Clostridium difficile: improving the prevention paradigm in healthcare settings

Abstract

Clostridium difficile infection (CDI) is a major public health problem worldwide with significant morbidity and mortality that is spread by spores and fecal oral transmission. A variety of risk factors have been identified. Some risk factors such as age, are not amenable to change, while others such as antimicrobial utilization have resulted in broadly implemented antimicrobial stewardship programs. New risk factors are emerging such as proton pump inhibitor (PPI) use, irritable bowel disease (IBD) and obesity, with others yet to be determined. Prevention of spread of CDI is imperative, since therapy remains imperfect. We review established and emerging risks for CDI and offer potential preventative strategies with the use of a multidisciplinary CDI prevention bundle checklist.

Keywords::

• antibiotic resistance
• antibiotic stewardship
• Clostridium difficile
• C. difficile bundle
• Clostridium difficile infection
• contact isolation
• contact precautions
• disinfection
• fecal microbiome
• hand hygiene
• hydrogen peroxide vapor infection prevention
• probiotics
• UV light

Financial & competing interests disclosure

EJC Goldstein is on Advisory Boards for Merck, Optimer, BioK+ International, Novartis Pharmaceuticals, Bayer, Rempex and Summit Pharmaceuticals. He has received research grants from Merck, Optimer, GSK, Rempex, Cubist, Cerexa and Forrest Pharmaceuticals. He is on the speakers’ bureaus of Merck, Cubist, Optimer, BioK+ and Forrest Pharmaceuticals. A Vassallo and MN Tran 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.

Key issues

• What is the source of community-associated and healthcare-associated Clostridium difficile spore exposure?

• What components of the microbiome and host immunity are protective for avoidance of C. difficile infection (CDI)?

• What are the appropriate hand hygiene practices for CDI patient care?

• Resolution of if/when to discontinue contact precautions for asymptomatic CDI patients.

• Improved environmental decontamination methods for the CDI patient environment.

Notes

CDI: C. difficile infection.