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Updated: Jun 21, 2025
A Protocol to Characterize the Morphological Changes of Clostridium difficile in Response to Antibiotic Treatment
Published on: May 25, 2017
Management of Clostridioides difficile infection: an Italian Delphi consensus
Matteo Bassetti1, Antonio Cascio2, Francesco Giuseppe De Rosa3
1Infectious Diseases Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy.
Background:
Clostridioides difficile infection (CDI), a leading cause of nosocomial deaths, is a microbiota-mediated disease. As such, the use of broader spectrum antibiotics, such as vancomycin and metronidazole, can prime the gastrointestinal tract to become more prone to CDI recurrences. Fidaxomicin, a narrow-spectrum antibiotic, has been demonstrated to be superior in preventing recurrence and in preserving the intestinal microbiota; however, widespread employment worldwide has been hindered due to high acquisition costs.
Objectives:
To integrate the currently available guidelines on the management of CDI and to shed light on the timeliest employment of fidaxomicin.
Methods:
An expert panel was gathered to obtain consensus using Delphi methodology on a series of statements regarding the management of CDI and on appropriate antibiotic use.
Results:
Consensus was reached on 21 of the 25 statements addressing the management of CDI.
Conclusions:
Delphi methodology was used to achieve consensus on the management of CDI, on the identification of patients at risk of recurrences or severe infection, and on the most appropriate use of fidaxomicin, with the final aim of fostering clinical practice application of treatment algorithms proposed by previous guidelines, in absolute synergy. It could be an important tool to promote more appropriate and cost-effective CDI treatments in European settings with limited resources, like Italy.
Insights
Clostridioides difficile infection (CDI) management guidelines were updated using expert consensus. Fidaxomicin offers advantages in preventing CDI recurrence and preserving gut microbiota, despite cost barriers.
Area of Science:
- Microbiology
- Infectious Diseases
- Pharmacology
Background:
- Clostridioides difficile infection (CDI) is a major cause of hospital-acquired deaths, linked to gut microbiota disruption.
- Broad-spectrum antibiotics like vancomycin and metronidazole can increase CDI recurrence risk.
- Fidaxomicin, a narrow-spectrum antibiotic, shows promise in preventing CDI recurrence and preserving microbiota but faces cost challenges.
Purpose of the Study:
- To consolidate existing Clostridioides difficile infection management guidelines.
- To determine optimal timing for fidaxomicin use in CDI treatment.
Main Methods:
- Expert panel convened to reach consensus on CDI management statements using Delphi methodology.
- Statements focused on CDI management and appropriate antibiotic selection.
Main Results:
- Consensus achieved on 21 out of 25 statements regarding CDI management.
- Agreement reached on identifying high-risk patients and appropriate fidaxomicin utilization.
Conclusions:
- Delphi methodology facilitated consensus on CDI management, risk stratification, and optimal fidaxomicin use.
- This consensus can guide clinical practice, promoting cost-effective CDI treatment, especially in resource-limited settings.
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