Five Things Pharmacists Should Know About C. difficile Infection

In keeping with the CDC, C. difficile an infection (CDI) is a significant and pressing risk that continues to be some of the widespread well being care-associated infections in US hospitals, affecting roughly half 1,000,000 individuals yearly.^1,2 Attributable to a contagious bacterium of the identical title, CDI can develop into a critical well being risk to not solely sufferers with CDI, but additionally others within the dwelling and the neighborhood.^2,3,4

Throughout the COVID-19 pandemic, there was a name for renewed consideration on CDI, notably occurrences of CDI with recurrent an infection. This enhance in consideration could also be a results of the rise in antibiotics being prescribed to sufferers with COVID-19 to deal with or stop bacterial infections akin to pneumonia—antibiotic use could be a danger issue for CDI.⁵

Because the pandemic started, an estimated 72% of sufferers with COVID-19 have been handled with broad-spectrum antibiotics.⁶ With this enhance antibiotic remedy, pharmacists can play an essential position in educating sufferers and different well being care practitioners on the indicators and signs of CDI, in addition to the chance components related to antibiotic use.

1. Though CDI can have an effect on anybody, the chance is greater for sure populations.

These at greater danger are people who find themselves taking, or have not too long ago taken, antibiotics, who’ve spent a while in a hospital or in a long-term care facility, who’ve a weakened immune system, or who’re aged 65 years or older.⁷

The commonest signs for CDI embody diarrhea, nausea, abdomen ache or cramps.³ If a affected person complains about these signs over a protracted time period, particularly after antibiotic use, a pharmacist ought to encourage the affected person to alert their doctor as quickly as attainable.

If not handled immediately, CDI can result in a really critical acute medical situation and will even be deadly, particularly in extremely weak affected person populations (ie, sufferers ≥ 65 years of age, sufferers who reside in long-term care amenities, sufferers with weakened immune programs, sufferers with a number of comorbidities, and so on).^3,8

2. CDIis contagious and will be unfold to others who could develop a critical an infection.⁹

CDI will be unfold by direct contact, oblique contact, or by contact with contaminated surfaces.⁹ Nonetheless, CDI is usually transmitted from individual to individual by the fecal-oral route.

Pharmacists can educate sufferers who’ve been recognized with CDI and people experiencing signs on the significance of fine hygiene. Common handwashing with cleaning soap and making certain surfaces are washed down with a robust cleaner are keys to the prevention and unfold of C. difficile.^10,11

3. Antibiotics are a predominant danger issue for CDI and its recurrence.^16,17,18

Pharmacists may also help educate different well being care practitioners that use of antibiotics for prolonged durations of time, or the usage of greater than 1 antibiotic for treating an sickness, can elevate the chance of CDI. The disruption of the intestinal microbiota by antibiotics is long-lasting, and danger of CDI will increase each throughout remedy and within the 3-month interval following cessation of remedy.²⁰

Whereas the chance of CDI will increase as a operate of antibiotic period and variety of antibiotics obtained, even 1 to 2 days of antibiotics can enhance a affected person’s danger of C. difficile colonization and symptomatic illness.^10,11,12,21 Therapy of CDI is extraordinarily difficult and sufferers with CDI usually require a number of CDI remedy programs as recurrences happen in as much as 35% of people that get CDI after the preliminary analysis.¹⁴ After the primary recurrence, it has been estimated that as much as 60% of sufferers are more likely to get a subsequent recurrence.^15,16,17

4. Within the case of recurrent CDI, restoring a wholesome intestine microbiome is more and more accepted as a promising remedy choice.¹⁸

Lately, scientists have realized a fantastic deal concerning the position of the intestine microbiome, which is the microbial neighborhood within the intestinal tract which influences metabolism and immunity and acts as a mediator of resistance to some pathogenic infections. Composed of greater than 100 trillion micro organism, the intestine microbiome has the capability to advertise total well being.

Disruption of the intestine microbiome (often known as dysbiosis) results in an intestinal microenvironment vulnerable to pathogenic insult from opportunistic micro organism akin to C. difficile. Whereas antibiotics are the usual of look after CDI, they don’t tackle the underlying dysbiosis and play a big position within the vicious cycle of recurrence.¹³ The goal of microbiome restoration is to repopulate the various intestine microbiota to deal with the illness.¹⁸

5. Therapeutic choices for intestine microbiome restoration are restricted and in want of an replace.

For recurrent CDI, one historic strategy to microbiome restoration has been fecal microbiota transplant (FMT). Information recommend FMT is efficacious for the remedy of recurrent CDIand reestablishes biodiversity within the intestine. Nonetheless, variability exists throughout scientific research—treatment charges have been decrease in randomized managed trials than in open-label research (67.7% vs 82.7%, respectively; P<.001).

Likewise, the dearth of product standardization and administration strategies has created a state of affairs the place a regulated, protected, and efficient product is critically wanted.¹⁹ Researchers are exploring promising microbiome-based therapeutics that work to revive a wholesome, numerous mixture of intestine micro organism to evolve requirements of look after recurrent CDI.^20,21

Concerning the Writer

Thomas Lodise, PharmD, PhD, is a professor at Albany School of Pharmacy and Well being Sciences.

REFERENCES

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