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Prevention of Clostridium difficile Infection in Critically Ill Adults
Author(s) -
Leedahl David D.,
Personett Heather A.,
Nagpal Avish,
Barreto Erin F.
Publication year - 2019
Publication title -
pharmacotherapy: the journal of human pharmacology and drug therapy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.227
H-Index - 109
eISSN - 1875-9114
pISSN - 0277-0008
DOI - 10.1002/phar.2200
Subject(s) - fidaxomicin , medicine , clostridium difficile , intensive care medicine , antimicrobial stewardship , transmission (telecommunications) , deprescribing , infection control , incidence (geometry) , hygiene , disease , vancomycin , metronidazole , antibiotics , antibiotic resistance , polypharmacy , physics , electrical engineering , engineering , optics , pathology , biology , bacteria , microbiology and biotechnology , genetics , staphylococcus aureus
The incidence and severity of Clostridium difficile infection ( CDI ) remain high across intensive care units in the United States despite national efforts to decrease this escalating health care burden. Most published literature and guidelines address treatment rather than prevention, yet this approach may be too downstream to limit morbidity and mortality from the disease and its complications. Mechanisms to prevent CDI successfully include reducing modifiable risk factors and minimizing horizontal transmission of C. difficile spores between patients and the health care environment. Because CDI prevention is characterized by a bundled approach, it is difficult to quantify the individual impact of any one element; however, a number of patient‐ and facility‐level strategies can be considered for CDI prevention. Robust hygiene strategies, diagnostic and antimicrobial stewardship, and particular prophylaxis maneuvers such as continuation of oral vancomycin or fidaxomicin in the setting of systemic antibiotics have all demonstrated benefit. The preventive roles of deprescribing acid suppressants, routine use of probiotics, or early fecal microbiota transplantation remain unclear. The focus of this review is to summarize the evidence related to primary and secondary CDI prevention in critically ill adults and provide a concise implementation pathway for clinicians and policymakers.