What is the risk of Clostridioides difficile (C. diff) infection?

From the Guidelines

The risk of Clostridioides difficile (C. diff) infection can be significantly reduced by avoiding unnecessary antibiotic use, practicing good hand hygiene with soap and water, and maintaining a healthy balance of gut bacteria through probiotics. To minimize the risk of C. diff infection, several key strategies can be employed:

• Avoiding unnecessary antibiotic use, as antibiotics play a central role in the pathogenesis of CDI by disrupting the normal gut flora 1
• Practicing good hand hygiene with soap and water, especially after using the bathroom and before eating, as alcohol-based hand sanitizers may not kill C. difficile spores or remove them from the hands 1
• Maintaining a healthy balance of gut bacteria through probiotics, although the specific strains and efficacy are not detailed in the provided evidence
• Cleaning and disinfecting frequently touched surfaces, especially in the bathroom, using chlorine-based products to reduce the spread of C. diff spores
• Ensuring healthcare providers clean their hands and wear appropriate protective equipment when caring for patients, particularly in hospital settings where the risk of transmission is higher 1 These measures are crucial in reducing the risk of C. diff infection, especially for high-risk individuals such as the elderly, immunocompromised, or those recently hospitalized. Key factors that increase the risk of CDI include:
• Antibiotic exposure, particularly with clindamycin, third-generation cephalosporins, penicillins, and fluoroquinolones 1
• Age over 65 years
• Comorbidity or underlying conditions
• Inflammatory bowel diseases
• Immunodeficiency, including human immunodeficiency virus infection
• Malnutrition and low serum albumin level By understanding these risk factors and implementing preventive measures, individuals can significantly reduce their risk of developing C. diff infection.

From the FDA Drug Label

What is DIFICID DIFICID is an antibiotic medicine used to treat an infection called Clostridioides difficile-associated diarrhea (CDAD) in adults and children 6 months of age and older. Clostridioides difficile (C-diff) is a bacterium that can cause an infection that can damage your colon and cause stomach pain and severe diarrhea.

The risk of Clostridioides difficile (C. diff) infection is not directly stated in the provided drug labels as a specific percentage or value. However, it is mentioned that DIFICID is used to treat C. difficile-associated diarrhea (CDAD), implying that the infection is a significant concern.

• The labels do provide information on the development of drug-resistant bacteria if DIFICID is prescribed without a proven or strongly suspected C. difficile infection.
• They also mention that DIFICID should only be used for the treatment of CDAD, as it is not expected to be effective for other types of infections.
• Additionally, the labels warn about hypersensitivity reactions and the importance of only using DIFICID when a C. difficile infection is proven or strongly suspected. 2 2 2

From the Research

Risk Factors for Clostridioides difficile (C. diff) Infection

• The most important modifiable risk factor for C. difficile infection is antibiotic exposure, which is dose-related and higher with longer courses and combination therapy 3
• Other risk factors include older age, recent hospitalization, multiple comorbidities, use of gastric acid blockers, inflammatory bowel disease, and immunosuppression 3
• The incidence and severity of C. difficile infection have increased in recent years, and it has become more common in younger, healthier patients in community settings 3

Recurrence Rate of C. diff Infection

• The recurrence rate of C. difficile infection remains high, up to 20% 4
• Recurrences of the infection should be treated based on severity, with tapering and the pulsed-dose method of oral vancomycin therapy for second recurrences being effective 3

Management of Patients with C. diff Infection on Concomitant Antibiotic Treatment

• The management of patients with C. difficile infection prescribed concomitant non-C. diff antibiotics is problematic and influences C. diff outcome and recurrence risk 5
• Attempts to minimize the number and duration of antibiotics with a change to a low-risk class are recommended, and fidaxomicin might be preferable to vancomycin due to its less effect on the gut microbiome 5

Prevention of C. diff Infection

• Prevention includes responsible antibiotic prescribing and vigilant handwashing 3
• Probiotics prevent antibiotic-associated diarrhea, but are not recommended specifically for preventing C. difficile infection 3
• Investigational approaches to reduce the effect of concomitant antibiotics on the gut microbiome could further optimize C. diff treatment in the presence of concomitant antibiotic use in the future 5