Antimicrobial stewardship program and Clostridium difficile

Institutional antimicrobial stewardship programs seek to decrease the occurrence of C difficile by implementing strategies to address antibiotic usage; however, optimal structure and strategies for accomplishing this remain largely unknown | American Journal of Infection Control

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

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

Highlights: 

  • More hospitals with non-better Clostridium difficile rank used prospective audit and feedback.
  • More better C difficile rank hospitals used a preauthorization strategy.
  • More better C difficile rank hospitals restricted more high-risk antibiotics.

Full reference: Barlow, G. et al. (2017) Associations between antimicrobial stewardship program elements and Clostridium difficile infection performance. American Journal of Infection Control. Published online: 27 July 2017.

Tobacco use as a screener for Clostridium difficile infection outcomes

A retrospective cohort study to evaluate the utility of self-reported tobacco use for developing a clinical prediction rule for poor outcomes of Clostridium difficile infection | Journal of Hospital Infection

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We found that patients with any history of smoking were significantly less likely than never smokers to be cured of their infection within two weeks. Disease recurrence, readmission within thirty days, death before treatment completion, and the severity of Clostridium difficile infection were not associated with smoking status.

Full reference: Barker, A.K. et al. (2017) Tobacco use as a screener for Clostridium difficile infection outcomes. Journal of Hospital Infection. Published online: 26 June 2017

Are alcohol-based dispensers fomites for C difficile?

The purpose of this study was to evaluate alcohol-based dispensers as potential fomites for Clostridium difficile | American Journal of Infection Control

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A convenience sample of 120 alcohol-based dispensers was evaluated for the presence of C difficile either by culture or polymerase chain reaction for C difficile toxin. The results demonstrated that C difficile was not cultured, and C difficile toxin was not detected using polymerase chain reaction; however, gram-positive rods, Clostridium perfringens, Pantoea agglomerans, coagulase-negative Staphylococcus, Peptostreptococcus, Bacillus spp, and microaerophilic Streptococcus were present within the overflow basins of the alcohol-based dispensers.

Full reference: Hall, J.A. et al. (2017) Dipping into the Clostridium difficile pool: Are alcohol-based dispensers fomites for C difficile? American Journal of Infection Control. DOI: 10.1016/j.ajic.2017.04.284

Risk Factors for Community-Associated Clostridium difficile Infection in Children

Adams, D.J. et al. The Journal of Pediatrics | Published online: 7 April 2017

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Objective: To characterize the medication and other exposures associated with pediatric community-associated Clostridium difficile infections (CA-CDIs).

Conclusions: CA-CDI is associated with medications regularly prescribed in pediatric practice, along with exposure to outpatient healthcare clinics and family members with CDI. Our findings provide additional support for the judicious use of these medications and for efforts to limit spread of CDI in ambulatory healthcare settings and households.

Read the full abstract here

Clostridium difficile: still costly, still difficult to treat, and still here

Trafford, G. Journal of Hospital Infection | Published online: 18 March 2017

Clostridium difficile infection (CDI) remains a formidable problem in the healthcare setting and there is much left to learn regarding the biology of this troublesome pathogen. This special section in this issue of the Journal contains a range of papers covering the epidemiology, treatment, and costs of CDI. Individual cases and outbreaks come at considerable cost to institutions, with the subset of patients who fail to respond to conventional antibiotic therapy presenting an even greater morbidity risk and cost largely due to increased length of stay

Read the abstract here

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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The burden of healthcare associated Clostridium difficile infection in a non-metropolitan setting

Bond, S.E. et al. The Journal of Hospital Infections. Published online: December 18 2016

Objective: Healthcare-associated Clostridium difficile infection (HCA-CDI) remains a major cause of morbidity and mortality in industrialised countries. However, few data exist on the burden of HCA-CDI in multisite non-metropolitan settings. This study examined the introduction of an antimicrobial stewardship program (ASP) in relation to HCA-CDI rates and the effect of HCA-CDI on length of stay (LOS) and hospital costs.

 

Conclusions: HCA-CDI placed a significant burden on our regional and rural health service through increased LOS and hospital costs. Interventions targeting HCA-CDI could be employed to consolidate the effects of ASPs.

Read the full abstract here