Materiały źródłowe

• #1 Prevention and treatment of Clostridium difficile infection

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5873812/

  Prior antimicrobial use is the most important risk factor for CDI. It has been difficult to produce a hit list of individual antimicrobials causing CDI based on risk, as published studies have methodological limitations and their conclusions are not necessarily applicable across institutions. Almost any antibiotic can predispose to CDI, but broad-spectrum cephalosporins and clindamycin are generally accepted as high-risk agents, with quinolones implicated in the recent BI/NAP1/027 strain outbreaks. Observational studies substituting other agents for broad-spectrum cephalosporins or clindamycin have resulted in reduction of CDI rates in endemic and outbreak situations. The use of narrow-spectrum agents for as short a duration as possible is encouraged […] […] Many studies have shown that C. difficile is carried and transmitted via the hands of healthcare workers. No antiseptic agent has reliable sporicidal activity. Water and soap are more effective than alcohol gel at decontaminating hands through the physical action of rubbing and rinsing. Existing guidelines recommend hand washing with soap and water before and after contact with patients infected with C. difficile […]

• #2 Clostridioides difficile infection: Prevention and control – UpToDate

  https://www.uptodate.com/contents/clostridioides-difficile-infection-prevention-and-control

  Clostridioides difficile infection: Prevention and control […] Clostridioides difficile is the causative organism of antibiotic-associated colitis. It is the most common infectious cause of health care-associated diarrhea and a significant cause of morbidity and mortality among hospitalized patients. […] Development of CDI usually requires two events: disruption of the fecal microbiota (typically via exposure to antibiotics) and ingestion of spores via the fecal-oral route. C. difficile may be shed into the environment by individuals who are infected or colonized. High colonization rates may occur among hospitalized adults, nursing home residents, and healthy infants. […] C. difficile spores can be transmitted between patients via environmental surfaces and contaminated hands of health care personnel. Thus, efforts to prevent CDI must focus on two goals: reducing patient susceptibility to CDI and preventing organism transmission. Prevention of C. difficile transmission is especially challenging because the organism forms spores that can persist on environmental surfaces for months and are resistant to commonly used cleaning agents and alcohol-based hand gels. […] Issues related to prevention of CDI in health care and community settings are discussed here. Issues related to prevention of CDI in individual patients are discussed separately.

• #3 Clinical Practice Guidelines for Clostridium difficile Infection in Adults and Children: 2017 Update by SHEA/IDSA

  https://www.idsociety.org/practice-guideline/clostridium-difficile/

  In routine or endemic settings, perform hand hygiene before and after contact of a patient with CDI and after removing gloves with either soap and water or an alcohol-based hand hygiene product (strong recommendation, moderate quality of evidence). […] Encourage patients to wash hands and shower to reduce the burden of spores on the skin (good practice recommendation). […] Use disposable patient equipment when possible and ensure that reusable equipment is thoroughly cleaned and disinfected, preferentially with a sporicidal disinfectant that is equipment compatible (strong recommendation, moderate quality of evidence). […] Terminal room cleaning with a sporicidal agent should be considered in conjunction with other measures to prevent CDI during endemic high rates or outbreaks, or if there is evidence of repeated cases of CDI in the same room (weak recommendation, low quality of evidence).

• #4 Clinical Practice Guidelines for Clostridium difficile Infection in Adults and Children: 2017 Update by SHEA/IDSA

  https://www.idsociety.org/practice-guideline/clostridium-difficile/

  Accommodate patients with CDI in a private room with a dedicated toilet to decrease transmission to other patients. If there is a limited number of private single rooms, prioritize patients with stool incontinence for placement in private rooms (strong recommendation, moderate quality of evidence). […] Healthcare personnel must use gloves (strong recommendation, high quality of evidence) and gowns (strong recommendation, moderate quality of evidence) on entry to a room of a patient with CDI and while caring for patients with CDI. […] Patients with suspected CDI should be placed on preemptive contact precautions pending the C. difficile test results if test results cannot be obtained on the same day (strong recommendation, moderate quality of evidence). […] Continue contact precautions for at least 48 hours after diarrhea has resolved (weak recommendation, low quality of evidence).

• #5 Prevention and treatment of Clostridium difficile infection

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5873812/

  Glove use has been shown to significantly reduce CDI but does not completely prevent hand contamination. Current guidelines recommend the use of both gloves and gowns when dealing with patients with CDI […] […] Prompt isolation of patients with infectious diarrhoea is an established infection control intervention. Guidance recommends patient isolation in a single room with toilet facility or dedicated commode as soon as CDI is suspected. Confirmed cases should remain isolated until there has been no diarrhoea for 48 hours and formed stool has been passed […] […] Isolation measures have been effective in controlling outbreaks of CDI as part of broader infection control interventions. Nevertheless, no randomised trials or systematic reviews of existing studies have assessed the value of isolation in controlling CDI. However, a systematic review of studies assessing the impact of isolation on methicillin-resistant Staphylococcus aureus (MRSA) colonisation and infection rates found such measures effective at controlling MRSA within the context of wider control measures. This has been quoted as indirect evidence for the value of isolation in CDI […]

• #6 Clinical Practice Guidelines for Clostridium difficile Infection in Adults and Children: 2017 Update by SHEA/IDSA

  https://www.idsociety.org/practice-guideline/clostridium-difficile/

  Accommodate patients with CDI in a private room with a dedicated toilet to decrease transmission to other patients. If there is a limited number of private single rooms, prioritize patients with stool incontinence for placement in private rooms (strong recommendation, moderate quality of evidence). […] Healthcare personnel must use gloves (strong recommendation, high quality of evidence) and gowns (strong recommendation, moderate quality of evidence) on entry to a room of a patient with CDI and while caring for patients with CDI. […] Patients with suspected CDI should be placed on preemptive contact precautions pending the C. difficile test results if test results cannot be obtained on the same day (strong recommendation, moderate quality of evidence). […] Continue contact precautions for at least 48 hours after diarrhea has resolved (weak recommendation, low quality of evidence).

• #7 Clostridium Difficile: Infection prevention and control guidance for management in acute care settings – Canada.ca

  https://www.canada.ca/en/public-health/services/infectious-diseases/nosocomial-occupational-infections/clostridium-difficile-infection-prevention-control-guidance-management-acute-care-settings.html

  Contact precautions should be implemented empirically, at onset of diarrhea, for patients with acute diarrhea, suspected or confirmed to be C. difficile infection, and not otherwise explained. […] Patients suspected or confirmed to have C. difficile infection should be placed on contact precautions, preferably in a single room, until the diarrhea is resolved or its cause is determined not to be infectious. […] Policies and procedures should be developed and implemented for the prevention and control of C. difficile infection, including the application of contact precautions, and outbreak recognition, reporting and management. […] A facility-wide, adequately resourced antimicrobial stewardship program should be established. […] Contact precautions should be maintained until C. difficile infection is ruled out, and/or diarrhea is determined as not infectious; or if C. difficile infection is confirmed, until diarrhea has resolved. […] An outbreak should be declared over when there is no further transmission and there has been a return to the organization’s baseline C. difficile infection rate.

• #8 Clinical Practice Guidelines for Clostridium difficile Infection in Adults and Children: 2017 Update by SHEA/IDSA

  https://www.idsociety.org/practice-guideline/clostridium-difficile/

  Accommodate patients with CDI in a private room with a dedicated toilet to decrease transmission to other patients. If there is a limited number of private single rooms, prioritize patients with stool incontinence for placement in private rooms (strong recommendation, moderate quality of evidence). […] Healthcare personnel must use gloves (strong recommendation, high quality of evidence) and gowns (strong recommendation, moderate quality of evidence) on entry to a room of a patient with CDI and while caring for patients with CDI. […] Patients with suspected CDI should be placed on preemptive contact precautions pending the C. difficile test results if test results cannot be obtained on the same day (strong recommendation, moderate quality of evidence). […] Continue contact precautions for at least 48 hours after diarrhea has resolved (weak recommendation, low quality of evidence).

