Table 2.

Keypoints on management of Clostridioides difficile infection (CDI) in adults with IBD. CDI—Clostridioides Difficile infection; TOX A/B—ELISA for detecting C. difficile toxin in fecal specimens, FMT—fecal microbiota transplantation.

In IBD population with diarrhea, always perform:	Clinical examination (asking them about recent antibiotics and corticosteroids use and registering vital signs) Stool cultures for enteroinvasive bacterial infections and C. difficile detection in feces (GDH and TOX A/B) Blood exams with hemoglobin and C-reactive protein [31]
If acute severe ulcerative colitis (ASUC) is suspected (>6 bloody stools per day and at least one among these systemic toxicity signs (temperature > 37.8 °C, pulse > 90 bpm, hemoglobin <105 g/L, or C-reactive protein > 30 mg/L), always perform:	Radiological imaging (CT) Sigmoidoscopy to re-staging and exclude CMV superinfection [31]
While stool cultures and exams for C. difficile detection are pending [31]	Do not delay corticosteroids treatment if ASUC is present
If C. difficile is confirmed [71]:	Suspend other antibiotics, if unnecessary Reduce dose of corticosteroids if they have been previously started In case of 1st or 2nd no fulminant episode, start Vancomycin or Fidaxomicin, adding Bezlotoxumab in high-risk subpopulations or in early recurrence (<6 months) In case of 2nd or subsequent recurrences, perform FMT if not contraindicated In case of Fulminant CDI (hypotension, shock, ileus, altered mental status, cardiorespiratory failure, lactic acidosis), always request surgical evaluation and radiological imaging. Always consider FMT via colonoscopy whenever the patient does not respond to standard antibiotic therapy or in severe presentation