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Unraveling the Complex Relationship Between Antimicrobials and Clostridioides Difficile Infections

Some of the most persistent and challenging issues surrounding healthcare infection prevention control today revolve around the bacterium known as Clostridioides difficile, or C diff. This microbe is particularly problematic for several reasons, not least the fact it’s resistant to many disinfection methods and requires meticulous hand hygiene, special isolation procedures, and specific treatment. Moreover, its effects on the patient, and by extension their families, can be severely distressing.

It is no surprise, therefore, that the Centers for Disease Control has classified C diff as a major public health risk. In 2017 alone, there were more than 223,900 cases among hospitalized patients, of which about 12,800 resulted in death. The majority of patients affected are over the age of 65, have a weakened immune system, are on antibiotics, or have a previous bout of C diff. They may also be patients who spend extended periods in hospitals or nursing homes.

As healthcare professionals work tirelessly to address this overarching public health menace, identifying the antibiotics that potentially augment the risks of C diff infection is pivotal. An investigation recently published in Cureus brings to light several such antibiotics. This research focuses on the strain of C diff – BI/NAP1/027 – known to cause the most severe disease. It should be noted that C diff is the primary cause of antibiotic-induced diarrhea, followed by pathogens like Staphylococcus aureus and Clostridium perfringens.

Antibiotics such as clindamycin, cephalosporins, penicillins, and fluoroquinolones have all been associated with C diff infection, and these relationships were further studied through an 8-year long, retrospective study at a single center. Here, apart from age, the researchers took into account factors like patient comorbidities, antibiotics administered, and prior stays in the hospital of over 3 days in the last three months. During this study, the authors made some revealing discoveries.

Of the 58 patients evaluated, the majority (79.3%) were male, 62% were adults, and the mean age was pegged at 30 years. Concurrently, 67.2% of the patients were found to have solid organ malignancy, while for 38%, severe C diff infection was reported. Likewise, 93% of the patients had undergone at least four days of antibiotic treatment in the three previous months.

The most often administered antibiotics included agents like piperacillin/tazobactam, meropenem, vancomycin, ciprofloxacin, ceftriaxone, and levofloxacin. Further, 98% of the patients were on standard doses of proton pump inhibitors and 93% had recent hospital stays that lasted longer than three days. Nearly a quarter of the patients exhibited neutropenia.

Final observations emphasized that previous hospitalization for over three days and specific antibiotics heightened the risk of a C diff infection.

Although this study was small and advocates for broader future research, it highlights critical considerations for antibiotics, proton pump inhibitors and certain chronic conditions. It is therefore imperative that healthcare professionals working in infection prevention are aware of these factors and integrate this knowledge into their daily work.

Source: https://www.contagionlive.com/view/c-diff-and-antibiotic-usage

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