How to Prevent C difficile Infection: A New Guide

Laura A. Stokowski, RN, MS

Disclosures

May 24, 2013

In This Article

Antimicrobial Stewardship and CDI

To colonize or infect the human gastrointestinal tract, C difficile attaches to receptors in the gut epithelial cells. If these receptors are occupied by organisms of the normal gut microbiome, C difficile strains reaching the gut mucosa will have no place to attach and will not be able to multiply and cause disease. The normal flora also deprives C difficile of nutrients essential for survival. However, if broad-spectrum antibiotics have wiped out the normal flora, C difficile is without competition and can attach and begin producing toxins.

Ruth Carrico emphasized that "From a medical practice perspective, a lack of antimicrobial stewardship is the biggest challenge in prevention of CDI." In the Pace of Progress Survey,[1] 60% of respondents reported that their facilities had antimicrobial stewardship programs, a number that leaves room for improvement. To remedy this situation, said Dr. Carrico, "We must place more reliance on collaboration between microbiology and pharmacy, along with leadership from infection prevention and healthcare epidemiology. These specialists can help ensure rapid and accurate microbiologic results and reports, appropriate selection and use of antimicrobials, and evaluation of local adherence with antimicrobial use guidelines. "

The most common inappropriate antimicrobial practice is continuing broad-spectrum antibiotic use after the pathogen has been identified and found to be sensitive to a narrower-spectrum antibiotic.[1] APIC recommends deescalation of antimicrobial therapy from broad- to narrow-spectrum agents as quickly as possible. Poor antimicrobial practices that must be addressed include the use of antibiotics to treat bacterial colonization (rather than infection) or contaminated cultures, and the use of antibiotics in patients without documented infection.[1]

The Way Forward

CDI is already responsible for an estimated 14,000 deaths annually in the United States.[10] More must be done to prevent and control CDI not just in hospitals, but across all healthcare settings.[10] The APIC guide offers a resource for collaboration between physicians, nurses, infection preventionists, environmental services staff, patients, and families. The team approach is now the only way forward.[2]

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