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Effective Health Care Program

Future Research Needs for Prevention and Treatment of Clostridium difficile Infection

Systematic Review Archived

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Archived: The systematic review on which this report is based has been updated. The findings of this report may be used for research purposes, but should not be considered current.

This report is from AHRQ's series on Future Research Needs Projects.


Clostridium difficile infection (CDI) is a serious healthcare-associated infection and a growing health care problem, especially with the emergence of more virulent strains in the early 2000s. CDI is now the most common cause of nosocomial infectious diarrhea and is increasing in incidence and, in all likelihood, severity.

A comparative effectiveness review (CER) was prepared by the Minnesota Evidence-based Practice Center (EPC) on Comparative Effectiveness of Early Diagnosis, Prevention, and Treatment of Clostridium difficile Infection (December 2011). The purpose of the CER was to provide an overarching assessment of the evidence for comparing the accuracy of diagnostic tests and the effectiveness of prevention and treatment interventions on initial and recurrent CDI-related patient outcomes in adults.

Limited high-quality evidence was available to support the diagnostic, preventive, and treatment practices for CDI carried out by providers in hospital, long-term care, and outpatient settings. Inconsistency in definitions of diarrhea, severity, resolution of symptoms, recurrence, or cure contributed to the difficulty in drawing conclusions from the evidence. There were a number of important evidence gaps identified in the CER. The objective of this Future Research Needs project was to systematically prioritize evidence gaps on prevention and treatment of CDI, and to develop a list of research questions to address the prioritized gaps. Although different diagnostic methods for toxigenic Clostridium difficile were evaluated in the CER, diagnostic methods were not included in this project primarily because polymerase chain reaction testing is rapidly becoming the standard diagnostic test for the infection.