• #9 Clostridioides (Clostridium) difficile Infection Prevention – MN Dept. of Health

  https://www.health.state.mn.us/diseases/cdiff/hcp/ic.html

  Surveillance programs are an important measure used to detect and prevent outbreak of C. difficile within health care facilities. […] At minimum, conduct surveillance for health care facility-onset CDI in all inpatient health care facilities to detect outbreaks and monitor patient safety. […] Implement Contact Precautions for all CDI patients; consider pre-emptively placing symptomatic patients on Contact Precautions until laboratory results are available. […] Discontinue precautions when diarrhea has resolved (i.e., patient has 3 unformed stools in a 24 hour period). […] Some experts recommend continuing Contact Precautions for 48 hours after the resolution of diarrhea due to continued C. diff shedding, environmental contamination and patient skin colonization. […] In facilities with high rates of CDI, consider continuing Contact Precautions until discharge.

• #10 Clostridioides (Clostridium) difficile Infection Prevention – MN Dept. of Health

  https://www.health.state.mn.us/diseases/cdiff/hcp/ic.html

  Surveillance programs are an important measure used to detect and prevent outbreak of C. difficile within health care facilities. […] At minimum, conduct surveillance for health care facility-onset CDI in all inpatient health care facilities to detect outbreaks and monitor patient safety. […] Implement Contact Precautions for all CDI patients; consider pre-emptively placing symptomatic patients on Contact Precautions until laboratory results are available. […] Discontinue precautions when diarrhea has resolved (i.e., patient has 3 unformed stools in a 24 hour period). […] Some experts recommend continuing Contact Precautions for 48 hours after the resolution of diarrhea due to continued C. diff shedding, environmental contamination and patient skin colonization. […] In facilities with high rates of CDI, consider continuing Contact Precautions until discharge.

• #11 Prevention and treatment of Clostridium difficile infection

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5873812/

  Environmental sampling of areas around patients with CDI has revealed high levels of contamination, particularly on the floors, bedrails, commodes, fomites and medical equipment. Increasing levels of contamination correlate with higher levels of C. difficile carriage on the hands of HCWs. The spores are resistant to conventional cleaning agents, hence sporicidal agents, such as sodium hypochlorite (bleach) or hydrogen peroxide vapour, are recommended to ensure effective decontamination. Cleaning with hypochlorite at a concentration of at least 1,000 ppm has been shown to be effective in decreasing rates of CDI in several studies […] […] UK guidance emphasises the need for at least daily cleaning of rooms hosting patients with CDI. Hydrogen peroxide vapour is an effective agent but its use is limited by cost and the requirement to vacate and seal the unit during cleaning. It may have a role in terminal disinfection of rooms […] […] Decontamination of medical equipment is also important as outbreaks have been linked to instruments, such as rectal thermometers. Use of disposable or dedicated equipment is recommended, particularly in outbreak situations […]

• #12 Clinical Guidance for C. diff Prevention in Acute Care Facilities | C. diff | CDC

  https://www.cdc.gov/c-diff/hcp/clinical-guidance/index.html

  Isolate and initiate contact precautions for suspected or confirmed Clostridioides (formerly known as Clostridium) difficile infection (CDI). […] Perform environmental cleaning to prevent CDI. […] Develop infrastructure to support CDI prevention. […] Engage the facility antibiotic stewardship program. […] Create daily and terminal cleaning protocols and checklists for patient-care areas and equipment. […] Perform daily cleaning of CDI patient rooms using a C. difficile sporicidal agent (EPA List K agent). […] Clean and disinfect the patient-care environment (including the immediate vicinity around a CDI patient and high-touch surfaces) at least once a day. […] Educate and train healthcare personnel on prevention practices for CDI. […] Implement the Core Elements of Hospital Antibiotic Stewardship and Targeted Assessment for Prevention (TAP) Strategy.

• #13 Prevention Strategies for Community-Acquired Clostridium difficile Infections | Consultant360

  https://www.consultant360.com/articles/prevention-strategies-community-acquired-clostridium-difficile-infections

  Household members of a person with CDI also should receive education on appropriate contact precautions. A 1:10 chlorine bleach and water solution should be used to clean the bathroom and kitchen of the infected household member. Family or household members should be advised of the importance of not sharing the bathroom, towels, or hygiene products of the infected person, especially if diarrhea is present. Gloves should be used to handle soiled linens and clothing. In addition, soiled linens and clothing should be kept separate from the laundry of other household members and should be washed in hot water, with laundry detergent and a 1:10 dilution of chlorine bleach. […] It is important that health care providers educate their patients on the appropriate use of antibiotics. Frequent and improper use of antibiotics is associated with increased microbial resistance. The Centers for Disease Control and Prevention has developed the Get Smart program, which offers resources for patients and health care providers on the appropriate and inappropriate uses of antibiotics, including charts that can be easily displayed in a primary care office for patients to read while waiting. Additionally, patients should be informed that certain classes of antibiotics (fluoroquinolones, cephalosporins, penicillins, and clindamycin) have been associated with an increased risk of CDI. Furthermore, limited use of gastric acid suppressants, whenever possible, should be emphasized.

• #14 Clinical Practice Guidelines for Clostridium difficile Infection in Adults and Children: 2017 Update by SHEA/IDSA

  https://www.idsociety.org/practice-guideline/clostridium-difficile/

  In routine or endemic settings, perform hand hygiene before and after contact of a patient with CDI and after removing gloves with either soap and water or an alcohol-based hand hygiene product (strong recommendation, moderate quality of evidence). […] Encourage patients to wash hands and shower to reduce the burden of spores on the skin (good practice recommendation). […] Use disposable patient equipment when possible and ensure that reusable equipment is thoroughly cleaned and disinfected, preferentially with a sporicidal disinfectant that is equipment compatible (strong recommendation, moderate quality of evidence). […] Terminal room cleaning with a sporicidal agent should be considered in conjunction with other measures to prevent CDI during endemic high rates or outbreaks, or if there is evidence of repeated cases of CDI in the same room (weak recommendation, low quality of evidence).

• #15 Prevention and treatment of Clostridium difficile infection

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5873812/

  Environmental sampling of areas around patients with CDI has revealed high levels of contamination, particularly on the floors, bedrails, commodes, fomites and medical equipment. Increasing levels of contamination correlate with higher levels of C. difficile carriage on the hands of HCWs. The spores are resistant to conventional cleaning agents, hence sporicidal agents, such as sodium hypochlorite (bleach) or hydrogen peroxide vapour, are recommended to ensure effective decontamination. Cleaning with hypochlorite at a concentration of at least 1,000 ppm has been shown to be effective in decreasing rates of CDI in several studies […] […] UK guidance emphasises the need for at least daily cleaning of rooms hosting patients with CDI. Hydrogen peroxide vapour is an effective agent but its use is limited by cost and the requirement to vacate and seal the unit during cleaning. It may have a role in terminal disinfection of rooms […] […] Decontamination of medical equipment is also important as outbreaks have been linked to instruments, such as rectal thermometers. Use of disposable or dedicated equipment is recommended, particularly in outbreak situations […]

• #16 Updated Clinical Practice Guidelines for C difficile Infection in Adults

  https://www.uspharmacist.com/article/updated-clinical-practice-guidelines-for-c-difficile-infection-in-adults

  A multifactorial approach is recommended for the prevention of CDI. This includes infection prevention measures (e.g., hand hygiene, isolation precautions, contact precautions, and appropriate environmental cleaning and disinfection) as well as implementation of antimicrobial stewardship programs that restrict high-risk antibiotics and focus on minimizing the use and duration of unnecessary antimicrobial agents. […] The updated ACG guidelines state that the use of oral vancomycin as prophylaxis (to prevent recurrence) may be considered in patients with a recent history of CDI who require antibiotic treatment and are at high risk for recurrent infection (i.e., aged 65 years or older or significantly immunocompromised and hospitalized within the previous 3 months for severe CDI); this is a conditional recommendation with a low quality of evidence. The suggested dosage of vancomycin for prophylaxis is 125 mg orally once daily, continued for 5 days after completion of antibiotic therapy.

