Clostridium difficile
Î Clostridium difficile now rivals methicillin-resistant Staphylococcus
aureus (MRSA) as the most common organism to cause healthcare-
associated infections (HAIs) in the United States, more than doubling
its incidence between 2000 and 2009.
Î C. difficile infection (CDI) with onset outside the hospital may be more
common than previously recognized, with ≥50% of CDIs having onset
in the community. In addition, ≥75% of CDI cases have onset outside
the acute care hospital.
Î There have been numerous reports of an increase in CDI severity.
Most reports of increases in the incidence and severity of CDI have
been associated with the BI/NAP1/027 strain of C. difficile. Some
studies have found that this strain produces more toxin A and B in
vitro than most other strains of C. difficile, and it may produce more
spores. It also produces a third toxin (binary toxin). BI/NAP1/027 is
highly resistant to fluoroquinolones.
Î CDI increases hospital length of stay by 2.8-5.5 days.
Î In studies over the past 10 years, fluoroquinolones, previously
infrequently associated with CDI, have been found to be primary
precipitating antimicrobials.
• Cephalosporins, ampicillin, and clindamycin remain important predisposing
antibiotics.
Î Gastric acid suppression has been recognized as a risk factor for CDI
in some studies.
Basic Practices for Prevention and Monitoring of CDI:
Recommended for All Acute Care Hospitals
Î Encourage appropriate use of antimicrobials (II).
Î Use contact precautions for infected patients, single-patient room
preferred (III for hand hygiene, II for gloves, III for gowns, III for
single-patient room).
Î Ensure cleaning and disinfection of equipment and the environment
(III for equipment, III for environment).
Î Implement a laboratory-based alert system to provide immediate
notification to infection prevention and control (IPC) and clinical
personnel about newly diagnosed CDI patients (III).
Î Conduct CDI surveillance and analyze and report CDI data (III).
Î Educate health care practitioners (HCPs), environmental service
personnel, and hospital administration about CDI (III).
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