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There is insufficient evidence to support the routine use of probiotics to prevent CDI. Probiotics for RCDI are discussed in a previous section. The remaining authors declare no conflict of interest. The emerging infectious challenge of Clostridium difficile -associated disease in Massachusetts hospitals: clinical and economic consequences. Clinical practice guidelines fo r Clostridium difficile infection in adults: 2010 update by the Society for Healthcare Epidemiology of America (SHEA) and the Infectious Diseases Society of America (IDSA).