• #17 Antimicrobial Stewardship Programs Essential for Preventing C. difficile in Hospitals – SHEA

  https://shea-online.org/antimicrobial-stewardship-programs-essential-for-preventing-c-difficile-in-hospitals/

  Five medical organizations say it is essential that hospitals establish antimicrobial stewardship programs to prevent Clostridioides difficile (C. difficile) infections. […] „Because the use of antibiotics is strongly associated with C. difficile infections, antimicrobial stewardship – an approach to making sure these drugs are prescribed and used appropriately – is a strong first-line defense.” […] Diagnostic stewardship for appropriate use and interpretation of C. difficile tests also was identified as an essential practice. […] The updated guidance also emphasizes assessment of the adequacy of room cleaning and addresses procedures for cleaning equipment and the environment of patients with C. difficile. […] The authors also address the need for timely alerts when patients are newly diagnosed; data reporting; education of environmental services personnel, administrators, patients and families; and additional steps hospitals can take if C. difficile incidence remains high after implementing essential practices.

• #18 Clinical Guidance for C. diff Prevention in Acute Care Facilities | C. diff | CDC

  https://www.cdc.gov/c-diff/hcp/clinical-guidance/index.html

  Assess the appropriateness of prescribing antibiotics that pose the highest risk for CDI, especially fluoroquinolones, carbapenems, and 3rd and 4th generation cephalosporins. […] Consider use of supplemental interventions. […] Dedicate healthcare personnel to the care of only patients with CDI, who are typically cohorted on a single ward or unit, to minimize the risk of transmission to others. […] Limit the use of other medications like proton pump inhibitors that are hypothesized to increase risk for CDI. […] Conduct additional disinfection of CDI patient rooms with no-touch technologies like UV light. […] Expand the use of environmental disinfection strategies (e.g., sporicidal agents [EPA List K agent]) for daily and terminal cleaning in all rooms on affected units.

• #19 Prevention and treatment of Clostridium difficile infection

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5873812/

  Prior antimicrobial use is the most important risk factor for CDI. It has been difficult to produce a hit list of individual antimicrobials causing CDI based on risk, as published studies have methodological limitations and their conclusions are not necessarily applicable across institutions. Almost any antibiotic can predispose to CDI, but broad-spectrum cephalosporins and clindamycin are generally accepted as high-risk agents, with quinolones implicated in the recent BI/NAP1/027 strain outbreaks. Observational studies substituting other agents for broad-spectrum cephalosporins or clindamycin have resulted in reduction of CDI rates in endemic and outbreak situations. The use of narrow-spectrum agents for as short a duration as possible is encouraged […] […] Many studies have shown that C. difficile is carried and transmitted via the hands of healthcare workers. No antiseptic agent has reliable sporicidal activity. Water and soap are more effective than alcohol gel at decontaminating hands through the physical action of rubbing and rinsing. Existing guidelines recommend hand washing with soap and water before and after contact with patients infected with C. difficile […]

• #20 Updated Clinical Practice Guidelines for C difficile Infection in Adults

  https://www.uspharmacist.com/article/updated-clinical-practice-guidelines-for-c-difficile-infection-in-adults

  A multifactorial approach is recommended for the prevention of CDI. This includes infection prevention measures (e.g., hand hygiene, isolation precautions, contact precautions, and appropriate environmental cleaning and disinfection) as well as implementation of antimicrobial stewardship programs that restrict high-risk antibiotics and focus on minimizing the use and duration of unnecessary antimicrobial agents. […] The updated ACG guidelines state that the use of oral vancomycin as prophylaxis (to prevent recurrence) may be considered in patients with a recent history of CDI who require antibiotic treatment and are at high risk for recurrent infection (i.e., aged 65 years or older or significantly immunocompromised and hospitalized within the previous 3 months for severe CDI); this is a conditional recommendation with a low quality of evidence. The suggested dosage of vancomycin for prophylaxis is 125 mg orally once daily, continued for 5 days after completion of antibiotic therapy.

• #21 Updated Clinical Practice Guidelines for C difficile Infection in Adults

  https://www.uspharmacist.com/article/updated-clinical-practice-guidelines-for-c-difficile-infection-in-adults

  A multifactorial approach is recommended for the prevention of CDI. This includes infection prevention measures (e.g., hand hygiene, isolation precautions, contact precautions, and appropriate environmental cleaning and disinfection) as well as implementation of antimicrobial stewardship programs that restrict high-risk antibiotics and focus on minimizing the use and duration of unnecessary antimicrobial agents. […] The updated ACG guidelines state that the use of oral vancomycin as prophylaxis (to prevent recurrence) may be considered in patients with a recent history of CDI who require antibiotic treatment and are at high risk for recurrent infection (i.e., aged 65 years or older or significantly immunocompromised and hospitalized within the previous 3 months for severe CDI); this is a conditional recommendation with a low quality of evidence. The suggested dosage of vancomycin for prophylaxis is 125 mg orally once daily, continued for 5 days after completion of antibiotic therapy.

• #22 Oral Vancomycin Prophylaxis for Primary and Secondary Prevention of Clostridioides difficile Infection in Patients Treated with Systemic Antibiotic Therapy: A Systematic Review, Meta-Analysis and Trial Sequential Analysis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8868369/

  OVP appears to be an efficacious option for prevention of CDI in high-risk subjects undergoing SAT. […] Nevertheless, additional data from RCTs are needed to establish OVP as good clinical practice and define optimal dosage and duration. […] The use of OVP was associated with a lower CDI occurrence compared with no intervention (OR 0.13, 95% CI 0.040.38). […] Overall, the NNT was six (95% CI 59), meaning that six subjects under SAT need OVP rather than no intervention to prevent one additional CDI. […] The protective effect of OVP was even more evident. […] The results of our meta-analysis underscore the usefulness of OVP in persons at high risk, with this finding being consistent across several subgroups, confirmed by pooling adjusted effect sizes and by TSA, and robust to numerous sensitivity and quantitative bias analyses. […] OVP represents a promising preventive weapon for both primary and recurrent CDI, and authoritative guidelines have already endorsed it, although cautiously in the light of the low-quality underlying evidence.

• #23 Oral Vancomycin Prophylaxis for Primary and Secondary Prevention of Clostridioides difficile Infection in Patients Treated with Systemic Antibiotic Therapy: A Systematic Review, Meta-Analysis and Trial Sequential Analysis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8868369/

  OVP appears to be an efficacious option for prevention of CDI in high-risk subjects undergoing SAT. […] Nevertheless, additional data from RCTs are needed to establish OVP as good clinical practice and define optimal dosage and duration. […] The use of OVP was associated with a lower CDI occurrence compared with no intervention (OR 0.13, 95% CI 0.040.38). […] Overall, the NNT was six (95% CI 59), meaning that six subjects under SAT need OVP rather than no intervention to prevent one additional CDI. […] The protective effect of OVP was even more evident. […] The results of our meta-analysis underscore the usefulness of OVP in persons at high risk, with this finding being consistent across several subgroups, confirmed by pooling adjusted effect sizes and by TSA, and robust to numerous sensitivity and quantitative bias analyses. […] OVP represents a promising preventive weapon for both primary and recurrent CDI, and authoritative guidelines have already endorsed it, although cautiously in the light of the low-quality underlying evidence.

• #24 Targeted Prophylaxis Reduces Hospital-Onset C difficile Infections in High-Risk Patients

  https://www.contagionlive.com/view/targeted-prophylaxis-reduces-hospital-onset-c-difficile-infections-in-high-risk-patients

  The STOP-CDI intervention presented by Matthew J.Ziegler, MD MSCE revealed using prophylactic enteral vancomycin, significantly reduced hospital-onset C difficile infections among immunocompromised patients. […] STOP-CDI investigated a prophylactic enteral vancomycin intervention aimed at reducing HO-CDI rates in high-risk hospitalized patients. […] The STOP-CDI intervention was found to effectively reduce HO-CDI rates, length of stay, and associated symptoms within this vulnerable population. […] The key finding of our research was that among the patients who were screened, there was a very low rate of HO-CDI, less than 1%, compared to our control group, which had roughly 5.6% after waiting for the same diseases. […] We found that this STOP intervention was very successful at reducing HO-CDI, which contrasts with common clinical and infection control practices.

