Clostridium difficile infection (Clostridium difficile)

A case is a patient two years or older to whom one or more of the following criteria applies:

  • Diarrhoeal stools or toxic megacolon WITH EITHER
    • Positive laboratory assay for C. difficile toxin TcdA and/or TcdB in stool
    • Toxin-producing C. difficile organism detected in stool via culture or other means
  • Pseudomembranous colitis revealed by lower gastrointestinal endoscopy
  • Colonic histopathology characteristic of C. difficile infection (with or without diarrhoea) on a specimen obtained during endoscopy, colectomy or autopsy

New case of C. difficile infection
A new case of C. difficile infection is defined as a patient with a first episode of C. difficile infection meeting the criteria outlined above.
OR
A patient with an episode of C. difficile infection meeting the criteria outlined above and presenting more than eight weeks after a previous positive specimen.

Recurrent C. difficile infection
A recurrent case is a patient with an episode of C. difficile infection that occurs within eight weeks following the onset of a previous episode, provided that C. difficile infection symptoms from the earlier episode resolved (with or without therapy).

Severe C. difficile infection
This is a patient with C. difficile infection to whom any of the following criteria apply:
- Admission to an intensive care unit for treatment of C. difficile infection or its complications (e.g., for shock requiring vasopressor therapy)
- Surgery (colectomy) for toxic megacolon, perforation or refractory colitis
- Death within 30 days after diagnosis, if C. difficile infection is either the primary or contributory cause of death

Case classification
A. Possible case
NA
B. Probable case
NA
C. Confirmed case
Any person meeting the criteria outlined above for a new or recurrent case 

Notes:

  1. Diarrhoea is defined as three or more loose/watery bowel movements that take up the shape of their container (which are unusual or different for the patient) in a 24 hour period
  2. The current international C. difficile case definition excludes diarrhoea with other known aetiology (as diagnosed by the attending physician) and asymptomatic patients with a stool culture positive for toxin-producing C. difficile or an assay positive for C. difficile toxin (TcdA and ⁄or TcdB) 

Current as of: 22 January 2019