Clostridioides difficile infection (CDI)

Background

Clostridioides difficile infection (CDI) is an important cause of infectious diarrhoea, which usually follows the use of antibiotics. While CDI is mainly associated with the healthcare setting, there's also a significant impact in the community.

In Scotland in 2006, national mandatory surveillance of CDI was introduced as a response to its rapid emergence at the turn of the century in:

  • UK
  • Europe
  • North America

Surveillance was initially carried out in patients aged 65 years and older, before being extended in April 2009 to include all patients aged 15 years old and older.

The epidemiology of CDI in Scotland and other countries was initially marked by high incidence rates and several outbreaks in hospital patients, with the highest rates in older patients. However, since 2008, there's been a dramatic and sustained decrease in CDI incidence rates, though the disease remains an important cause of ill health, especially in hospitalised and vulnerable patients.

Guidance

This is a revised edition of the Guidance on Prevention and Control of Clostridioides difficile Infection (CDI) in Health and Social Care Settings in Scotland document. It provides easily accessible advice covering key aspects of prevention and control of CDI.

Following Scottish Health Protection Network (SHPN) methodology for development of guidelines this version helps staff deliver safe care and support the reduction of CDI in their organisation by providing a standardised evidence-based approach to CDI's:

  • diagnosis
  • prevention
  • control
  • treatment

New elements of the guidance include:

  • monitoring and treatment of CDI in children under 15 years old
  • clarification of the roles and responsibilities for GPs and health protection teams
  • revision of recommendations for patient assessment for CDI cases in care homes and those receiving care at home
  • consensus on the role of asymptomatic carriers and probiotics for prevention and treatment of CDI
  • updated information on the use of faecal microbiota transplantation for the treatment of CDI

Read SHPN's guidance on Prevention and Control of Clostridioides difficile Infection (CDI) in Health and Social Care Settings in Scotland No 6 2017 edition

CDI treatment algorithms

Please refer to the guidance for full details. The individual treatment algorithms for CDI can be read below:

For all infection prevention and control guidance visit the A-Z ​pathogens section of the National Infection and Prevention Control Manual.

Data and surveillance

Quarterly epidemiological data commentaries

The commentaries contain quarterly epidemiological data by NHS board and nationally for Scotland jointly for:

  • Clostridioides difficile infection
  • Escherichia coli bacteraemia
  • Staphylococcus aureus bacteraemia
  • surgical site infection

Read the latest commentary on quarterly epidemiological data in Scotland:

View all previous quarterly epidemiological reports

Protocol for the Scottish Surveillance Programme for Clostridioides difficile infection: user manual

Mandatory surveillance for CDI currently includes all patients aged 15 and above in all healthcare settings who have diarrhoea that's not caused by something else.

In 2016, we collaborated with the Scottish Microbiology and Virology Network (SMVN) and the Scottish Salmonella, Shigella and Clostridioides difficile Reference Laboratory (SSSCDRL) to publish a revised version of the Recommended Protocol for Testing for Clostridioides difficile and Subsequent Culture

The revised testing guidance recommends testing stools in patients aged three or above; however, the mandatory surveillance of CDI remains limited to those patients aged 15 or above. Therefore, other than for submissions to the C. difficile Reference Laboratory for ribotyping, the following surveillance protocol only applies to those aged 15 or above.

View our Protocol for the Scottish Surveillance Programme for Clostridioides difficile infection

Recommended protocol for testing for Clostridioides difficile and subsequent culture

This consensus guidance has been produced by a group of microbiologists representing the Scottish Microbiology and Virology Network (SMVN), the Scottish Salmonella, Shigella and Clostridioides difficile reference laboratory and ourselves in consultation with the full SMVN membership.

It's intended for use by microbiology laboratories in NHSScotland and supersedes the previous recommended protocol published in December 2012.

View the recommended protocol for testing for Clostridioides difficile and subsequent culture

Protocol for the Clostridioides difficile snapshot programme

In conjunction with the C. difficile Reference Laboratory we've developed a snapshot programme in order to get a better understanding of the epidemiology of C. difficile in Scotland.

This protocol describes how the isolates should be collected and submitted.

Published in September 2017, the current version of the protocol is version 3.0.

View the protocol for Clostridioides difficle