• #25 Targeted Prophylaxis Reduces Hospital-Onset C difficile Infections in High-Risk Patients

  https://www.contagionlive.com/view/targeted-prophylaxis-reduces-hospital-onset-c-difficile-infections-in-high-risk-patients

  The STOP-CDI intervention presented by Matthew J.Ziegler, MD MSCE revealed using prophylactic enteral vancomycin, significantly reduced hospital-onset C difficile infections among immunocompromised patients. […] STOP-CDI investigated a prophylactic enteral vancomycin intervention aimed at reducing HO-CDI rates in high-risk hospitalized patients. […] The STOP-CDI intervention was found to effectively reduce HO-CDI rates, length of stay, and associated symptoms within this vulnerable population. […] The key finding of our research was that among the patients who were screened, there was a very low rate of HO-CDI, less than 1%, compared to our control group, which had roughly 5.6% after waiting for the same diseases. […] We found that this STOP intervention was very successful at reducing HO-CDI, which contrasts with common clinical and infection control practices.

• #26 Targeted Prophylaxis Reduces Hospital-Onset C difficile Infections in High-Risk Patients

  https://www.contagionlive.com/view/targeted-prophylaxis-reduces-hospital-onset-c-difficile-infections-in-high-risk-patients

  Notable reductions in 90-day HO-CDI rates, stool output, and length of stay were observed, while no differences in vancomycin-resistant Enterococcus (VRE) infections or mortality were noted. […] Our oncology patients historically had roughly a 7.5% rate of HO-CDI, and that went down to 1% in our intervention, showing a large difference and significant benefit from the intervention. […] Those who tested positive received oral vancomycin prophylaxis for 10 days or until discharge. […] The primary outcome being HO-CDI and secondary outcomes including 90-day CDI rates, stool output, length of stay, VRE infections, and mortality. […] Ziegler discussed the integration of screening and prophylactic measures for CDI evolving in clinical settings, considering emerging guidelines and antibiotic stewardship initiatives: I think the uptake of this practice, clinically or more broadly, requires some additional research to identify other patient populations that are at high risk.

• #27 Targeted Prophylaxis Reduces Hospital-Onset C difficile Infections in High-Risk Patients

  https://www.contagionlive.com/view/targeted-prophylaxis-reduces-hospital-onset-c-difficile-infections-in-high-risk-patients

  Notable reductions in 90-day HO-CDI rates, stool output, and length of stay were observed, while no differences in vancomycin-resistant Enterococcus (VRE) infections or mortality were noted. […] Our oncology patients historically had roughly a 7.5% rate of HO-CDI, and that went down to 1% in our intervention, showing a large difference and significant benefit from the intervention. […] Those who tested positive received oral vancomycin prophylaxis for 10 days or until discharge. […] The primary outcome being HO-CDI and secondary outcomes including 90-day CDI rates, stool output, length of stay, VRE infections, and mortality. […] Ziegler discussed the integration of screening and prophylactic measures for CDI evolving in clinical settings, considering emerging guidelines and antibiotic stewardship initiatives: I think the uptake of this practice, clinically or more broadly, requires some additional research to identify other patient populations that are at high risk.

• #28 Assessing the Efficacy and Risks of Oral Vancomycin Prophylaxis for Clostridioides difficile Infections

  https://www.contagionlive.com/view/assessing-the-efficacy-and-risks-of-oral-vancomycin-prophylaxis-for-clostridioides-difficile-infections

  Clostridioides difficile infection (CDI) presents a risk of up to 9 times higher for patients undergoing hematopoietic stem cell transplantation (HSCT) compared to the general population. […] While the use of Oral Vancomycin Prophylaxis (OVP) has been effective in reducing the incidence of C difficile infection, it has been concurrently linked to a rise in the rate of gram-negative bacteremia among HSCT recipients, escalating from 13% to 21.8%. […] The administration of OVP resulted in a halved incidence of CDI among HSCT recipients, dropping from 14% to 7%. […] The study reports a concerning spike in the incidence of gram-negative bacteremia, increasing from 13% to 21.8% among patients receiving OVP. […] Alexander Vartanov, MD, advocates for a more discerning approach to OVP administration, focusing on identifying HSCT recipients who would benefit most from CDI prophylaxis while minimizing the risk of fostering other infections. […] This study underscores the importance of medical interventions, advocating for a strategic, evidence-based application of prophylactic measures.

• #29 Assessing the Efficacy and Risks of Oral Vancomycin Prophylaxis for Clostridioides difficile Infections

  https://www.contagionlive.com/view/assessing-the-efficacy-and-risks-of-oral-vancomycin-prophylaxis-for-clostridioides-difficile-infections

  Clostridioides difficile infection (CDI) presents a risk of up to 9 times higher for patients undergoing hematopoietic stem cell transplantation (HSCT) compared to the general population. […] While the use of Oral Vancomycin Prophylaxis (OVP) has been effective in reducing the incidence of C difficile infection, it has been concurrently linked to a rise in the rate of gram-negative bacteremia among HSCT recipients, escalating from 13% to 21.8%. […] The administration of OVP resulted in a halved incidence of CDI among HSCT recipients, dropping from 14% to 7%. […] The study reports a concerning spike in the incidence of gram-negative bacteremia, increasing from 13% to 21.8% among patients receiving OVP. […] Alexander Vartanov, MD, advocates for a more discerning approach to OVP administration, focusing on identifying HSCT recipients who would benefit most from CDI prophylaxis while minimizing the risk of fostering other infections. […] This study underscores the importance of medical interventions, advocating for a strategic, evidence-based application of prophylactic measures.

• #30

  https://journals.lww.com/ajg/fulltext/2021/06000/acg_clinical_guidelines__prevention,_diagnosis,.12.aspx

  We recommend against probiotics for the prevention of CDI in patients being treated with antibiotics (primary prevention) (conditional recommendation, moderate quality of evidence). We recommend against probiotics for the prevention of CDI recurrence (secondary prevention) (strong recommendation, very low quality of evidence). […] We recommend that oral vancomycin 125 mg 4 times daily for 10 days be used to treat an initial episode of nonsevere CDI (strong recommendation, low quality of evidence). We recommend that oral fidaxomicin 200 mg twice daily for 10 days be used for an initial episode of nonsevere CDI (strong recommendation, moderate quality of evidence). Oral metronidazole 500 mg 3 times daily for 10 days may be considered for treatment of an initial nonsevere CDI in low-risk patients (strong recommendation/moderate quality of evidence).

• #31 Updated Clinical Practice Guidelines for C difficile Infection in Adults

  https://www.uspharmacist.com/article/updated-clinical-practice-guidelines-for-c-difficile-infection-in-adults

  Additionally, long-term suppression with oral vancomycin may be used in patients with recurrent CDI who are not candidates for FMT, developed a recurrence after FMT, or require antibiotics (either ongoing use or frequent courses); this recommendation is conditional with a very low quality of evidence. The suggested dosage of vancomycin for chronic suppression is 125 mg orally once daily. […] The ACG guidelines advise against the use of probiotics for primary prevention in patients receiving antibiotics or for secondary prevention of CDI recurrence. However, regarding their role in managing GI disorders, the AGA guidelines suggest that probiotics may be used in patients receiving antibiotics in order to prevent CDI; this is a conditional recommendation with a low quality of evidence.

• #32 Clostridioides difficile Infection: Update on Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2020/0201/p168.html

  The use of probiotics for the prevention of C. difficile infection and, more specifically, C. difficile associated diarrhea has also been examined. A 2017 Cochrane review of 39 studies found moderate evidence that probiotics are effective for preventing C. difficile associated diarrhea, but only in trials where the C. difficile event rate was more than 5%. In these studies, probiotics had a number needed to treat of 12 to prevent C. difficile associated diarrhea. Investigators determined that 27 of the studies were at high or unclear risk of bias, and there was marked heterogeneity between the studies in probiotic formulations, duration of administration, definitions of C. difficile infection, and duration of follow-up. Probiotics may impede recovery of normal gut flora after antibiotic use and increase the risk of bacteremia and fungemia in immunocompromised people. Because of the potential bias and variations in the Cochrane review and the potential for harm from probiotic use, the IDSA concluded that there is insufficient evidence to recommend probiotics as a preventive measure. […] There is also insufficient evidence to recommend stopping proton pump inhibitors and histamine H2 blockers to decrease the incidence of C. difficile infection. […] There is insufficient evidence to recommend screening for asymptomatic carriers of C. difficile, or for instituting contact precautions for asymptomatic carriers. Thus, it is not necessary to screen or treat close contacts if they are asymptomatic.

