What are the indications for referring a patient with recurrent C. difficile infections to a specialist?

Indications for referring a patient with recurrent Clostridioides difficile infections (CDI) to a specialist include:

• Having had at least two previous episodes of CDI, indicating recurrent infection, which warrants consideration of referral to a gastroenterologist for further management, including possible faecal microbiota transplantation.
• Severe or fulminant infection, or rapidly worsening symptoms or signs, which require urgent specialist or hospital referral.
• High risk of complications or recurrence due to individual factors such as advanced age, frailty, or significant comorbidities.
• Failure to respond to initial antibiotic treatment or if oral treatment is not possible, necessitating specialist advice on alternative therapies.

Referral is recommended pragmatically based on NICE guidelines and good clinical practice to ensure appropriate specialist input for complex or recurrent cases.

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