Diagnosis, treatment, and prophylaxis of <i>Clostridioides difficile</i> infections: A cross-sectional survey of Canadian clinicians

Background: A recent international survey of clinician practices in the management of Clostridioides difficile infections (CDIs) identified numerous areas of practice heterogeneity. The degree of practice variability within Canada is unknown. Methods: Data from Canadian participants of an international survey of clinician CDI practices were extracted. Practice alignment with the Association of Medical Microbiology and Infectious Diseases (AMMI) Canada CDI treatment guidelines was assessed. CDI practices were compared across provinces using Fisher's exact test with a simulated P value. Results: A total of 112 responses were obtained from eight provinces. Vancomycin (85.3% for first episode), vancomycin pulse and taper (P-T) (61.8% and 32.4% for first and second recurrences, respectively), and fecal microbiota transplant (32.4% for third recurrence) were preferred treatment strategies. Practice alignment with the AMMI Canada CDI guidelines for the treatment of recurrences was low (range 23.5%–32.4%, depending on the recurrence number). With respect to secondary CDI prophylaxis during antibiotic reexposure, there were interprovincial differences in the perceived indication ( P = .03), whether to prescribe at all ( P &lt; .001), and duration of prophylaxis ( P = .004). There was significant clinician support (&gt;50%) for randomized clinical trials testing treatment strategies for recurrent episodes and for secondary prophylaxis. Conclusion: Despite the availability of national guidelines, we found significant heterogeneity in practice across Canada, often not aligned with guideline recommendations. These findings underscore the need for a platform trial comparing treatment strategies and a trial to establish the efficacy of secondary prophylaxis.