Table 2.

Recommendation statements extracted from the CP

CP recommendation statement	Clinical phase	Clinical Activity	GEM Action Type
Begin CP if inpatient, positive C. diff test, AND clinical signs/symptoms consistent with CDI	Pre Pathway Initiationa	Identify Patient	Diagnose
Begin CP if inpatient and high clinical suspicion (eg, fever, high white blood cell count, ≥ 3 documented liquid stools in 24 hours)	Pathway Initiationa	Identify Patient	Diagnose
When starting the CP, if possible STOP precipitating antibiotic(s). Discontinue therapy with inciting antibiotic agent(s) as soon as possible, as this may influence the risk of CDI recurrence.	Treatment Initiation	Stop Antibiotics	Prescribe
When starting the CP, if possible, STOP laxatives.	Treatment Initiation	Stop Laxatives	Prescribe
When starting the CP, stop and avoid anti-peristaltic agents (loperamide, Lomotil) throughout treatment course.	Treatment Initiation	Stop anti-peristaltic agents; Avoid anti-peristaltic agents	Prescribe
When starting the CP, stop and avoid unnecessary PPI.	Treatment Initiation	Stop PPI; Avoid PPI	Prescribe
Diagnose as recurrent CDI if positive C. diff test with recurrent symptoms attributable to CDI within 8 weeks of successfully completing treatment for previous CDI that was associated with interval improvement.	Treatment Selection	Diagnose as recurrent CDI	Prescribe
Diagnose as refractory CDI if lack of symptomatic improvement to appropriate prescribed treatment for CDI.	Treatment Selection	Diagnose as refractory CDI	Diagnose
If refractory CDI is suspected, consider alternative causes for infection.	Treatment Selection	Management of Refractory CDI	Consider
If refractory CDI is suspected, consult infectious disease.	Treatment Selection	Management of Refractory CDI	Refer/ Consult
If first (ie, nonrecurrent) CDI, obtain OR ensure has obtained within the last 24 hours CBC and BMP.	Treatment Selection	Evaluation, first episode	Test
Diagnose patient presenting with non-recurrent CDI as “CDI, non-severe” if WBC < 15 000 cells/mL AND Cr <1.5 mg/dl.	Treatment Selectionb	Diagnose as CDI Non-Severe	Diagnose
Diagnose patient presenting with non-recurrent CDI as “CDI, severe” if WBC>=15 000 cells/mL or Cr >=1.5 mg/dl.	Treatment Selectionb	Diagnose as CDI Severe	Diagnose
Diagnose patient presenting with non-recurrent CDI as “CDI, fulminant” if sepsis with acute organ dysfunction OR septic shock OR abdominal signs/symptoms (vomiting, distention) concerning for ileus, toxic megacolon.	Treatment Selection	Diagnose as CDI Fulminant	Diagnose
If CDI and not on antibiotics, treat with vancomycin, 125 mg q6h for 10 days.	Treatment Selection	Manage CDI Non-Fulminant, off antibiotics	Prescribe
If CDI and on antibiotics, treat with vancomycin, 125 mg q6h for 10 days minimum but consider extending the treatment course for 7 days beyond the current course of treatment.	Treatment Selection	Manage CDI Non-Fulminant, on antibiotics	Prescribe
If diagnosed with fulminant CDI, order a C. diff test to confirm.	Treatment Selection	Manage CDI Fulminant	Prescribe
If diagnosed with fulminant CDI, abdominal x-ray or CT is recommended if abdominal signs/symptoms (vomiting, distention) concerning for ileus, toxic megacolon.	Treatment Selection	Manage CDI Fulminant	Prescribe
If diagnosed with fulminant CDI, surgical and infectious disease consults are recommended.	Treatment Selection	Manage CDI Fulminant	Refer/ Consult
If diagnosed with fulminant CDI, and no significant abdominal findings treat with vancomycin 500 mg PO/NG Q6h x14 days and metronidazole 500 mg IV Q8H x 14 days.	Treatment Selection	Mange CDI Fulminant	Prescribe
If diagnosed with fulminant CDI, and significant abdominal findings treat with vancomycin 500 mg PO/NG Q6h x14 days vancomycin retention enema 500 mg in 100 mL sterile water q6h x14 days and metronidazole 500 mg IV Q8H x 14 days.	Treatment Selection	Mange CDI Fulminant	Prescribe
If recurrent CDI and first recurrence then treat with vancomycin 125 mg PO Q6H for 10 days (especially if previously treated with metronidazole) or vancomycin tapered regimen	Treatment Selection	Mange first recurrence	Prescribe
If recurrent CDI and not first recurrence then treat with vancomycin taper, consider infectious disease consult, and consider fecal microbiota transplantation.	Treatment Selection	Manage multiple recurrences	Prescribe
If following CP and no improvement within 5 days consider alternative diagnosis and consult infectious disease	Treatment Monitoringc	Monitor	Monitor

Abbreviations: BMP, basic metabolic panel; CBC, complete blood count; CDI, Clostridioides difficile infection; CDS, clinical decision support; PPI, proton pump inhibitors; WBC, white blood cell.

^aRemoved during CP revisions but retained in the CDS.

^bRemoved during CP revisions and removed from CDS.

^cExcluded from CDS translation as out of scope for project.