tests and toxigenic culture. Immediate determination of sensitivity to drugs such as vancomycin, metronidazole or fidaxomycin is not required. The evolution of toxin persistence is not a suitable test for follow up. Laboratory diagnosis of CDI should be rapid and results reported and interpreted to clinicians immediately. In addition to the basic support of all diarrheic episodes, CDI treatment requires the suppression of antiperistaltic agents, proton pump inhibitors and antibiotics, where possible. Oral vancomycin and fidaxomycin are the antibacterials of choice in treatment, intravenous metronidazole being restricted for patients in whom the presence of the above drugs in the intestinal lumen cannot be assured. Fecal material transplantation is the treatment of choice for patients with multiple recurrences but uncertainties persist regarding its standardization and safety. Bezlotoxumab is a monoclonal antibody to C. difficile toxin B that should be administered to patients at high risk of recurrence. Surgery is becoming less and less necessary and prevention with vaccines is under research. Probiotics have so far not been shown to be therapeutically or preventively effective. The therapeutic strategy should be based, rather than on the number of episodes, on the severity of the episodes and on their potential to recur. Some data point to the efficacy of oral vancomycin prophylaxis in patients who reccur CDI when systemic antibiotics are required again.
publishDate	2020
dc.date.none.fl_str_mv	2020 2021 2021
dc.type.none.fl_str_mv	info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion
format	article
status_str	publishedVersion
dc.identifier.none.fl_str_mv	http://hdl.handle.net/10230/47213 http://dx.doi.org/10.37201/req/2065.2020
url	http://hdl.handle.net/10230/47213 http://dx.doi.org/10.37201/req/2065.2020
dc.language.none.fl_str_mv	Inglés
language_invalid_str_mv	Inglés
dc.rights.none.fl_str_mv	http://creativecommons.org/licenses/by-nc/4.0/ info:eu-repo/semantics/openAccess
rights_invalid_str_mv	http://creativecommons.org/licenses/by-nc/4.0/
eu_rights_str_mv	openAccess
dc.format.none.fl_str_mv	application/pdf application/pdf
dc.publisher.none.fl_str_mv	Sociedad Española de Quimioterapia
publisher.none.fl_str_mv	Sociedad Española de Quimioterapia
dc.source.none.fl_str_mv	reponame:Recercat. Dipósit de la Recerca de Catalunya instname:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)
instname_str	Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)
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collection	Recercat. Dipósit de la Recerca de Catalunya
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