From the Guidelines
Clostridioides difficile (C. diff) prophylaxis is not recommended for routine use, but rather for high-risk patients who require antibiotics and have specific risk factors, such as a history of recurrent C. diff infections, immunocompromised individuals, those receiving high-risk antibiotics, elderly patients, and those with prolonged hospitalizations. The preferred approach to prevent C. diff infection is to minimize the frequency and duration of high-risk antibiotic therapy and the number of antibiotic agents prescribed, as recommended by the Infectious Diseases Society of America (IDSA) and the Society for Healthcare Epidemiology of America (SHEA) 1.
Key Considerations
- High-risk antibiotics, such as fluoroquinolones, clindamycin, and cephalosporins, should be restricted or used judiciously to reduce the risk of C. diff infection 1.
- Antibiotic stewardship programs should be implemented to promote the appropriate use of antibiotics and reduce the risk of C. diff infection 1.
- Fecal microbiota transplantation (FMT) may be considered for patients with multiple recurrences of C. diff infection who have failed appropriate antibiotic treatments 1.
Patient Selection
- Patients who should receive prophylaxis include those with a history of recurrent C. diff infections, immunocompromised individuals, those receiving high-risk antibiotics, elderly patients (>65 years), and those with prolonged hospitalizations.
- The use of oral vancomycin or fidaxomicin as prophylaxis may be considered in these high-risk patients, but the evidence for this approach is limited and should be used judiciously to prevent antimicrobial resistance 1.
Treatment Options
- For patients with C. diff infection, treatment options include oral vancomycin, fidaxomicin, or metronidazole, depending on the severity of the infection and the patient's risk factors 1.
- FMT may be considered for patients with multiple recurrences of C. diff infection who have failed appropriate antibiotic treatments 1.
Prevention Measures
- Basic preventive measures, such as hand hygiene and antimicrobial stewardship, remain essential components of C. diff prevention 1.
- Healthcare providers should follow proper infection control procedures, including the use of personal protective equipment (PPE) and proper cleaning and disinfection of surfaces, to reduce the risk of C. diff transmission 1.
From the Research
Prophylaxis for Clostridioides difficile (C. diff)
There are several strategies for the prophylaxis of Clostridioides difficile (C. diff) infection, including:
- Fecal microbiota transplantation (FMT) for patients with multiple recurrences 2, 3, 4
- Bezlotoxumab for patients at high risk for recurrent C. diff infection (R-CDI) 2
- Microbiota-based interventions, such as ribaxamase and DAV-132, which bind and inactivate concomitantly administered antibiotics 2
- Development of a new effective non-toxin-based vaccine 2
Primary Prophylaxis
There are no proven effective, evidence-based prophylaxis options for primary C. diff infection 2
Secondary Prophylaxis
FMT is considered the option of choice in patients with multiple recurrences 2, 3, 4 Bezlotoxumab can be added to standard treatment for patients at high risk for R-CDI 2
Risk Factors
Independent risk factors for developing C. diff infection include:
- Severe comorbidities
- Receiving antibiotics within the previous 6 months
- Undergoing orthopedic surgery 5
- Not receiving the recommended prophylactic antibiotic regimen 5
Limitations of Current Therapies
Current antibiotic therapies for C. diff infection, mainly vancomycin and metronidazole, have limitations with respect to efficacy, recurrence rates, and adverse effects 6