5 Important Developments in C difficile Management

John G. Bartlett, MD

The Role of Infection Control

Standard teaching is that Clostridium difficile infection (CDI) is a hospital-acquired infection that reflects a failure of infection control, but it may be more closely related to antibiotic control. A recent report from the Centers for Disease Control and Prevention (CDC), based on an analysis of 10,342 cases of CDI in 111 hospitals and 310 nursing homes, showed that 75% of the patients were already colonized with C difficile at the time of admission.[1] Nearly all (94%) of these cases were "healthcare-associated," meaning that acquisition occurred during an outpatient visit, a nursing home stay, the current hospitalization, or a previous hospitalization. Only 25% of patients actually acquired the pathogen in the same hospital where clinical expression of CDI occurred.

Clinical relevance. The CDC study suggests that infection control personnel and physicians need to be aware of this association, because this may require changes in infection control practice. The implication is that to prevent CDI, clinicians need to find ways to identify patients who are already colonized to protect them from obvious risks, and also to consider them to be potential sources of infection to others. This could substantially change infection control practice for prevention of CDI.