In the past two years an enormous amount of molecular, genetic, metabolomic and mechanistic data on the hostbacterium interaction, a healthy gut microbiota and a possible role for probiotics in Clostridium difficile infection (CDI) has been accumulated. Also, new hypervirulent strains of C. difficile have emerged. Yet, clinical trials in CDI have been less promising than in antibiotic associated diarrhoea in general, with more meta-analysis than primary papers on CDI-clinical-trials. The fact that C. difficile is a spore former, producing at least three different toxins has not yet been incorporated in the rational design of probiotics for (recurrent) CDI. Here we postulate that the plethora of effects of C. difficile and the vast amount of data on the role of commensal gut residents and probiotics point towards a multistrain mixture of probiotics to reduce CDI, but also to limit (nosocomial) transmission and/or endogenous reinfection. On the basis of a retrospective chart review of a series of ten CDI patients where recurrence was expected, all patients on adjunctive probiotic therapy with multistrain cocktail (Ecologic®AAD/OMNiBiOTiC® 10) showed complete clinical resolution. This result, and recent success in faecal transplants in CDI treatment, are supportive for the rational design of multistrain probiotics for CDI.
Contaminated surfaces contribute to transmission of Clostridium difficile in the healthcare setting. the aim of the investigation was to assess the effectiveness of an environmental disinfection protocol consisting of daily use of the oxygen-releasing sporocide Oxygenon ® Liquid (Antiseptica) (i.e. new protocol) in preventing nosocomial CDI, compared to daily surface disinfection with a quaternary ammonium compound-based product plus the oxygen-releasing sporicide Perform ® (Schülke+) for targeted sporicidal environmental disinfection (i.e. usual protocol). In a pre-post single group study with patients of two internal medicine wards (A and B) between February 2008 and May 2011, we compared the CDI rate between the pre-and post-intervention phase by calculating the post-pre phase CDI rate-difference and preventable fraction. In a pre-post parallel groups study from August 2009 until May 2011, the post-pre phase CDI rate-difference of the experimental group (internal medicine ward B) was compared with the post-pre CDI rate-difference of a control group (general surgery department) by calculating the between-group difference in the post-pre CDI rate-difference. In the pre-post single group study, among patients ≥ 70 year olds, the post-pre phase CDI rate reduction of 14.0/10,000 beddays was significant, and preventable fraction of CDI was 60.2% (95%CI: 15.6%-82.8%). The results of the prepost parallel groups study suggested a superiority of the new environmental disinfection protocol at borderline significance. The post-pre CDI rate-difference in the experimental group was greater than the post-pre ratedifference in the control group by 10.4/10,000 bed-days. Using a sporicide for daily surface decontamination may be superior to targeted sporicidal disinfection in preventing nosocomial transmission of C. difficile.
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