『CDI』のカバーアート

CDI

CDI

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 Clostridioides difficile Infection (CDI) Treatment Protocol1.0 Purpose and ScopeThis protocol establishes a standardized, evidence-based framework for the diagnosis and management of Clostridioides difficile infection (CDI). Its strategic importance lies in unifying our clinical approach to improve patient outcomes, reduce the incidence of recurrence, and ensure the appropriate stewardship of antimicrobial and biologic therapies. By adhering to this protocol, we aim to optimize care from the initial diagnosis through the management of complex, recurrent disease.The scope of this document applies to the diagnosis, severity assessment, and staged treatment of initial and recurrent CDI in adult patients within our clinical and hospital settings. It provides clear therapeutic pathways based on disease severity and treatment history. Successful management begins with a precise and timely diagnosis, the criteria for which are detailed in the following section.2.0 Diagnostic Criteria and DefinitionsAccurate diagnosis is the cornerstone of effective CDI management. This principle prevents the inappropriate treatment of asymptomatic colonization, which can further disrupt the gut microbiome, while ensuring that timely and decisive intervention is initiated for true infection. This section defines the precise criteria required to diagnose an active infection and to classify a subsequent recurrence.2.1 Defining Active CDIA diagnosis of active CDI is a clinical diagnosis supported by laboratory evidence. It requires the presence of BOTH of the following criteria:Clinical Symptoms: The patient must present with clinically significant diarrhea, defined as the passage of three or more unformed stools in a 24-hour period for which there is no other obvious cause (e.g., laxative use, new enteral feeding formula).Laboratory Evidence: A stool sample must test positive for the presence of a toxin-producing strain of C. difficile.Crucially, patients with formed stool or who are asymptomatic should not be tested for CDI. A positive laboratory test in an asymptomatic individual signifies colonization, not active infection, and does not warrant antimicrobial therapy.2.2 Interpreting Laboratory TestsThis protocol is based on a standard two-step testing algorithm involving a nucleic acid amplification test (PCR) and a toxin enzyme immunoassay (EIA). The combination of these results dictates the clinical interpretation and subsequent action. When both PCR and toxin EIA are positive, this indicates active CDI requiring treatment. When PCR is positive but toxin EIA is negative, this suggests colonization rather than active infection, and treatment should be withheld unless clinical suspicion remains high. When both tests are negative, CDI is ruled out.2.3 Defining RecurrenceA CDI recurrence is formally defined as the reappearance of clinical symptoms (≥3 unformed stools/24 hours) accompanied by a positive stool test within 8 weeks of completing therapy for a prior episode. This timeline suggests a relapse from persistent spores. An episode that occurs more than 8 weeks after the completion of therapy is typically considered a reinfection or a new episode.Once an active infection is confirmed, the next critical step is to assess its severity, which directly guides the initial therapeutic choice.3.0 Initial Patient Assessment and Severity StagingThe strategic staging of disease severity is a critical decision point in CDI management. This assessment determines not only the choice and dose of antimicrobial therapy but also dictates the need for a higher level of care, intensive monitoring, and immediate surgical consultation.3.1 Non-Fulminant CDIA case of CDI is classified as non-fulminant if it does not meet any of the criteria for fulminant disease listed below. This category encompasses the majority of initial CDI episodes.3.2 Fulminant CDIFulminant CDI is a severe, life-threatening presentation characterized by systemic toxicity and colonic collapse. A diagnosis of fulminant CDI is made if any of the following are present:Hypotension or shockIleus (paralysis of the bowel)Megacolon (significant dilation of the colon on imaging)The following sections will outline the specific treatment pathways based on this crucial severity assessment.4.0 Management of an Initial CDI EpisodeThe primary goals for treating an initial episode of CDI are to achieve clinical resolution of symptoms and, critically, to minimize the risk of subsequent recurrence. The choice of therapy is guided by disease severity and patient-specific risk factors for relapse.4.1 Treatment of Non-Fulminant Initial CDIPreferred Therapy: FidaxomicinRegimen: 200 mg orally twice daily for 10 days.Rationale: Fidaxomicin is the preferred agent due to its targeted, narrow-spectrum activity that functions like a sniper, eliminating C. difficile with minimal collateral damage to the protective gut flora. This microbiome-sparing property preserves and promotes the restoration of ...
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