Update on the Management of Clostridium difficile Infection
Early detection leads to early treatment and infection control. Pharmacists from various practice settings can emphasize preventive strategies for CDI. They can educate their patients along with their caregivers and other healthcare workers on complying with proper hand hygiene. C difficile in its spore form is resistant to alcohol; thus, alcohol-based antiseptics will not eradicate the spores. When caring for patients with CDI, hands must be washed with soap and running water. Contact precaution is another measure pharmacists can counsel upon. Healthcare workers and visitors must use gloves and gowns when caring for or entering the room of a patient with CDI. Contact precaution and private rooms when possible should be used for patients with CDI until the resolution of diarrhea.
Antimicrobial stewardship programs can be designed to reduce the risk of CDI. Pharmacists can help prevent transmission of C difficile by being cognizant of high-risk patients such as those with recent or current antibiotic therapy or hospitalizations. They can also help minimize exposure and ensure that the appropriate healthcare personnel are informed once a positive C difficile test has resulted, so that optimal therapy and necessary precautions can be initiated.
There are limited data available to recommend the widespread use of probiotics in preventing CDI. Lactobacillus casei, Lactobacillus bulgaricus, and Streptococcus thermophiles were found to decrease the risk of CDI in patients >50 years of age who were prescribed antibiotics and were capable of oral intake. However, the study had its limitations, since the sample size was small and high-risk antibiotics were not used. Another small study also found benefit with Lactobacillus acidophilus, yet there are insufficient data to recommend the routine use of probiotics in the prevention of CDI. Other probiotics, such as Lactobacillus rhamnosus GG and Saccharomyces boulardii, have shown a decrease in antibiotic-associated diarrhea but have limited evidence with decreasing CDI. Although there is moderate evidence for the use of certain probiotics in preventing antibiotic-associated diarrhea, further studies are needed to justify their use in the prevention of CDI.
Prevention
Early detection leads to early treatment and infection control. Pharmacists from various practice settings can emphasize preventive strategies for CDI. They can educate their patients along with their caregivers and other healthcare workers on complying with proper hand hygiene. C difficile in its spore form is resistant to alcohol; thus, alcohol-based antiseptics will not eradicate the spores. When caring for patients with CDI, hands must be washed with soap and running water. Contact precaution is another measure pharmacists can counsel upon. Healthcare workers and visitors must use gloves and gowns when caring for or entering the room of a patient with CDI. Contact precaution and private rooms when possible should be used for patients with CDI until the resolution of diarrhea.
Antimicrobial stewardship programs can be designed to reduce the risk of CDI. Pharmacists can help prevent transmission of C difficile by being cognizant of high-risk patients such as those with recent or current antibiotic therapy or hospitalizations. They can also help minimize exposure and ensure that the appropriate healthcare personnel are informed once a positive C difficile test has resulted, so that optimal therapy and necessary precautions can be initiated.
There are limited data available to recommend the widespread use of probiotics in preventing CDI. Lactobacillus casei, Lactobacillus bulgaricus, and Streptococcus thermophiles were found to decrease the risk of CDI in patients >50 years of age who were prescribed antibiotics and were capable of oral intake. However, the study had its limitations, since the sample size was small and high-risk antibiotics were not used. Another small study also found benefit with Lactobacillus acidophilus, yet there are insufficient data to recommend the routine use of probiotics in the prevention of CDI. Other probiotics, such as Lactobacillus rhamnosus GG and Saccharomyces boulardii, have shown a decrease in antibiotic-associated diarrhea but have limited evidence with decreasing CDI. Although there is moderate evidence for the use of certain probiotics in preventing antibiotic-associated diarrhea, further studies are needed to justify their use in the prevention of CDI.
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