Healthcare-facility associated Clostridioides difficile infection - antibiotic treatment as a risk factor at the individual and group levels

Abstract

Clostridioides difficile infection (CDI) is a gastrointestinal infection that primarily affects older, vulnerable individuals. It is most commonly contracted in healthcare facilities (HCF-CDI), where the main risk factor is antibiotic treatment. Paper I shows that HCF-CDI incidence was considerably reduced through antibiotic stewardship aimed at regulating cephalosporin use. Incidence at the hospital where the intervention was carried out was compared with a similar institution with no intervention, and the changes were attributed to differences in cephalosporin use. Paper II recounts an examination of risk factors for recurrent HCF-CDI in the Swedish setting with high CDI incidence but prudent antibiotic use. The risk factors identified after multiple regression analysis were renal failure and treatment of CDI with metronidazole. Moreover, there was a dose–response relationship between the duration of cephalosporin treatment and the risk of recurrent HCF-CDI. Paper III reports that cephalosporin treatment was associated with two to three times faster onset of HCF CDI than exposure with other high-risk antibiotics, with onset frequently occurring during ongoing treatment. Finally, Paper IV describes inadequate information delivery in the context of Sweden, leading to unproductive preventive behaviours among patients suffering from recurrent CDI. The connection between antibiotic treatment and CDI is well known, but more structured and personalised information provision and a recognition of antibiotics as both an asset and a risk factor for CDI are needed to foster effective prevention. In conclusion, antibiotic stewardship targeting the regulation of cephalosporin use is an efficient measure for minimising the incidence of HCF-CDI, delaying the onset of infections and even reducing recurrence. This is an opportunity to prevent suffering among patients and save money and resources for healthcare systems. Structured information provision routines should also be implemented, preferably within the framework of person-centred care, to cultivate healthy preventive behaviours and a sound perspective on antibiotics among patients most severely affected by recurrent CDI.