Effects of control interventions on Clostridium difficile infection in England

Dingle, K.E. et al. The Lancet Infectious Diseases. Published online: 24 January 2017

A colour-enhanced scanning electron micrograph image showing a cluster of Clostridium difficile on a surface.

Image source: Annie Cavanagh – Wellcome Images // CC BY-NC-ND 4.0

A colour-enhanced scanning electron micrograph image showing a cluster of Clostridium difficile on a surface.

Background: The control of Clostridium difficile infections is an international clinical challenge. The incidence of C difficile in England declined by roughly 80% after 2006, following the implementation of national control policies; we tested two hypotheses to investigate their role in this decline. First, if C difficile infection declines in England were driven by reductions in use of particular antibiotics, then incidence of C difficile infections caused by resistant isolates should decline faster than that caused by susceptible isolates across multiple genotypes. Second, if C difficile infection declines were driven by improvements in hospital infection control, then transmitted (secondary) cases should decline regardless of susceptibility.

Interpretation: Restricting fluoroquinolone prescribing appears to explain the decline in incidence of C difficile infections, above other measures, in Oxfordshire and Leeds, England. Antimicrobial stewardship should be a central component of C difficile infection control programmes.

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