Criteria

Case definition​[2]​​

The recommended case definition for surveillance requires:

  • The presence of diarrhea or evidence of megacolon or severe ileus; and

  • A positive laboratory diagnostic test result or evidence of pseudomembranes on endoscopy or histopathology.

Incident case:

  • A new primary episode of symptom onset (no episode of symptom onset with positive result in the previous 8 weeks) and a positive assay result.

Recurrent case:

  • An episode of symptom onset and positive assay result following an episode in the previous 2 to 8 weeks.

Disease severity​[2]​​[78]​​

Nonsevere

  • Supportive clinical data: leukocytosis with WBC count of ≤15,000 cells/mL and serum creatinine <1.5 mg/dL (<0.13 mmol/L).

Severe

  • Supportive clinical data: leukocytosis with WBC count of ≥15,000 cells/mL and serum creatinine >1.5 mg/dL (>0.13 mmol/L).

Fulminant (severe, complicated infection)

  • Supportive clinical data: hypotension, shock, ileus, or megacolon.

The above criteria are recommended by the Infectious Diseases Society of America/Society for Healthcare Epidemiology of America (IDSA/SHEA) guidelines. However, current definitions for severe disease are heterogenous across guidelines, and there is no commonly agreed upon definition. The most common criteria for severe disease in clinical guidelines were elevated WBC count, hypoalbuminemia, and elevated creatinine levels.[79]

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