• #33 Clostridioides difficile Infection: Update on Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2020/0201/p168.html

  The use of probiotics for the prevention of C. difficile infection and, more specifically, C. difficile associated diarrhea has also been examined. A 2017 Cochrane review of 39 studies found moderate evidence that probiotics are effective for preventing C. difficile associated diarrhea, but only in trials where the C. difficile event rate was more than 5%. In these studies, probiotics had a number needed to treat of 12 to prevent C. difficile associated diarrhea. Investigators determined that 27 of the studies were at high or unclear risk of bias, and there was marked heterogeneity between the studies in probiotic formulations, duration of administration, definitions of C. difficile infection, and duration of follow-up. Probiotics may impede recovery of normal gut flora after antibiotic use and increase the risk of bacteremia and fungemia in immunocompromised people. Because of the potential bias and variations in the Cochrane review and the potential for harm from probiotic use, the IDSA concluded that there is insufficient evidence to recommend probiotics as a preventive measure. […] There is also insufficient evidence to recommend stopping proton pump inhibitors and histamine H2 blockers to decrease the incidence of C. difficile infection. […] There is insufficient evidence to recommend screening for asymptomatic carriers of C. difficile, or for instituting contact precautions for asymptomatic carriers. Thus, it is not necessary to screen or treat close contacts if they are asymptomatic.

• #34 Biotherapeutics for the Prevention of Clostridium difficile Infection – Infectious Disease Advisor

  https://www.infectiousdiseaseadvisor.com/features/biotherapeutics-for-the-prevention-of-clostridium-difficile-infection/

  The goal of FMT is to restore the intestinal microbiota to its normal state through the administration of stool from a healthy donor, thus promoting intestinal colonization resistance against C difficile. […] Although promising, criticism of both studies includes a study design permitting multiple FMTs in experimental groups, but only single courses of antibiotics in controls. […] Commercially available FMT products are in development. […] Despite FMT efficacy, safety concerns remain. […] Although probiotics and FMT likely reduce CDI through intestinal microbiota restoration, some nontoxigenic C difficile strains are thought to directly outcompete toxigenic C difficile in the intestinal tract. […] In summary, biotherapeutics provide a novel preventive strategy for recurrent CDI prevention that reduces dysbiosis that initially led to CDI and that persists after CDI treatment with vancomycin and metronidazole.

• #35

  https://journals.lww.com/ajg/fulltext/2021/06000/acg_clinical_guidelines__prevention,_diagnosis,.12.aspx

  We suggest FMT be considered for patients with severe and fulminant CDI refractory to antibiotic therapy, in particular, when patients are deemed poor surgical candidates (strong recommendation, low quality of evidence). […] For patients with rCDI who are not candidates for FMT, who relapsed after FMT, or who require ongoing or frequent courses of antibiotics, long-term suppressive oral vancomycin may be used to prevent further recurrences (conditional recommendation, very low quality of evidence). Oral vancomycin prophylaxis (OVP) may be considered during subsequent systemic antibiotic use in patients with a history of CDI who are at high risk of recurrence to prevent further recurrence (conditional recommendation, low quality of evidence).

• #36 Biotherapeutics for the Prevention of Clostridium difficile Infection – Infectious Disease Advisor

  https://www.infectiousdiseaseadvisor.com/features/biotherapeutics-for-the-prevention-of-clostridium-difficile-infection/

  Experts review biotherapeutics for the prevention of C difficile infection, including probiotics, fecal microbiota transplantation, and nontoxigenic C difficile. […] We review biotherapeutics for the prevention of C difficile infection, including probiotics, fecal microbiota transplantation (FMT), and nontoxigenic C difficile. […] Several commercially available probiotics have been studied for CDI prevention, but data supporting efficacy were limited until recently. […] However, 2 large meta-analyses each suggested efficacy of probiotics for CDI prevention, particularly when started within 2 days of initiation of CDI treatment. […] Some data support specific probiotic formulations for CDI prevention. […] Despite the relative success of FMT in reducing recurrent CDI, FMT logistical challenges and risks of invasive procedures for FMT administration are nontrivial.

• #37

  https://journals.lww.com/ajg/fulltext/2021/06000/acg_clinical_guidelines__prevention,_diagnosis,.12.aspx

  We suggest FMT be considered for patients with severe and fulminant CDI refractory to antibiotic therapy, in particular, when patients are deemed poor surgical candidates (strong recommendation, low quality of evidence). […] For patients with rCDI who are not candidates for FMT, who relapsed after FMT, or who require ongoing or frequent courses of antibiotics, long-term suppressive oral vancomycin may be used to prevent further recurrences (conditional recommendation, very low quality of evidence). Oral vancomycin prophylaxis (OVP) may be considered during subsequent systemic antibiotic use in patients with a history of CDI who are at high risk of recurrence to prevent further recurrence (conditional recommendation, low quality of evidence).

• #38 Updated Clinical Practice Guidelines for C difficile Infection in Adults

  https://www.uspharmacist.com/article/updated-clinical-practice-guidelines-for-c-difficile-infection-in-adults

  Additionally, long-term suppression with oral vancomycin may be used in patients with recurrent CDI who are not candidates for FMT, developed a recurrence after FMT, or require antibiotics (either ongoing use or frequent courses); this recommendation is conditional with a very low quality of evidence. The suggested dosage of vancomycin for chronic suppression is 125 mg orally once daily. […] The ACG guidelines advise against the use of probiotics for primary prevention in patients receiving antibiotics or for secondary prevention of CDI recurrence. However, regarding their role in managing GI disorders, the AGA guidelines suggest that probiotics may be used in patients receiving antibiotics in order to prevent CDI; this is a conditional recommendation with a low quality of evidence.

• #39 Clostridioides (Clostridium) Difficile Colitis Treatment & Management: Approach Considerations, Pharmacologic Management, Fecal Microbiota Transplantation

  https://emedicine.medscape.com/article/186458-treatment

  A systematic review and meta-analyses of observational studies have shown evidence of an increased risk for recurrent CDI among patients who use gastric acid suppressants; the investigators suggest it may be reasonable for clinicians to reassess whether their patients with CDI need to take these agents.

• #40 Clinical Practice Guidelines for Clostridium difficile Infection in Adults and Children: 2017 Update by SHEA/IDSA

  https://www.idsociety.org/practice-guideline/clostridium-difficile/

  Incorporate measures of cleaning effectiveness to ensure quality of environmental cleaning (good practice recommendation). […] Minimize the frequency and duration of high-risk antibiotic therapy and the number of antibiotic agents prescribed, to reduce CDI risk (strong recommendation, moderate quality of evidence). […] Although there is an epidemiologic association between proton pump inhibitor (PPI) use and CDI, and unnecessary PPIs should always be discontinued, there is insufficient evidence for discontinuation of PPIs as a measure for preventing CDI (no recommendation). […] There are insufficient data at this time to recommend administration of probiotics for primary prevention of CDI outside of clinical trials (no recommendation).

