Fecal Microbiota Transplantation

Breaking the Chain of Recurrent C. difficile Infection

Amy Marinski, MSN, RN, CCRN, CNL


Am Nurs Today. 2013;8(6) 

In This Article

Emerging Concerns

CDI commonly follows exposure to antibiotics, which alter the intestinal flora and cause an imbalance of the natural gut flora. Initial treatment involves discontinuing the suspected causative antibiotic and starting oral vancomycin, metronidazole, or fidaxomicin.

Unfortunately, more than 1 million CDI patients who receive these drugs experience treatment failure. One possible explanation is the emergence of multiple-relapse CDI (MR-CDI). Relapse rates are nearing 30% in patients with first-time CDI and exceed 65% for patients with a history of recurrent CDI.

To make matters worse, a hypervirulent strain of C. difficile, known as BI/NAP1/027, recently emerged. Experts believe this strain accounts largely for the increased CDI incidence. First noted in the early 2000s in North America and Europe, this strain differs from other C. difficile strains in four dangerous ways:

  • causes increased toxin production

  • leads to more severe diarrhea

  • involves increased spore production

  • causes fluoroquinolone resistance.

Emergence of the new strain underscores the importance of prevention. (See the box below.)

Crucial preventive measures
Preventing the spread of C. difficile is crucial to reducing the incidence of CDI. Prevention requires a threefold approach: preventing person-to-person transmission, minimizing risk factors, and practicing antimicrobial stewardardship through the following measures:
  • hand hygiene with soap and water to rinse off C. difficile spores

  • early contact precautions for patients with diarrhea (isolation in a private room, gloves and gowns worn by visitors and healthcare personnel)

  • environmental cleaning and disinfection (single-patient-use equipment or bleach cleaning of shared equipment)

  • CDI education for healthcare workers and environmental personnel

  • CDI education for patient and families

  • decreased overall use and duration of antibiotic therapy.