Strategies to Prevent<i>Clostridium difficile</i>Infections in Acute Care Hospitals: 2014 Update

Dubberke, Erik R.; Carling, Philip; Carrico, Ruth; Donskey, Curtis J.; Loo, Vivian G.; McDonald, L. Clifford; Maragakis, Lisa L.; Sandora, Thomas J.; Weber, David J.; Yokoe, Deborah S.; Gerding, Dale N.

doi:10.1017/s0899823x00193857

Cited by 108 publications

(107 citation statements)

References 119 publications

(79 reference statements)

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“…In North America, 2 Canadian government advisory documents [34,35] and 4 documents from US–based professional bodies (3 guidelines [23,26,27], and an implementation guide [36]) were identified. In Europe, documents from government and professional organizations from 18 countries [24,25,28,30–33,37–54] and by the European Centre for Disease Control (ECDC) [29] were reviewed.…”

Section: Resultsmentioning

confidence: 99%

“…Discussion: Although one guideline established that available evidence on the effect of ASP did not fully meet all criteria for the highest level of quality (research has mainly relied on before–and–after studies) [26], judicious use of antibiotics was widely recognized as essential for CDI prevention. Despite the limitations in the evidence, the beneficial effect of prudent antibiotic use on CDI is noteworthy.…”

Section: Resultsmentioning

confidence: 99%

“…Although systematic reviews and meta–analyses report a protective effect of probiotics [70–72] and some publications reviewed here mention their potential use, studies exploring the contribution of probiotics to CDI prevention are largely limited by high heterogeneity between studies, high risk of bias, inadequate study power or significant levels of missing outcome data [26]. In light of these limitations in the evidence base, guidelines that systematically graded evidence stated that current scientific evidence on probiotics’ effect on CDI is insufficient to recommend their use for IPC.…”

Section: Resultsmentioning

confidence: 99%

“…Maintaining contact precautions until at least after diarrheal episodes have stopped (most commonly for 48 hours or longer) was generally recommended. However, extended contact precautions until the discharge of the CDI case [26,60,63] were also advised. Administrative support and communication were underscored as key factors given that isolation of cases can incur managerial difficulties and costs.…”

Section: Resultsmentioning

confidence: 99%

“…The strength of recommendations for implementation were grouped into the following categories: strong recommendation (two levels differentiated by quality of supporting evidence); recommended , consideration, and legal requirement. Strategies were also classified as Basic, Special (ie, likely to reduce risk but concerns exist about undesirable outcomes), or Unresolved Issue / Area of Research/Inconclusive in one guideline [26]. (See Appendix S2 in Online Supplementary Document(Online Supplementary Document) ).…”

Section: Quality Of Evidence and Strength Of Recommendationsmentioning

confidence: 99%

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Infection prevention and control of Clostridium difficile: a global review of guidelines, strategies, and recommendations

Balsells¹,

Filipescu²,

Kyaw³

et al. 2016

Journal of Global Health

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BackgroundClostridium difficile is the leading cause of health care–associated infections. Given the high incidence of C. difficile infection (CDI) and the lack of primary prevention through immunization, health care professionals should be aware of the most current guidance, as well as strengths and limitations of the evidence base underpinning this guidance.MethodsWe identified publicly available national or organizational guidelines related to CDI infection and prevention control (IPC) published between 2000 and 2015 and for any health care setting through an internet search using the Google search engine. We reviewed CDI–targeted IPC recommendations and describe the assessment of evidence in available guidelines.ResultsWe identified documents from 28 countries/territories, mainly from acute care hospitals in North America, the Western Pacific, and Europe (18 countries). We identified only a few specific recommendations for long–term care facilities (LTCFs) and from countries in South America (Uruguay and Chile), South East Asia (Thailand), and none for Africa or Eastern Mediterranean. Of 10 IPC areas, antimicrobial stewardship was universally recognized as essential and supported by high quality evidence. Five other widely reported “strong” recommendations were: effective environment cleaning (including medical equipment), case isolation, use of personal protective equipment, surveillance, and education. Several unresolved and emerging issues were documented and currently available evidence was classified mainly as of mixed quality.ConclusionOur review underlines the need for targeted CDI IPC guidelines in several countries and for LTCFs. International harmonisation on the assessment of the evidence for best practices is needed as well as more robust evidence to support targeted recommendations.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Quality Of Evidence and Strength Of Recommendationsmentioning

confidence: 99%

See 3 more Smart Citations

Infection prevention and control of Clostridium difficile: a global review of guidelines, strategies, and recommendations

