Question

Look at where and how these Clostridioides difficile ( are problematic in the US and around the world. Please describe at least 3 different interventions that have been effective in someplace in the world. Back up one of your interventions with a scientific paper that includes data.

Answer 1

Clostridium difficile is the leading cause of health care-associated infections. Given the high incidence of C. difficile infection (CDI) and the lack of primary prevention through immunization, health care professionals should be aware of the most current guidance, as well as strengths and limitations of the evidence base underpinning this guidance.

Clostridium difficile infection is a major clinical challenge worldwide. At least three antimicrobial classes are deemed to be high-risk C difficile infection triggers, including most cephalosporins, to which C difficile is inherently resistant, and clindamycin, to which genotypes causing early outbreaks were resistant. Global dispersion of hypervirulent NAP1/PCR-ribotype-027 C difficile revealed an association between fluoroquinolone resistance and epidemic spread. Accordingly, clindamycin or fluoroquinolone use has been restricted and combined with other measures aiming to control localized C difficile infection outbreaks.

Most cases of C difficile infection are temporally associated with health care, reflecting a combination of health-care-associated acquisition, and health-care-related triggers including antibiotics. Three UK studies using highly discriminatory whole genome sequences, and a US study using alternative high-resolution typing, found as few as a third of C difficile infections involved recent acquisition from an active case, leaving the source for two-thirds of infections unexplained.

Clostridioides difficile (formerly Clostridium difficile) is an anaerobic, spore-forming, Gram-positive bacillus, which may be part of the normal intestinal microbiota in healthy babies [22,23,24,25]. The organism is spread via the oral-fecal route and in hospitalized patients may be acquired through the ingestion of spores from other patients, healthcare personnel’s hands, or from environmental surfaces [26, 27]. C. difficile is the main pathogen associated with nosocomial infections and is the most common cause of diarrhea in hospitalized patients [28]. CDI can present as a spectrum of symptoms ranging from an asymptomatic carriage to fulminant disease with toxic megacolon. The basis for this range of clinical manifestations is not fully understood but is likely related to host and pathogen interactions.

The rapid evolution of antibiotic resistance in C. difficile and the consequent effects on prevention and treatment of CDIs are a matter of concern for public health. Multi-drug resistant (MDR) C. difficile strains are increasing (about 60% of the epidemic strains circulating in hospital settings show resistance to three or more antibiotics)