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JAMA Insights
Clinical Update
March 9, 2020

Diagnosis and Treatment of Clostridioides (Clostridium) difficile Infection in Adults in 2020

Author Affiliations
  • 1Division of Infectious Diseases, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
  • 2Associate Editor, JAMA
JAMA. Published online March 9, 2020. doi:10.1001/jama.2019.3849

Clostridioides (formerly Clostridium) difficile infection (CDI) remains a major public health problem and accounted for an estimated 450 000 cases and 35 000 deaths in the US in 2015.1 Since publication of a review of the diagnosis and management of CDI in adults,2 new clinical tests and therapies have become available and clinical practice guidelines were updated. New evidence supports fecal microbiota transplant (FMT).3 While overall rates of CDI have stopped increasing, rates of recurrent CDI (rCDI), defined as 2 or more recurrences after an initial CDI, have increased from 1.07 to 3.09 cases per 100 000 person-years between 2001 and 2012.4 Because rCDI is associated with adverse outcomes, such as hospitalization, the increased incidence deserves attention. This update summarizes current evidence regarding diagnosis and management of CDI in adults, emphasizing management of rCDI.