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      Evolving insights into the epidemiology and control of Clostridium difficile in hospitals.

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          Abstract

          Typing studies suggest most cases of hospital-onset Clostridium difficile infection are unrelated to other cases of active disease in the hospital. New cases may instead be due to transmissions from asymptomatic carriers or progression of latent C.difficile present-on-admission to active infection. Direct exposure to antibiotics remains the primary risk factor for C.difficile infection but ward-level antibiotic use, antibiotic exposure of the prior room occupant, and C.difficile status of the prior room occupant increase risk for C.difficile acquisition while antibiotic exposure, gastric acid suppression, and immunosuppression increase risk for progression to infection. These insights suggest possible new approaches to prevent C.difficile infections, including screening to identify and isolate carriers, universal gloving, greater use of sporicidal cleaning methods, enhancing antibiotic and possibly proton pump inhibitor stewardship, and prescribing prophylactic vancomycin and/or probiotics to colonized patients to prevent progression from colonization to infection. We review current evidence and questions related to these interventions.

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          Author and article information

          Journal
          Clin. Infect. Dis.
          Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
          Oxford University Press (OUP)
          1537-6591
          1058-4838
          May 17 2017
          Affiliations
          [1 ] Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Healthcare Institute, Boston, MA.
          [2 ] Department of Medicine, Brigham and Women's Hospital, Boston, MA.
          Article
          3829913
          10.1093/cid/cix456
          28520953
          e2c46048-2a0d-42b7-a616-9001e631ed5a
          History

          Clostridium difficile,antibiotic stewardship,environmental cleaning,infection control,screening and isolation

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