Primary Prevention of Clostridium difficile-Associated Diarrhea: Current Controversies and Future Tools

Abstract

Purpose of Review

Clostridium difficile infection (CDI) is a major cause of morbidity and mortality in hospitalized patients and rates in most places have not decreased significantly despite broad efforts by both hospitals and public health entities. This review aims to provide readers with a better understanding of the limitations of current prevention strategies. We also review potential future tools that may be available for the primary prevention of CDI in the next decade.

Recent Findings

Research over the last decade has expanded our appreciation of the role of asymptomatic shedding in the healthcare setting and in the community. This review demonstrates that poor quality data underlies even well-established guidance from national authorities on basic topics such as contact precautions, avoidance of alcohol-based hand hygiene products, CDI testing, supplemental cleaning modalities, and the use of bleach solutions. Additionally, we review research on novel preventative interventions such as identification of asymptomatic carriers, supplemental environmental cleaning technologies, vaccines, and the manipulation of the intestinal microbiome. While there is preliminary data that supports further research in all of these areas, the research is not yet robust enough on which to base local or national policy recommendations, though late-phase human clinical trials of CDI vaccine trials are ongoing.

Summary

Over the last decade, researchers have begun to reassess the traditional infection prevention model for CDI. Data suggesting a greater role for asymptomatic shedders has increased our understanding of current vertical prevention techniques and is forcing researchers to look more at new processes and technologies to decrease disease incidence.

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Correspondence to Zachary A. Rubin.

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Conflict of Interest

Zachary Rubin and Elise Martin are receiving research funding from Pfizer for an ongoing clinical trial on a CDI vaccine. Paul Allyn owns stock in Pfizer.

Human and Animal Rights and Informed Consent

This article cites one study with human subjects performed by Zachary Rubin, which previously was reviewed and approved by the local IRB. All other studies cited with human or animal subjects were not performed by any of the authors.

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This article is part of the Topical Collection on Healthcare Associated Infections

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Rubin, Z.A., Martin, E.M. & Allyn, P. Primary Prevention of Clostridium difficile-Associated Diarrhea: Current Controversies and Future Tools. Curr Infect Dis Rep 20, 32 (2018). https://doi.org/10.1007/s11908-018-0639-4

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Keywords

  • Clostridium difficile
  • Review
  • Prevention