Balsells¹,

Filipescu²,

Kyaw³

et al. 2016

Journal of Global Health

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Receipt of Antibiotics in Hospitalized Patients and Risk for Clostridium difficile Infection in Subsequent Patients Who Occupy the Same Bed

et al. 2016

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lostridium difficile infection (CDI) is the most common cause of diarrhea in the hospital and is responsible for an estimated 27 000 deaths annually in the United States. 1 Clostridium difficile infection occurs when there is a susceptible host and sufficient exposure to the organism. Many factors may increase host susceptibility to CDI, but the most crucial host-related risk factor is exposure to antibiotics. 2 Antibiotics are a risk factor for CDI not only when they are assessed at the level of the individual patient but also when they are assessed at the level of the hospital ward, 3,4 the level of the institution, 5 and the regional level. 6 Exposure to C difficile is common in the hospital because C difficile spores are capable of persisting in the environment for months. 7 High counts of C difficile spores can be detected in the stool of infected or colonized individuals, and C difficile can be readily cultured from the beds, bed rails, floors, and walls of hospital rooms where prior occupants have had CDI. 8,9 When individuals enter a new environment, they rapidly acquire C difficile as well as the other microorganisms that are present. 10 When one hospital roommate has CDI, patients who share that room are at increased risk for CDI. 11 Furthermore, when the previous occupant of a given hospital room has CDI, the subsequent patient in that room is at increased risk for CDI. 12 It is uncertain how antibiotics or other CDI risk factors might act on one patient to increase risk for CDI in a subsequent patient who shares the same hospital environment. We examined whether receipt of antibiotics by prior occupants of OBJECTIVE To assess whether receipt of antibiotics by prior hospital bed occupants is associated with increased risk for CDI in subsequent patients who occupy the same bed. DESIGN, SETTING, AND PARTICIPANTSThis is a retrospective cohort study of adult patients hospitalized in any 1 of 4 facilities between 2010 and 2015. Patients were excluded if they had recent CDI, developed CDI within 48 hours of admission, had inadequate follow-up time, or if their prior bed occupant was in the bed for less than 24 hours. MAIN OUTCOMES AND MEASURESThe primary exposure was receipt of non-CDI antibiotics by the prior bed occupant and the primary outcome was incident CDI in the subsequent patient to occupy the same bed. Incident CDI was defined as a positive result from a stool polymerase chain reaction for the C difficile toxin B gene followed by treatment for CDI. Demographics, comorbidities, laboratory data, and medication exposures are reported. RESULTS Among 100 615 pairs of patients who sequentially occupied a given hospital bed, there were 576 pairs (0.57%) in which subsequent patients developed CDI. Receipt of antibiotics in prior patients was significantly associated with incident CDI in subsequent patients (log-rank P < .01). This relationship remained unchanged after adjusting for factors known to influence risk for CDI including receipt of antibiotics by the subsequent patient (adjusted hazard ratio [aHR...

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Association of Visitor Contact Precautions With Estimated Hospital-Onset Clostridioides difficile Infection Rates in Acute Care Hospitals

et al. 2021

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Strategies to PreventClostridium difficileInfections in Acute Care Hospitals: 2014 Update

Abstract: Weber, David J.; Yokoe, Deborah S.; and Gerding, Dale N., ,"Strategies to prevent Clostridium difficile infections in acute care hospitals: 2014 update

Cited by 108 publications

References 119 publications

Infection prevention and control of Clostridium difficile: a global review of guidelines, strategies, and recommendations

Infection prevention and control of Clostridium difficile: a global review of guidelines, strategies, and recommendations

Receipt of Antibiotics in Hospitalized Patients and Risk for Clostridium difficile Infection in Subsequent Patients Who Occupy the Same Bed

Association of Visitor Contact Precautions With Estimated Hospital-Onset Clostridioides difficile Infection Rates in Acute Care Hospitals

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