Controlling clostridium difficile infection and the role of antibiotic stewardship

Abstract

Since 2002, increasing rates of nosocomial Clostridium difficile infection (CDI) with a more severe course, higher mortality, and more complications have been reported in Canada, USA and Europe. One specific strain (PCR ribotype 027, REA-group BI, PFGE-type NAP1) was identified and accounted for at least half of the isolates. CDI can be prevented by robust infection control practice and prudent antibiotic use. In an outbreak setting it is often practical to combine multiple different CDI interventions which may consist of increased and early case finding, expanded infection-control measures, and antibiotic stewardship. Antimicrobials to be targeted ideally should be based on the local epidemiology and the C. difficile strains present, but restricting the use of cephalosporins and clindamycin have been the most effective. The results of fluoroquinolone restriction have been varied and may be of particular importance for outbreaks associated with the hyper-virulent PCR ribotype 027 strains.