Clostridium difficile infection classification

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Yazan Daaboul, M.D.

Overview

C. difficile infection may be classified based on the clinical severity of the disease. The severity of the infection dictates the choice of antimicrobial therapy and the need for surgical consultation/management. Mild disease is defined as isolated diarrhea, whereas severe/complicated disease is defined as either delirium, shock, organ failure, high-grade fever, or marked leukocytosis.

Classification

Shown below is a table that classifies C. difficile infection based on clinical features and lab findings. The severity of the infection dictates the choice of antimicrobial therapy.

Severity	Criteria
Mild	Diarrhea as the only symptom
Moderate	Raised white cell count but <15,000 cells/mL and serum creatine <1.5 times baseline
Severe	Leucocytosis >15,000 cells/mL OR serum creatinene level >1.5 times baseline or abdominal tenderness and serum albumin < 3 g/dL
Severe complicated	Hypotension or shock, ileus, megacolon, leucocytosis >20,000 cells/mL OR leucopenia <2,000, lactate >2.2 mmol/L, delirium, fever ≥ 38.5 °C, organ failure

References

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