• #41 Strategies to prevent Clostridioides difficile infections in acute-care hospitals: 2022 Update | Infection Control & Hospital Epidemiology | Cambridge Core

  https://www.cambridge.org/core/journals/infection-control-and-hospital-epidemiology/article/strategies-to-prevent-clostridioides-difficile-infections-in-acutecare-hospitals-2022-update/575A2A0C9E68BD8535D14B2E337FD0A4

  6. Encourage appropriate use of antimicrobials through implementation of an antimicrobial stewardship program. […] […] 7. Implement diagnostic stewardship practices for ensuring appropriate use and interpretation of C. difficile testing. […] […] 8. Use contact precautions for infected patients, single-patient room preferred. […] […] 9. Adequately clean and disinfect equipment and the environment of patients with CDI. […] […] 10. Assess the adequacy of room cleaning. […] […] 11. Implement a laboratory-based alert system to provide immediate notification to infection preventionists and clinical personnel about newly diagnosed patients with CDI. […] […] 12. Conduct CDI surveillance and analyze and report CDI data. […] […] 13. Educate HCP, environmental service personnel, and hospital administration about CDI, including risk factors, routes of transmission, local CDI epidemiology, patient outcomes, and treatment and prevention measures. […]

• #42 Prevention Strategies for Community-Acquired Clostridium difficile Infections | Consultant360

  https://www.consultant360.com/articles/prevention-strategies-community-acquired-clostridium-difficile-infections

  Discharge teaching must impart innovative education about the prevention of CDI and introduce a team approach to infection control. Families, household members, coworkers, visitors, and those with CDI should partner in the prevention of the infection. Furthermore, discharge instructions should safeguard that visitors and family members are aware of who may be at high risk for acquiring CDI. Prevention strategies include proper hand washing, environmental cleaning, and judicious use of certain medications. […] Strict adherence to hand hygiene is critical in minimizing the spread of infection; therefore, family and household members should be instructed on the importance of proper hand hygiene. C difficile in the spore form is known to be highly resistant to alcohol, and so alcohol-based products likely are not as effective in removing C difficile spores as are soap and water. Mechanical scrubbing with soap and water should be further emphasized among family and household members.

• #43 Clostridium difficile (C. diff) infection

  https://www.nhs.uk/conditions/c-difficile/

  C. diff infections can spread very easily. There are some things you can do to reduce the risk of passing it on to others. […] stay at home until at least 48 hours after your diarrhoea stops […] wash your hands regularly using soap and water […] clean the toilet and area around it with disinfectant after each use […] wash clothes and sheets with poo on separately from other washing at the highest possible temperature […] do not share towels and flannels […] do not take medicine to stop diarrhoea like loperamide because it can prevent the infection being cleared from your body.

• #44 Prevention Strategies for Community-Acquired Clostridium difficile Infections | Consultant360

  https://www.consultant360.com/articles/prevention-strategies-community-acquired-clostridium-difficile-infections

  Household members of a person with CDI also should receive education on appropriate contact precautions. A 1:10 chlorine bleach and water solution should be used to clean the bathroom and kitchen of the infected household member. Family or household members should be advised of the importance of not sharing the bathroom, towels, or hygiene products of the infected person, especially if diarrhea is present. Gloves should be used to handle soiled linens and clothing. In addition, soiled linens and clothing should be kept separate from the laundry of other household members and should be washed in hot water, with laundry detergent and a 1:10 dilution of chlorine bleach. […] It is important that health care providers educate their patients on the appropriate use of antibiotics. Frequent and improper use of antibiotics is associated with increased microbial resistance. The Centers for Disease Control and Prevention has developed the Get Smart program, which offers resources for patients and health care providers on the appropriate and inappropriate uses of antibiotics, including charts that can be easily displayed in a primary care office for patients to read while waiting. Additionally, patients should be informed that certain classes of antibiotics (fluoroquinolones, cephalosporins, penicillins, and clindamycin) have been associated with an increased risk of CDI. Furthermore, limited use of gastric acid suppressants, whenever possible, should be emphasized.

• #45 Clostridium difficile (C. diff) infection

  https://www.nhs.uk/conditions/c-difficile/

  C. diff infections can spread very easily. There are some things you can do to reduce the risk of passing it on to others. […] stay at home until at least 48 hours after your diarrhoea stops […] wash your hands regularly using soap and water […] clean the toilet and area around it with disinfectant after each use […] wash clothes and sheets with poo on separately from other washing at the highest possible temperature […] do not share towels and flannels […] do not take medicine to stop diarrhoea like loperamide because it can prevent the infection being cleared from your body.

• #46 Prevention Strategies for Community-Acquired Clostridium difficile Infections | Consultant360

  https://www.consultant360.com/articles/prevention-strategies-community-acquired-clostridium-difficile-infections

  Household members of a person with CDI also should receive education on appropriate contact precautions. A 1:10 chlorine bleach and water solution should be used to clean the bathroom and kitchen of the infected household member. Family or household members should be advised of the importance of not sharing the bathroom, towels, or hygiene products of the infected person, especially if diarrhea is present. Gloves should be used to handle soiled linens and clothing. In addition, soiled linens and clothing should be kept separate from the laundry of other household members and should be washed in hot water, with laundry detergent and a 1:10 dilution of chlorine bleach. […] It is important that health care providers educate their patients on the appropriate use of antibiotics. Frequent and improper use of antibiotics is associated with increased microbial resistance. The Centers for Disease Control and Prevention has developed the Get Smart program, which offers resources for patients and health care providers on the appropriate and inappropriate uses of antibiotics, including charts that can be easily displayed in a primary care office for patients to read while waiting. Additionally, patients should be informed that certain classes of antibiotics (fluoroquinolones, cephalosporins, penicillins, and clindamycin) have been associated with an increased risk of CDI. Furthermore, limited use of gastric acid suppressants, whenever possible, should be emphasized.

• #47 Prevention Strategies for Community-Acquired Clostridium difficile Infections | Consultant360

  https://www.consultant360.com/articles/prevention-strategies-community-acquired-clostridium-difficile-infections

  Household members of a person with CDI also should receive education on appropriate contact precautions. A 1:10 chlorine bleach and water solution should be used to clean the bathroom and kitchen of the infected household member. Family or household members should be advised of the importance of not sharing the bathroom, towels, or hygiene products of the infected person, especially if diarrhea is present. Gloves should be used to handle soiled linens and clothing. In addition, soiled linens and clothing should be kept separate from the laundry of other household members and should be washed in hot water, with laundry detergent and a 1:10 dilution of chlorine bleach. […] It is important that health care providers educate their patients on the appropriate use of antibiotics. Frequent and improper use of antibiotics is associated with increased microbial resistance. The Centers for Disease Control and Prevention has developed the Get Smart program, which offers resources for patients and health care providers on the appropriate and inappropriate uses of antibiotics, including charts that can be easily displayed in a primary care office for patients to read while waiting. Additionally, patients should be informed that certain classes of antibiotics (fluoroquinolones, cephalosporins, penicillins, and clindamycin) have been associated with an increased risk of CDI. Furthermore, limited use of gastric acid suppressants, whenever possible, should be emphasized.

• #48 Clostridium difficile (C. diff) infection

  https://www.nhs.uk/conditions/c-difficile/

  C. diff infections can spread very easily. There are some things you can do to reduce the risk of passing it on to others. […] stay at home until at least 48 hours after your diarrhoea stops […] wash your hands regularly using soap and water […] clean the toilet and area around it with disinfectant after each use […] wash clothes and sheets with poo on separately from other washing at the highest possible temperature […] do not share towels and flannels […] do not take medicine to stop diarrhoea like loperamide because it can prevent the infection being cleared from your body.

• #49 Strategies to prevent Clostridioides difficile infections in acute-care hospitals: 2022 Update | Infection Control & Hospital Epidemiology | Cambridge Core

  https://www.cambridge.org/core/journals/infection-control-and-hospital-epidemiology/article/strategies-to-prevent-clostridioides-difficile-infections-in-acutecare-hospitals-2022-update/575A2A0C9E68BD8535D14B2E337FD0A4

  6. Encourage appropriate use of antimicrobials through implementation of an antimicrobial stewardship program. […] […] 7. Implement diagnostic stewardship practices for ensuring appropriate use and interpretation of C. difficile testing. […] […] 8. Use contact precautions for infected patients, single-patient room preferred. […] […] 9. Adequately clean and disinfect equipment and the environment of patients with CDI. […] […] 10. Assess the adequacy of room cleaning. […] […] 11. Implement a laboratory-based alert system to provide immediate notification to infection preventionists and clinical personnel about newly diagnosed patients with CDI. […] […] 12. Conduct CDI surveillance and analyze and report CDI data. […] […] 13. Educate HCP, environmental service personnel, and hospital administration about CDI, including risk factors, routes of transmission, local CDI epidemiology, patient outcomes, and treatment and prevention measures. […]

