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The Key to Preventing C. difficile? Reducing Antibiotics—Part 3

NOV 24, 2017 | KRISTI ROSA
Known to cause around 250,000 infections per year, and a staggering 14,000 deaths, it is not surprising that Clostridium difficile (C. diff) has been given a threat level of urgent by the Centers for Disease Control and Prevention. Preventing transmission of this life-threatening infection continues to be a difficult challenge faced by health care workers everywhere.

There are many risk factors for C. diff infection (CDI), which include underlying conditions/comorbidities, individuals with disease states such as cardiopulmonary disease and diabetes, and, arguably most importantly, antibiotic exposure.

In an exclusive interview with Contagion ®, Maureen Spencer, RN, BSN, MEd, CiC, FAPIC, director of clinical implementation at Accelerate Diagnostics, discussed the importance of infection prevention, the role that reducing antibiotics plays in preventing CDIs, and how any successful prevention effort requires teamwork.

Contagion®: As an infection preventionist (IP), can you explain the importance of prevention, especially when it comes to a healthcare-associated infection like C. diff?

Spencer: A lot of our job should be prevention, but we still end up handling infection control efforts. They changed our title years ago from infection control practitioners to infection preventionists, and yet, when you hear most of the things being spoken about at conferences like this, we’re talking about the control of the environment, of people using precautions, and of treating patients’ infections.

The prevention aspect is to stop the inappropriate use of antibiotics. If we didn’t use so many antibiotics, we wouldn’t have conditions like this developing. That’s the prevention piece of it—the antimicrobial stewardship program (ASP), and having infection preventionists actively involved in taking on antimicrobial resistance and assisting the ASP program members with reducing the number and length of treatments, or days of therapy with the antibiotics. That is what causes these multidrug-resistant organisms (MDROs) and C. diff.

Contagion: What’s a major way to prevent CDIs?

Spencer: Decreasing the use of antibiotics. Many laboratories are using older, traditional methods of doing cultures, and it can take anywhere from 2 to 3 days to get not only the culture itself speciated out and colonies picked off, but to put it into some identification (ID) system—whether it be PCR or some other kind of rapid technology. Then they go on to do sensitivities that can take anywhere from 2 to 4 to 5 days, depending on the specimen. In the interim, patients are on antibiotics waiting for the results. I feel that it’s the number one problem we have in hospitals—delayed lab results.

For example, you’ve got somebody in septic shock in the intensive care unit (ICU). We are wiping out all the good flora in their mouth, their colon, and their skin being on antifungal, anti-Gram-positive, anti-Gram-negative, and even sometimes double therapy, while physicians are covering their tails. The physician doesn’t know what [infection the patient] has, and so they want to give them everything. We call that empiric therapy. After physicians get the lab results, they can de-escalate the patient and then get to more targeted therapy. For instance, rather than use imipenem, which is more expensive, the physician can maybe switch to gentamicin based on a sensitivity result and have the patient on something that’s safer and less expensive.

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