What is the best strategy to prevent Clostridioides difficile (C. diff) infection?

From the Guidelines

The best strategy to prevent Clostridioides difficile (C. diff) infection is appropriate antibiotic stewardship, which means using antibiotics only when necessary and selecting the narrowest spectrum agent for the shortest effective duration. This approach is crucial in reducing the risk of C. diff infection, as it minimizes the disruption of normal gut flora, which can lead to the proliferation of C. diff bacteria 1.

Key Preventive Measures

• Hand hygiene with soap and water is essential, as alcohol-based sanitizers do not effectively kill C. diff spores 1.
• Healthcare facilities should implement contact precautions for infected patients, including dedicated equipment and proper environmental cleaning with sporicidal agents like bleach solutions (1:10 dilution) or other EPA-approved products 1.
• For high-risk patients receiving antibiotics (especially elderly, immunocompromised, or those with previous C. diff infections), probiotics containing Lactobacillus or Saccharomyces boulardii may be considered, though evidence is mixed 1.
• Avoiding unnecessary proton pump inhibitors is also important, as they increase the risk of C. diff infection by reducing gastric acid that normally helps kill ingested bacteria 1.

Environmental Cleaning and Disinfection

• Daily cleaning with a sporicidal agent should be considered in conjunction with other measures to prevent CDI during outbreaks or in hyperendemic settings, or if there is evidence of repeated cases of CDI in the same room 1.
• Patients should be encouraged to wash their hands and shower to reduce the burden of spores on the skin 1.

Importance of Antibiotic Stewardship

• Antibiotic stewardship programs have been shown to be effective in reducing the incidence of C. diff infection, with a significant protective role (overall RR = 0.48,95% CI 0.38–0.62) found in a systematic review and meta-analysis 1.
• Restricting the use of fluoroquinolones, clindamycin, and cephalosporins (except for surgical antibiotic prophylaxis) should be considered, as these antibiotics have been associated with an increased risk of C. diff infection 1.

From the Research

Strategies to Prevent C. diff Infection

The prevention of Clostridioides difficile (C. diff) infection can be approached through several strategies, including:

• The use of probiotics to restore the balance of the intestinal microbiota 2, 3, 4, 5, 6
• The application of fecal microbiota transplantation (FMT) to transfer beneficial microorganisms into the intestinal tract 2
• The development of microbiota-preserving antimicrobial agents to reduce the disturbance of the intestinal microbiota during treatment 2

Probiotics for C. diff Prevention

Probiotics have been studied extensively for their potential in preventing C. diff infection, with certain strains showing promise, including:

• Lactobacillus species, such as Lactobacillus rhamnosus GG 3, 4, 5, 6
• Saccharomyces boulardii 3, 4, 5, 6
• Clostridium butyricum 2

Limitations and Future Directions

While probiotics show potential in preventing C. diff infection, there are limitations to their use, including:

• The need for more well-defined clinical studies to support their efficacy and safety 4, 6
• The potential for probiotics to be ineffective in certain patient groups, such as premature infants and immunocompromised patients 6
• The need for further research on the mechanisms of action of probiotics against C. diff and their comprehensive safety assessments 6