Statement of Need

Increases in the incidence and severity of Clostridium difficile-associated disease (CDAD) have been identified in Canada, Europe and 27 states in the United States over the past few years.^1-3 This changing epidemiology may be the result of the emergence of a new, more virulent epidemic strain of C. difficile or changes in antimicrobial prescribing or infection control practices.⁴ Infection caused by this epidemic strain has been associated with more severe disease, disease that is more refractory to therapy, increased length of hospitalization and increased healthcare costs.⁵

Guidelines for the management of CDAD highlight the importance of the judicious use of antimicrobials, adherence to contact precautions and use of appropriate infection control practices. Antimicrobial restriction of targeted agents has been associated with decreased rates of CDAD.⁶ Infection control measures that encompass proper isolation and contact precautions, meticulous hand hygiene and environmental cleaning represent the other major component of prevention. Effective management of outbreaks requires a multidisciplinary approach with a focus on the changing epidemiology of C. difficile infection, antimicrobial stewardship and prevention and control strategies.

¹ Warny M, et al. Lancet. 2005;366:1079-1084.
² Kuijper EJ, et al. Clin Microbiol Infect. 2006;12(Suppl 6):2-18.
³ Centers for Disease Control and Prevention. Data and statistics about Clostridium difficile infections.
  http://www.cdc.gov/ncidod/dhqp/id_Cdiff_data.html. Accessed May 22, 2007.
⁴ Centers for Disease Control and Prevention. Fact Sheet. July 2005.
⁵ Kyne L, et al. Clin Infect Dis. 2002;34:346-353.
⁶ Climo MW, et al. Ann Intern Med. 1998;128:989-995.