Better antibiotic stewardship needed as C. difficile-associated diarrhea surges

The Centers for Disease Control and Prevention (CDC) is calling for more appropriate use of antibiotics to combat historically high levels of mortality associated with Clostridium difficile infections (CDI) in hospitals and other healthcare settings.

More than 14,000 deaths are linked to C. difficile-associated diarrhea each year in the United States, according to the CDC. The No. 1 step recommended to halt the increase is better antibiotic stewardship. CDC estimates that half of U.S. antibiotic use is inappropriate.

The C. difficile report was issued in the March issue of the CDC publication, Vital Signs. Older adults are at highest risk, especially those who take antibiotics. About 25% of C. difficile infections appear in hospital patients, the other 75% first appeared in nursing-home patients or those who recently received care in physician offices or clinics.

CDC noted that patients could acquire the infection from contaminated surfaces and from healthcare workers who fail to practice appropriate hand hygiene and other infection contamination control measures. The warning follows a British study published earlier this year that found only one-quarter of C. difficile infections are spread from patient to patient in hospitals and other facilities. The other three-quarters are spread by other routes and can be controlled in part by more effective antibiotic stewardship.

The Society for Healthcare Epidemiology of America (SHEA) echoed calls for improved antimicrobial stewardship and hand-hygiene practices.

“The increased prevalence of C. difficile demonstrates the need for better control and use of antibiotics, not only to preserve the efficacy of these lifesaving drugs, but to prevent adverse events like C. difficile infection,” said SHEA President Jan Patterson, MD, MS.

SHEA noted that evidence shows soap-and-water hand cleansing is more effective than alcohol-based cleansers for removing C. difficile spores. The Infectious Disease Society of America (IDSA) has published similar findings. 

The SHEA/IDSA Compendium of Practice Recommendations to Prevent Healthcare-Associated Infections as well as the joint Clinical Practice Guidelines for CDI recommend the use of soap and water over alcohol-based hand hygiene products during a C. difficile outbreak.