Curbside Consults Podcast

By Leslie Chang, MD

Published July 20, 2022

In this episode of Curbside Consults, we examine the latest guidelines on the management of Clostridiodes difficile (C. difficile) infection. This year, updated guidelines were developed by the Infectious Diseases Society of America and Society for Healthcare Epidemiology of America, as well as the American College of Gastroenterology. Here, we discuss diagnosis and treatment of C. difficile infection through the lens of a clinical case with one of the guideline authors, Dr. Jessica Allegretti, a gastroenterologist at Brigham and Women’s Hospital.


00:05 – Introduction
00:59 – Overview of guideline development
03:35 – What’s new in these updated guidelines
05:29 – Introduction to clinical case
06:07 – Diagnosing C. difficile infection
08:04 – Fidoximicin versus vancomycin for first-line treatment
09:34 – Treatment of recurrent C. difficile infection
10:59 – Bezlotoxumab for prevention of recurrence
12:38 – Risk factors for recurrence
13:35 – C. difficile prophylaxis
17:02 – Fecal microbiota transplantation
20:07 – Final learning points
21:00 – Concluding remarks

Articles discussed in this episode:

1. Johnson S et al. Clinical Practice Guideline by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA): 2021 Focused Update Guidelines on Management of Clostridioides difficile Infection in Adults. Clin Infect Dis 2021.
2. Kelly CR et al. ACG Clinical Guidelines: Prevention, Diagnosis, and Treatment of Clostridioides difficile Infections. Am J Gastroenterol 2021.
3. Wilcox MH et al. Bezlotoxumab for Prevention of Recurrent Clostridium difficile Infection. N Engl J Med 2017.
4. Louie TJ et al. Fidaxomicin versus Vancomycin for Clostridium difficile Infection. N Engl J Med 2011.

The Curbside Consults series complements the foundational information in Rotation Prep by taking a deep dive into key clinical topics with expert clinicians and educators. These podcasts explore and critique the evidence behind clinical practice and break down statistical concepts for the busy clinical trainee.

Dr. Jessica Allegretti is Associate Director of the Crohn's and Colitis Center and a gastroenterologist at Brigham and Women’s Hospital.
Leslie Chang, MD, is a 2021-2022 NEJM Editorial Fellow and a hospitalist at Massachusetts General Hospital. She graduated from Duke University School of Medicine in 2018 and completed her internal medicine residency at Massachusetts General Hospital in 2021.