In the war on health care-associated infections, the battle against Clostridioides difficile (C. difficile) infection (CDI) poses significant challenges. This is considered an urgent public health problem in the US, impacting an estimated 450,000 patients annually. Its repercussions range from morbidity and mortality among patients to the heavy financial toll on health care institutions.
C. difficile, being a gram-positive, anaerobic, spore-forming bacillus, can spread easily via the fecal to oral route due to poor sanitation and/or deficient contact precautions, leading to increased cases of pathogen transmission. Some common risk factors for CDI include age, antibiotic exposure, hospitalization, proton-pump inhibitor use, immunosuppression, and a history of CDI. As such, not only is the appropriate treatment for CDI imperative, but proactive prevention, which includes inhibiting initial and recurrent infections, is equally critical. This prevention strategy involves a diverse set of health care professionals, among which pharmacists play a vital role.
Pharmacists often take the lead in hospital Antimicrobial Stewardship (AMS) programs, which are integral to containing CDI. These healthcare professionals play a crucial role in optimizing antimicrobial use by publishing local treatment guidelines, implementing antimicrobial restriction criteria, conducting allergy assessments, and performing prospective audits along with feedback. By following these initiatives, pharmacists can mitigate CDI by optimizing conditions that limit antibiotic exposure, an essential and controllable risk factor. It’s clear to see the deep-seated connection between CDI and subpar antimicrobial therapy in recent studies, which have shown increased hospitalization length and CDI rates in patients initiated on antimicrobial treatment for asymptomatic bacteriuria (ASB) in emergency departments.
In recent times, pharmacists have further expanded their preventative strategies by advocating for fecal microbiota transplant (FMT) in appropriate situations. FMT is recommended particularly for patients with a second or subsequent CDI recurrence by the Infectious Diseases Society of America. This preventative strategy works by restoring the gastrointestinal microbiome through the transfer of stool from a healthy donor. In the past few years, access to FMT products has become more streamlined, increasing the need for pharmacists to have knowledge not only about these agents, but also about formulary additions, acquisitions, and patient counseling protocols.
In conclusion, it is clear that in addressing the public health threat that is CDI, a concerted effort from all healthcare providers is necessary. Among these, pharmacists play an instrumental role in disease control and prevention. Their involvement in AMS programs, antibiotic optimization, and FMT advocacy is fundamental in battling this ailment. The role of pharmacists is not solely confined within the walls of a hospital but extends to the wider public health sphere, including community outreach and health promotion.
Source: https://www.pharmacytimes.com/view/pharmacists-are-key-players-in-c-difficile-infection-prevention