New Recommendations for Treating Clostridium Difficile Infections

A new clinician consensus report reveals that Clostridium difficile infection (CDI) is twice as common as methicillin-resistant Staphylococcus aureus (MRSA) infections in hospitals.

The report was initiated by a consortium of leading European experts in order to determine attitudes and perceived unmet clinical needs of CDI treatment in Europe. A series of 29 statements representing their collective views was prepared, covering diagnosis and management; definitions of severity; treatment failure, recurrence, and its consequences; infection prevention and control interventions; antimicrobial stewardship and education; and national CDI clinical guidance and policy.

They then sent questionnaires to 1,047 clinicians involved in managing CDI from Germany, France, Spain, Italy, Sweden, and the United Kingdom. The clinicians, from specialties such as infectious diseases, internal medicine, and intensive care, indicated their levels of agreement with each of the statements. Theyfound levels of agreement exceeding a 66% threshold for 27 of 29 statements (93.1%), indicating strong support for the majority. Variance between countries and specialties was analyzed and showed strong alignment with the overall consensus scores.

The consensus recommendations included implementation of clearly defined algorithms for stool specimen selection, collection, and testing; a better definition of how optimal CDI treatment can be planned for patients with co-morbidities; and improved antibiotic stewardship. They also agreed to ensure that national policies warrant consistent surveillance, prevention, diagnosis and treatment of CDI across Europe. The clinician consensus report was presented at the Healthcare Infection Society (HIS) International Congress, held during November 2014 in Lyon (France).

“Patients who suffer from CDI tend to be those who are already extremely vulnerable, such as cancer patients, people who have received immunosuppressants or antibiotics, and those who had recent surgery,” said Simon Goldenberg, MD, of Guy's and St Thomas' NHS Foundation Trust (London, United Kingdom). “This survey is important because it identifies the views of healthcare professionals who are actively involved in the day-to-day testing, diagnosis and treatment of CDI and who are responsible for reducing transmission and recurrence rates.”

“The biggest problem we face in treating CDI is recurrence. Not only does recurrent CDI cause increased patient suffering, but it also significantly raises healthcare costs,” said Nicola Petrosillo, MD, director of the infectious diseases division at the Lazzaro Spallanzani national institute for infectious diseases (Rome, Italy). “The recommendations put forward as a result of this survey could help to ensure appropriate diagnosis and treatment strategies are applied at a national and European level to improve patient outcomes and reduce the economic burden of this potentially fatal disease.”

CDI is a serious illness resulting from infection of the internal lining of the colon by C. difficile bacteria, and typically develops after the use of broad-spectrum antibiotics that disrupt normal bowel flora, allowing the bacteria to flourish; it is the leading cause of nosocomial diarrhea in industrialized countries. The risk of CDI is particularly high in patients aged 65 years and older, and disease recurrence occurs in up to 25% of patients within 30 days of initial treatment.

Related Links:
Guy's and St Thomas' NHS Foundation Trust
Lazzaro Spallanzani National Institute for Infectious Diseases