• #50 Strategies to prevent Clostridioides difficile infections in acute-care hospitals: 2022 Update | Infection Control & Hospital Epidemiology | Cambridge Core

  https://www.cambridge.org/core/journals/infection-control-and-hospital-epidemiology/article/strategies-to-prevent-clostridioides-difficile-infections-in-acutecare-hospitals-2022-update/575A2A0C9E68BD8535D14B2E337FD0A4

  6. Encourage appropriate use of antimicrobials through implementation of an antimicrobial stewardship program. […] […] 7. Implement diagnostic stewardship practices for ensuring appropriate use and interpretation of C. difficile testing. […] […] 8. Use contact precautions for infected patients, single-patient room preferred. […] […] 9. Adequately clean and disinfect equipment and the environment of patients with CDI. […] […] 10. Assess the adequacy of room cleaning. […] […] 11. Implement a laboratory-based alert system to provide immediate notification to infection preventionists and clinical personnel about newly diagnosed patients with CDI. […] […] 12. Conduct CDI surveillance and analyze and report CDI data. […] […] 13. Educate HCP, environmental service personnel, and hospital administration about CDI, including risk factors, routes of transmission, local CDI epidemiology, patient outcomes, and treatment and prevention measures. […]

• #51 Prevention and treatment of Clostridium difficile infection

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5873812/

  Prior antimicrobial use is the most important risk factor for CDI. It has been difficult to produce a hit list of individual antimicrobials causing CDI based on risk, as published studies have methodological limitations and their conclusions are not necessarily applicable across institutions. Almost any antibiotic can predispose to CDI, but broad-spectrum cephalosporins and clindamycin are generally accepted as high-risk agents, with quinolones implicated in the recent BI/NAP1/027 strain outbreaks. Observational studies substituting other agents for broad-spectrum cephalosporins or clindamycin have resulted in reduction of CDI rates in endemic and outbreak situations. The use of narrow-spectrum agents for as short a duration as possible is encouraged […] […] Many studies have shown that C. difficile is carried and transmitted via the hands of healthcare workers. No antiseptic agent has reliable sporicidal activity. Water and soap are more effective than alcohol gel at decontaminating hands through the physical action of rubbing and rinsing. Existing guidelines recommend hand washing with soap and water before and after contact with patients infected with C. difficile […]

• #52 Strategies to prevent Clostridioides difficile infections in acute-care hospitals: 2022 Update | Infection Control & Hospital Epidemiology | Cambridge Core

  https://www.cambridge.org/core/journals/infection-control-and-hospital-epidemiology/article/strategies-to-prevent-clostridioides-difficile-infections-in-acutecare-hospitals-2022-update/575A2A0C9E68BD8535D14B2E337FD0A4

  6. Encourage appropriate use of antimicrobials through implementation of an antimicrobial stewardship program. […] […] 7. Implement diagnostic stewardship practices for ensuring appropriate use and interpretation of C. difficile testing. […] […] 8. Use contact precautions for infected patients, single-patient room preferred. […] […] 9. Adequately clean and disinfect equipment and the environment of patients with CDI. […] […] 10. Assess the adequacy of room cleaning. […] […] 11. Implement a laboratory-based alert system to provide immediate notification to infection preventionists and clinical personnel about newly diagnosed patients with CDI. […] […] 12. Conduct CDI surveillance and analyze and report CDI data. […] […] 13. Educate HCP, environmental service personnel, and hospital administration about CDI, including risk factors, routes of transmission, local CDI epidemiology, patient outcomes, and treatment and prevention measures. […]

• #53 Strategies to prevent Clostridioides difficile infections in acute-care hospitals: 2022 Update | Infection Control & Hospital Epidemiology | Cambridge Core

  https://www.cambridge.org/core/journals/infection-control-and-hospital-epidemiology/article/strategies-to-prevent-clostridioides-difficile-infections-in-acutecare-hospitals-2022-update/575A2A0C9E68BD8535D14B2E337FD0A4

  6. Encourage appropriate use of antimicrobials through implementation of an antimicrobial stewardship program. […] […] 7. Implement diagnostic stewardship practices for ensuring appropriate use and interpretation of C. difficile testing. […] […] 8. Use contact precautions for infected patients, single-patient room preferred. […] […] 9. Adequately clean and disinfect equipment and the environment of patients with CDI. […] […] 10. Assess the adequacy of room cleaning. […] […] 11. Implement a laboratory-based alert system to provide immediate notification to infection preventionists and clinical personnel about newly diagnosed patients with CDI. […] […] 12. Conduct CDI surveillance and analyze and report CDI data. […] […] 13. Educate HCP, environmental service personnel, and hospital administration about CDI, including risk factors, routes of transmission, local CDI epidemiology, patient outcomes, and treatment and prevention measures. […]

• #54 Strategies to prevent Clostridioides difficile infections in acute-care hospitals: 2022 Update | Infection Control & Hospital Epidemiology | Cambridge Core

  https://www.cambridge.org/core/journals/infection-control-and-hospital-epidemiology/article/strategies-to-prevent-clostridioides-difficile-infections-in-acutecare-hospitals-2022-update/575A2A0C9E68BD8535D14B2E337FD0A4

  6. Encourage appropriate use of antimicrobials through implementation of an antimicrobial stewardship program. […] […] 7. Implement diagnostic stewardship practices for ensuring appropriate use and interpretation of C. difficile testing. […] […] 8. Use contact precautions for infected patients, single-patient room preferred. […] […] 9. Adequately clean and disinfect equipment and the environment of patients with CDI. […] […] 10. Assess the adequacy of room cleaning. […] […] 11. Implement a laboratory-based alert system to provide immediate notification to infection preventionists and clinical personnel about newly diagnosed patients with CDI. […] […] 12. Conduct CDI surveillance and analyze and report CDI data. […] […] 13. Educate HCP, environmental service personnel, and hospital administration about CDI, including risk factors, routes of transmission, local CDI epidemiology, patient outcomes, and treatment and prevention measures. […]

• #55 Strategies to prevent Clostridioides difficile infections in acute-care hospitals: 2022 Update | Infection Control & Hospital Epidemiology | Cambridge Core

  https://www.cambridge.org/core/journals/infection-control-and-hospital-epidemiology/article/strategies-to-prevent-clostridioides-difficile-infections-in-acutecare-hospitals-2022-update/575A2A0C9E68BD8535D14B2E337FD0A4

  6. Encourage appropriate use of antimicrobials through implementation of an antimicrobial stewardship program. […] […] 7. Implement diagnostic stewardship practices for ensuring appropriate use and interpretation of C. difficile testing. […] […] 8. Use contact precautions for infected patients, single-patient room preferred. […] […] 9. Adequately clean and disinfect equipment and the environment of patients with CDI. […] […] 10. Assess the adequacy of room cleaning. […] […] 11. Implement a laboratory-based alert system to provide immediate notification to infection preventionists and clinical personnel about newly diagnosed patients with CDI. […] […] 12. Conduct CDI surveillance and analyze and report CDI data. […] […] 13. Educate HCP, environmental service personnel, and hospital administration about CDI, including risk factors, routes of transmission, local CDI epidemiology, patient outcomes, and treatment and prevention measures. […]

• #56 Strategies to prevent Clostridioides difficile infections in acute-care hospitals: 2022 Update | Infection Control & Hospital Epidemiology | Cambridge Core

  https://www.cambridge.org/core/journals/infection-control-and-hospital-epidemiology/article/strategies-to-prevent-clostridioides-difficile-infections-in-acutecare-hospitals-2022-update/575A2A0C9E68BD8535D14B2E337FD0A4

  6. Encourage appropriate use of antimicrobials through implementation of an antimicrobial stewardship program. […] […] 7. Implement diagnostic stewardship practices for ensuring appropriate use and interpretation of C. difficile testing. […] […] 8. Use contact precautions for infected patients, single-patient room preferred. […] […] 9. Adequately clean and disinfect equipment and the environment of patients with CDI. […] […] 10. Assess the adequacy of room cleaning. […] […] 11. Implement a laboratory-based alert system to provide immediate notification to infection preventionists and clinical personnel about newly diagnosed patients with CDI. […] […] 12. Conduct CDI surveillance and analyze and report CDI data. […] […] 13. Educate HCP, environmental service personnel, and hospital administration about CDI, including risk factors, routes of transmission, local CDI epidemiology, patient outcomes, and treatment and prevention measures. […]

