Clostridioides difficile infections: Preventive strategies
Abstract
Clostridioides difficile infections primarily affect elderly, hospitalised patients treated with antibiotics and are among the most common healthcare-related infections. This thesis aimed to improve the understanding of the best prevention strategies for this disease, particularly in a Swedish setting. In Paper I, we evaluated the effects of an antibiotic stewardship programme. C. difficile infection incidence fell after a substantial reduction of cephalosporin use at the hospital. No significant change in incidence was seen at a comparable hospital where no stewardship programme was implemented. In Paper II, we evaluated two surveillance algorithms intended to detect outbreaks. None of these could accurately discriminate transmission events. We combined different typing methods with epidemiological links to determine the frequency of intrahospital disease transmission. Transmissions occurred infrequently in our setting. In Paper III, we constructed a mathematical, compartmental model of C. difficile transmission dynamics, where the environmental reservoir of C. difficile spores was modelled alongside patient compartments. Antibiotic stewardship had the largest potential for decreasing infections, while improved cleaning and disinfection practices could best decrease colonisations and environmental spores. Improved isolation had modest effects overall.
In conclusion, antibiotic stewardship, directed primarily at cephalosporins, is effective to reduce C. difficile infections in a real-life as well as a modelled Swedish setting. For optimal surveillance and outbreak detection, there is a need to further develop and validate methods. Improved general cleaning and disinfection in hospitals can potentially prevent colonisation and infections if a substantially increased rate of spore reduction is achieved. Such measures may be more important than isolation of infected patients.
Parts of work
I. Karp J*, Edman-Wallér J*, Toepfer M, Lundqvist A, Jacobsson G. Clostridioides difficile incidence related to in-hospital cephalosporin use: a tale of two highly comparable hospitals. Journal of Antimicrobial Chemotherapy 2019; 74(1):182-189. https://doi.org/10.1093/jac/dky408
*Shared first authorship. II. Edman-Wallér J, Toepfer M, Karp J, Rizzardi K, Jacobsson G, Werner M. Clostridioides difficile outbreak detection: evaluation by ribotyping and whole genome sequencing of a surveillance algorithm based on ward-specific cut-offs. Infection Control and Hospital Epidemiology 2023; Jun 23;1-5, online ahead of print. https://doi.org/10.1017/ice.2023.113 III. Edman-Wallér J, Rizzardi K, Jacobsson G, Gerlee P. Clostridioides difficile transmission: a compartmental model accounting for environmental spore persistence. Submitted manuscript.
Degree
Doctor of Philosophy (Medicine)
University
University of Gothenburg. Sahlgrenska Academy
Institution
Institute of Biomedicine. Department of Infectious Diseases
Disputation
Fredagen den 24 november 2023, kl. 13.00, Föreläsningssalen plan 3, Guldhedsgatan 10 A, Göteborg
Date of defence
2023-11-24
jon.edman@vgregion.se
Date
2023-11-02Author
Edman Wallér, Jon
Keywords
Clostridioides difficile
Transmission
Antibiotic stewardship
Outbreak surveillance
Mathematical modelling
Infection Prevention and Control
Publication type
Doctoral thesis
ISBN
978-91-8069-402-5 (PDF)
978-91-8069-401-8 (tryckt)
Language
eng