OVERVIEW OF CLINICAL GUIDELINES FOR THE DIAGNOSIS AND TREATMENT OF CLOSTRIDIODIOIDES DIFFICILE-ASSOCIATED INFECTION

Background. Clostridioides difficile-associated infection (CD-АI) is a condition caused by excessive replication of C. difficile in the gut, typically due to disruption of normal microbiota. It is the leading cause of nosocomial infections globally. Aim: to summarize recent data on epidemiological trends, clinical presentation, diagnostic criteria, severity assessment, and current treatment approaches for CD-AI. Material and methods. A systematic review of literature from 2020–2024 was conducted using PubMed, Medscape, UpToDate, and ESCMID library. It incorporates updated guidelines from IDSA/SHEA, ESCMID, and ACG on diagnosis, risk factors, severity criteria, and patient management. Results. CD-AI manifests as a spectrum, from asymptomatic carriage to fulminant disease, and have high recurrence risk. Modern data show a rise in community-acquired cases. Risk factors for CD-AI may vary depending on whether it is a primary episode of the disease, a relapse, a severe or complicated course, or a fatal outcome. CD-АI symptoms (diarrhea, abdominal pain, fever) during or shortly after antibiotic therapy should prompt testing for C. difficile toxins or antigens to guide timely treatment and recurrence prevention. Modern treatment strategies include fidaxomicin, vancomycin, and occasionally metronidazole or tigecycline. Preventative measures for recurrence, such as bezlotoxumab (a monoclonal antibody) and fecal microbiota transplantation (FMT) products ("Rebyota," "Vowst"), demonstrate promising outcomes. Conclusion. The incidence of community-acquired CD-АI is increasing compared to nosocomial cases. Key risk factors include advanced age, antibiotic use, and hospitalization. Early diagnosis and treatment guided by clinical guidelines are crucial. According to current guidelines, the approach to C. difficile treatment has evolved, shifting from the previous standard of metronidazole to vancomycin or fidaxomicin as first-line therapies. These agents have demonstrated efficacy in treating primary episodes of CDI; however, they do not eliminate the underlying residual dysbiosis, which may lead to spore germination and recurrent infection. Restoration of the gut microbiome—through fecal microbiota transplantation (FMT) following antibiotic therapy—or the use of bezlotoxumab alongside standard antibiotics are important strategies for preventing CD-АI recurrence, both of which have shown their efficacy and safety.