New-borns require special diagnosis and treatment considerations for the infectious diarrhoea Clostridioides difficile (C. difficile) infection, according to a new evidence-based white paper. The publication is in conjunction with the release of a companion review by the Centres for Disease Control and Prevention's Healthcare Infection Control Practices Advisory Committee (HICPAC) and recommends against routine testing for C. difficile in neonatal patients and suggests evaluating first for more common causes of diarrhoea.
C. difficile infections are one of the most common healthcare-associated infections, but are rarely identified in patients less than a year old because of protective factors in the digestive systems of infants that resist the effects of its toxins. This means lab tests for C. difficile in infants are difficult to interpret since many infants may show evidence of the bacteria with no symptoms.
"Few data exist to guide front-line clinicians about prevention of C. difficile in this vulnerable population," said Dr Thomas Sandora, lead author of the white paper and a paediatric infectious diseases physician at Boston Children's Hospital. "This white paper is the first of a planned series of reports that will synthesise the latest and best research in infection prevention to ensure we are providing care based on the most current information and expert opinion."
The white paper also provides practical, expert opinion-based answers to frequently asked questions on C. difficile detection and prevention in the neonatal intensive care unit (NICU). The question-and-answer format addresses hand hygiene, contact precautions, as well as cleaning and disinfection in the NICU.
According to the authors, antibiotic stewardship – coordinated programs to improve appropriate use of these drugs – has shown a beneficial impact on adverse events seen in the NICU and should be continued even though there is no specific evidence on the impact of stewardship on C. difficile infections for neonatal patients.
Thomas J Sandora, Kristina K Bryant, Joseph B Cantey, Alexis M Elward, Deborah S Yokoe, Allison H Bartlet
[link url="https://www.sciencedaily.com/releases/2018/08/180830143042.htm"]Society for Healthcare Epidemiology of America material[/link]
[link url="https://www.cambridge.org/core/journals/infection-control-and-hospital-epidemiology/article/shea-neonatal-intensive-care-unit-nicu-white-paper-series-practical-approaches-to-clostridioides-difficile-prevention/58A118CA053D3275655703216DD64610"]Infection Control & Hospital Epidemiology abstract[/link]