Clostridioides difficile, commonly referred to as C. diff, is a high-priority pathogen causing severe diarrhoea, toxic megacolon, sepsis, and even death. It is registered to occur in approximately 58 per 100,000 hospital admissions, as well as 63 per 100,000 persons in the general community, as reported by the CDC, with hospitalization-associated mortality rates ranging between 6% and 11%.
Recent progress in curtailing the prevalence of C. diff in hospitals, regrettably, coincides with an increase in community-associated cases and recurrence rates. Recurrent infections are particularly distressing, inflicting severe personal, familial, and societal consequences. Consequently, strategies that encompass rigorous prevention, efficacious treatment towards mitigating recurrence, and community-level intervention are urgently needed.
A potential pathway forward is as follows. First, granting broader access to more effectual treatment that curbs recurrence is essential. This involves enhancing insurance coverage, and reinforcing patient and physician education. Second, for some patients, opening access for the use of a live biotherapeutic or fecal microbial transplant, especially after a first recurrence, could be beneficial. Lastly, the implementation of antibiotic stewardship and infection prevention protocols are required in long-term care facilities.
The latest C. diff treatment guidelines emphasize that primary treatment with fidoxamicin can avert recurrence compared to less expensive therapies such as oral vancomycin. However, not all patients have the ability to access this recommended therapy, with it not being included in some healthcare settings’ formulary due to its elevated cost, and certain insurance providers not covering fidaxomicin. This predicament calls for immediate change.
Additionally, there are areas where physicians, in particular those in primary care, may lack updated training and education. Recurrence of diseases presents a critical situation where different guidelines suggest a variation in approaches to treatment. Proactive measures such as treatment with a live biotherapeutic or fecal microbial transplant at the first recurrence are encouraged for patients at high risk of serious disease. These therapies are noticeably efficient but costlier. Upon the second recurrence, the consensus across most guidelines is to incorporate these therapies within the treatment regimen.
Hospitals have successfully reduced C. diff infection rates by incorporating antimicrobial stewardship protocols, isolating infected patients, and conducting rigorous environmental cleaning. Translating the same approach for the long-term care setting is equally crucial, particularly since a large number of cases are now appearing outside hospital premises. The need to rethink the prevention and treatment model for C. diff is vital in mitigating the burden of this disease in our communities, and ultimately, salvaging lives.
Source: https://www.acsh.org/news/2024/06/26/we-can-do-better-tackling-c-diff-48837