Control of Clostridium difficile infection in the hospital setting

Abstract

Clostridium difficile infection (CDI) has emerged as a leading challenge in the control of healthcare-associated infection (HCAI). The epidemiology of CDI has changed dramatically, this is associated with emergence of ‘hypervirulent’ strains, particularly PCR ribotype 027. Despite the epidemic spread of these strains, there are recent reports of decreasing incidence from healthcare facilities where multi-facetted targeted control programs have been implemented. We consider these changes in epidemiology and reflect on the tools available to control CDI in the hospital setting. The precise repertoire of measures adopted and emphasis on different interventions will vary, not only between healthcare systems, but also within different institutions within the same healthcare system. Finally, we consider both the sustainability of reductions already achieved, and the potential to reduce CDI further. This takes account of newly emerging data on more recent changes in the epidemiology of CDI, and the potential of novel interventions to decrease the burden of disease.

Keywords::

• antimicrobial stewardship
• Clostridium difficile infection
• hospital epidemiology
• infection prevention and control measures
• nosocomial infection

Financial & competing interests disclosure

JE Coia has received honoraria for preparation and presentation of educational material, advisory board membership and travel from Pfizer and Astellas, and has received grants for clinical research from Pfizer and MSD. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Clostridium difficile infection (CDI) remains a leading healthcare-associated infection challenge.

• Multifacetted intervention strategies have demonstrated success in controlling CDI in different healthcare systems, but the precise contribution of individual strategy components remains uncertain.

• The epidemiology of CDI continues to evolve, and the contribution of community-associated disease and the potential role of asymptomatic carriage need to be better defined.

• There is still significant room for improvement in CDI diagnostic strategies.

• Recurrent CDI remains an important challenge.

• The availability of sporicidal disinfectants that are less damaging to other materials within the healthcare environment would be helpful.

• Immunization and measures to address the underlying dysbiosis of the intestinal microbiota in CDI are likely to be important in the future.

Notes