IDSA/SHEA Strategies to Prevent Clostridioides difficile Infections in Acute-Care Hospitals Guideline Summary

Summary of Recommendations

Essential Practices

Encourage appropriate use of antimicrobials through implementation of an antimicrobial stewardship program

Ensure appropriate use of antimicrobials for CDI treatment.
Ensure appropriate use of non–CDI-treatment antimicrobials.

(Moderate)

3305355

Rationale and statements of concern

Epidemiology of Clostridioides difficile infection (CDI)

C. difficile is the most common pathogen causing HAIs in the United States (US).
In the US, C. difficile has been classified by the CDC as one of the most urgent antibiotic-resistant public health threats, one that requires “urgent and aggressive action." This classification is because of the profound morbidity, mortality, and excess healthcare expenditures associated with CDI.
Over the past 20 years, CDI increased among all age groups, including children, but it remains disproportionately higher in the older adult population. Women and individuals identifying as white race also experience higher frequency of CDI. The proportion of US hospital discharges in which a patient received the International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) discharge diagnosis code for CDI more than doubled between 2000 and 2009.
More recently, improvements in those previously described trends were observed. US CDI surveillance performed by the CDC Emerging Infections Program noted that since 2014, CDI incidence has leveled off and is perhaps beginning to decrease. However, this trend was marked by a decrease in healthcare-associated (HA) CDI concomitant with an increase in community-associated (CA) CDI. CDI with onset outside the hospital now accounts for >50% of US CDI cases. CDI present on admission to the hospital may increase the risk of CDI for other hospitalized patients.Notably, laboratory-identified healthcare-associated CDI decreased during the first year (ie, 2020) of the coronavirus disease 2019 (COVID-19) pandemic.
CDI incidence increased in the early 2000s concomitant with observations of increased CDI severity. Increases in incidence and severity of CDI were associated with the 027/BI/NAP1 strain of C. difficile. However, 027/BI/NAP1 cases has declined significantly in the US8, Canada, and Europe.In the US in 2017, the prevalence of the 027/BI/NAP1 strain was 15% of HA-CDI and 6% of CA-CDI cases. Currently, 027/BI/NAP1 is no longer the predominant US strain. Ribotypes 106, 002, and 014/020 have increased in prevalence over the last several years.

Overview

Title

Strategies to Prevent Clostridioides difficile Infections in Acute-Care Hospitals