Unifying Concepts

Severity Criteria for Clostridium difficile Infection

Patients with severe disease may develop a colonic ileus or toxic dilatation and present with abdominal pain and distension but with minimal or no diarrhea. Complications of severe C. difficile colitis include dehydration, electrolyte disturbances, hypoalbuminemia, toxic megacolon, bowel perforation, hypotension, renal failure, systemic inflammatory response syndrome, sepsis, and death.
Severity Criteria for Clostridium difficile Infection
The severity of episodes of C. difficile diarrhoea are classified according to the following guidelines:
  • normal white blood cell count (WCC)
  • stool frequency less than three per day and
  • stool consistency type 5–7 on Bristol Stool Form Scale.
  • WCC raised but <15 ×109/l and
  • stool frequency three to five per day.
  • WCC raised but >15 ×109/l or
  • an acute rising serum creatinine (>50% increase above baseline) or
  • temperature >38.5 °C or
  • evidence of severe colitis (based on clinical examination or imaging).
  • hypotension or
  • partial or complete ileus or
  • toxic megacolon or
  • radiological evidence of severe disease.
Requirement for intensive care unit (ICU) admission
The presence of at least 2 of the following factors:
  1. Age >70 years
  2. Leukocytosis >15,000 cells/mm3
  3. Deviation to the left marked (segmented neutrophils > 20% of the leukocyte count)
  4. Increased creatinine >/= 1.5 times baseline
  5. Serum lactate > 2.5 mmol/l
  6. Temperature > 38.5 °C
  7. Multiple daily diarrheal stools (>10 per day)
  8. Presence of paralytic ileus or signs of peritonitis
  9. Albumin <2.5 mg/dl
  10. Evidence of colitis on CT scan
  1. Rodríguez-Pardo D, Mirelis B, Navarro F. Infections caused by Clostridium difficile. Enferm Infecc Microbiol Clin. 2013 Apr;31(4):254-63. [Medline]
  2. Leffler DA, Lamont JT. Clostridium difficile infection. N Engl J Med. 2015 Apr 16;372(16):1539-48. [Medline]
  3. Allen SJ, Wareham K, Wang D, et al. A high-dose preparation of lactobacilli and bifidobacteria in the prevention of antibiotic-associated and Clostridium difficile diarrhoea in older people admitted to hospital: a multicentre, randomised, double-blind, placebo-controlled, parallel arm trial (PLACIDE). Health Technology Assessment, No. 17.57. Southampton (UK): NIHR Journals Library; 2013 Dec. [Medline]
Created Jan 06, 2017.
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