• #57 Updated Clinical Practice Guidelines for C difficile Infection in Adults

  https://www.uspharmacist.com/article/updated-clinical-practice-guidelines-for-c-difficile-infection-in-adults

  A multifactorial approach is recommended for the prevention of CDI. This includes infection prevention measures (e.g., hand hygiene, isolation precautions, contact precautions, and appropriate environmental cleaning and disinfection) as well as implementation of antimicrobial stewardship programs that restrict high-risk antibiotics and focus on minimizing the use and duration of unnecessary antimicrobial agents. […] The updated ACG guidelines state that the use of oral vancomycin as prophylaxis (to prevent recurrence) may be considered in patients with a recent history of CDI who require antibiotic treatment and are at high risk for recurrent infection (i.e., aged 65 years or older or significantly immunocompromised and hospitalized within the previous 3 months for severe CDI); this is a conditional recommendation with a low quality of evidence. The suggested dosage of vancomycin for prophylaxis is 125 mg orally once daily, continued for 5 days after completion of antibiotic therapy.

• #58 Clostridioides (Clostridium) difficile Infection Prevention – MN Dept. of Health

  https://www.health.state.mn.us/diseases/cdiff/hcp/ic.html

  In long-term care facilities, consider continuing Contact Precautions for a minimum of 48 hours after resolution of diarrhea. […] Appropriate antibiotic use is a key component of CDI prevention. […] Infection prevention and control practices in long term care and home health settings are similar to those practices taken in acute care settings. […] Consider continuing Contact Precautions for a minimum of 48 hours after resolution of diarrhea. […] After resolution of symptoms, assure clean, dry incontinence products and hand hygiene is performed prior to resident leaving their room or participating in group activities.

• #59 Clostridioides (Clostridium) difficile Infection Prevention – MN Dept. of Health

  https://www.health.state.mn.us/diseases/cdiff/hcp/ic.html

  In long-term care facilities, consider continuing Contact Precautions for a minimum of 48 hours after resolution of diarrhea. […] Appropriate antibiotic use is a key component of CDI prevention. […] Infection prevention and control practices in long term care and home health settings are similar to those practices taken in acute care settings. […] Consider continuing Contact Precautions for a minimum of 48 hours after resolution of diarrhea. […] After resolution of symptoms, assure clean, dry incontinence products and hand hygiene is performed prior to resident leaving their room or participating in group activities.

• #60 Assessing the Efficacy and Risks of Oral Vancomycin Prophylaxis for Clostridioides difficile Infections

  https://www.contagionlive.com/view/assessing-the-efficacy-and-risks-of-oral-vancomycin-prophylaxis-for-clostridioides-difficile-infections

  Clostridioides difficile infection (CDI) presents a risk of up to 9 times higher for patients undergoing hematopoietic stem cell transplantation (HSCT) compared to the general population. […] While the use of Oral Vancomycin Prophylaxis (OVP) has been effective in reducing the incidence of C difficile infection, it has been concurrently linked to a rise in the rate of gram-negative bacteremia among HSCT recipients, escalating from 13% to 21.8%. […] The administration of OVP resulted in a halved incidence of CDI among HSCT recipients, dropping from 14% to 7%. […] The study reports a concerning spike in the incidence of gram-negative bacteremia, increasing from 13% to 21.8% among patients receiving OVP. […] Alexander Vartanov, MD, advocates for a more discerning approach to OVP administration, focusing on identifying HSCT recipients who would benefit most from CDI prophylaxis while minimizing the risk of fostering other infections. […] This study underscores the importance of medical interventions, advocating for a strategic, evidence-based application of prophylactic measures.

• #61 Antibiotic prophylaxis for surgical site infections as a risk factor for infection with Clostridium difficile | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0179117

  We aimed to measure the association between 2013 guideline concordant prophylactic antibiotic use prior to surgery and infection with Clostridium difficile. […] Adherence to the recommended prophylactic antibiotics among surgical patients likely reduces the probability of being case of C. difficile. Antibiotic stewardship should be a priority in strategies to decrease the morbidity, mortality, and costs associated with C. difficile infection. […] The general recommendation that pertains to our study is that surgical patients be given the recommended type of antibiotic based on the type of surgical procedure and that surgical patients be given 24 hours or less of antibiotic prophylaxis after the end of surgery. […] Our findings strongly support the use of guideline concordant antibiotic prophylaxis to reduce the risk of C. difficile infection. Specifically, the odds of not receiving guideline concordant antibiotic prophylaxis were 6.7 times higher (95% CI: 2.9, 15.5) among those patients who developed an infection with C. difficile compared to those who did not. […] The main results from our study supported our hypothesis that patients with C. difficile infection more frequently received antibiotics longer than the recommended 24-hour duration compared to patients who did not have C. difficile infection.

• #62 Antibiotic prophylaxis for surgical site infections as a risk factor for infection with Clostridium difficile | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0179117

  We aimed to measure the association between 2013 guideline concordant prophylactic antibiotic use prior to surgery and infection with Clostridium difficile. […] Adherence to the recommended prophylactic antibiotics among surgical patients likely reduces the probability of being case of C. difficile. Antibiotic stewardship should be a priority in strategies to decrease the morbidity, mortality, and costs associated with C. difficile infection. […] The general recommendation that pertains to our study is that surgical patients be given the recommended type of antibiotic based on the type of surgical procedure and that surgical patients be given 24 hours or less of antibiotic prophylaxis after the end of surgery. […] Our findings strongly support the use of guideline concordant antibiotic prophylaxis to reduce the risk of C. difficile infection. Specifically, the odds of not receiving guideline concordant antibiotic prophylaxis were 6.7 times higher (95% CI: 2.9, 15.5) among those patients who developed an infection with C. difficile compared to those who did not. […] The main results from our study supported our hypothesis that patients with C. difficile infection more frequently received antibiotics longer than the recommended 24-hour duration compared to patients who did not have C. difficile infection.

• #63 Clostridioides difficile infection: Prevention and control – UpToDate

  https://www.uptodate.com/contents/clostridioides-difficile-infection-prevention-and-control

  Clostridioides difficile infection: Prevention and control […] Clostridioides difficile is the causative organism of antibiotic-associated colitis. It is the most common infectious cause of health care-associated diarrhea and a significant cause of morbidity and mortality among hospitalized patients. […] Development of CDI usually requires two events: disruption of the fecal microbiota (typically via exposure to antibiotics) and ingestion of spores via the fecal-oral route. C. difficile may be shed into the environment by individuals who are infected or colonized. High colonization rates may occur among hospitalized adults, nursing home residents, and healthy infants. […] C. difficile spores can be transmitted between patients via environmental surfaces and contaminated hands of health care personnel. Thus, efforts to prevent CDI must focus on two goals: reducing patient susceptibility to CDI and preventing organism transmission. Prevention of C. difficile transmission is especially challenging because the organism forms spores that can persist on environmental surfaces for months and are resistant to commonly used cleaning agents and alcohol-based hand gels. […] Issues related to prevention of CDI in health care and community settings are discussed here. Issues related to prevention of CDI in individual patients are discussed separately.

• #64 Clostridium Difficile Infection

  https://www.gillettechildrens.org/your-visit/patient-education/clostridium-difficile-infection-cdi-infection-prevention

  People who have other illnesses or conditions that require antibiotic use are at risk for developing a Clostridium difficile infection (CDI or C. diff). […] If we suspect you have CDI while you are at Gillette, you will be placed in a private room until you no longer have diarrhea. An Enteric Precautions sign will be placed on your room door. We will limit your activities outside your room. […] It is important that you wash your hands after going to the bathroom and before eating. Your room will be cleaned regularly and any equipment removed from your room will be cleaned as well. […] Healthy family and friends who are not taking antibiotics are at very low risk of developing CDI. However, hand hygiene (washing hands) is always important and should be done after using the bathroom and before eating.

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