recurrent C. difficile

Q: How the recurrent C. difficile infection (CDI) is defined?

Answer: Recurrent C. difficile infection is defined by resolution of CDI symptoms while on appropriate therapy, followed by the reappearance of symptoms within two to eight weeks after treatment has been stopped.

Looking closely, it has four aspects. 

1. is less likely to be a re-infection. Usually, it is a relapse of the previous infection.
2. There should be a resolution of CDI symptoms while on appropriate therapy previously 
3. Time-period to define recurrent C. difficile infection is within two to eight weeks 
4. This time-period should be counted after the treatment has been stopped

Clinically, this is important as it distinguishes between relapsing, re-infecting and refractory CDI infections. And, all three may require different clinical approaches.

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References:

1. McDonald LC, Gerding DN, Johnson S, et al. Clinical Practice Guidelines for Clostridium difficile Infection in Adults and Children: 2017 Update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA). Clin Infect Dis 2018; 66:e1.

2. Kamboj M, Khosa P, Kaltsas A, et al. Relapse versus reinfection: surveillance of Clostridium difficile infection. Clin Infect Dis 2011; 53:1003.