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Updated: Dec 13, 2025
A Protocol to Characterize the Morphological Changes of Clostridium difficile in Response to Antibiotic Treatment
Published on: May 25, 2017
Diagnostic and therapy of severe Clostridioides difficile infections in the ICU
Benoit Guery1,2,3,4, Frédéric Barbut2,5,6,4, Sarah Tschudin-Sutter4,7
1Infectious Diseases Service, Department of Medicine, University Hospital and University of Lausanne, Lausanne, Switzerland.
Purpose Of Review:
The purpose of the review is to provide all the recent data focusing on the diagnostic and treatment of Clostridioides difficile infection in patients admitted in the ICU.
Recent Findings:
In the ICU, diagnosis remains complicated with a large number of alternative diagnosis. The treatment classically relies on vancomycin but fidaxomicin and fecal microbiota transplantation are now potential solutions in selected indications.
Summary:
Data on ICU-related CDI remain limited and conflicting. To date, there is no unique and simple way to obtain a diagnosis for CDI, the combination of clinical signs and a two-step testing algorithm remains the recommended gold-standard. Two molecules can be proposed for first line treatment: vancomycin and fidaxomicin. Although metronidazole may still be discussed as a treatment option for mild CDI in low-risk patients, its use for ICU-patients does not seem reasonable. Several reports suggest that fecal microbiota transplantation could be discussed, as it is well tolerated and associated with a high rate of clinical cure. CDI is a dynamic and active area of research with new diagnostic techniques, molecules, and management concepts likely changing our approach to this old disease in the near future.
Insights
Diagnosing and treating Clostridioides difficile infection (CDI) in ICU patients is challenging. Recent data suggest vancomycin and fidaxomicin are key treatments, with fecal microbiota transplantation as a potential option.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Microbiology
Background:
- Clostridioides difficile infection (CDI) poses significant challenges in intensive care units (ICUs).
- Diagnosis in the ICU setting is complicated by numerous alternative diagnoses.
- Limited and conflicting data exist regarding ICU-specific CDI.
Purpose of the Study:
- To review recent data on the diagnosis and treatment of Clostridioides difficile infection in ICU patients.
- To highlight current challenges and emerging therapeutic strategies for ICU-acquired CDI.
Main Methods:
- Comprehensive literature review of recent studies on CDI in ICU settings.
- Analysis of diagnostic algorithms and treatment options for Clostridioides difficile infection.
- Evaluation of emerging therapies including fecal microbiota transplantation.
Main Results:
- Diagnosis of CDI in ICUs requires a combination of clinical signs and a two-step testing algorithm.
- Vancomycin and fidaxomicin are recommended first-line treatments for CDI.
- Fecal microbiota transplantation shows promise as a well-tolerated option with high cure rates in selected cases.
- Metronidazole is not recommended for ICU patients with CDI.
Conclusions:
- Accurate diagnosis of CDI in the ICU remains complex, with the gold standard being clinical assessment combined with a two-step diagnostic approach.
- Vancomycin and fidaxomicin are the primary therapeutic agents for CDI in critically ill patients.
- Fecal microbiota transplantation represents a viable alternative for refractory or recurrent CDI in the ICU.
- Ongoing research is expected to yield new diagnostic and therapeutic advancements for CDI.
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