antibiotic stewardship superbug

Clostridium difficile (klos-TRID-e-um dif-uh-SEEL), often called C. difficile or C. diff, is a bacterium that can cause symptoms ranging from diarrhea to life-threatening inflammation of the colon.

On November 25, NPR reported that C. diff, first seen as a problem mainly in hospitals and nursing homes, is emerging more in communities, according to research. Traditional risk factors may no longer tell the whole story.

In 1974, scientists in Cincinnati discovered a toxin in affected patients’ stool, and traced it to C. diff. A surge of interest in C. diff followed and investigators quickly determined risk factors for the disease. Antibiotic use was already known, but hospitalization emerged as another dominant factor — so much so that C. diff became known almost exclusively as a hospital-acquired infection.

The Centers for Disease Control and Prevention (CDC) estimated that nearly 350,000 C. diff infections occurred outside of hospitals in 2011 and found that 46 percent were fully community-acquired and 36 percent were not from antibiotic exposure. Researchers are saying that traditional risk factors, such as antibiotics and hospitalization can no longer explain many of these infections. “There’s definitely something going on, but we don’t fully understand what,” said Dr. Alice Guh, a researcher with the CDC. Diet is a strong influence on the intestinal microbiome and a common food additive, trehalose, markedly enhances the virulence of C. diff. 

Popular drugs for heartburn that suppress acid in the stomach are also associated with C. diff infections. A study published earlier this year in Nature that evaluated the effects of a thousand non-antibiotic medications on friendly bacteria in the human colon found that 25 percent had antimicrobial activity.

Read more 

Great Plains QIN is partnering with nursing homes across the region to prepare them for future quality reporting requirements, improve infection control practices, and improve resident outcomes. Participating nursing homes are using NHSN (National Healthcare Safety Network) to track  Clostridium difficile rates as well as receiving tools, resources, and education for infection prevention, control and communication.


In August 2018, the Great Plains Quality Innovation Network hosted a WebEx, Top 10 Countdown for Improving Your Long-Term Care Infection Prevention Program. Expert Peg Gilbert, RN, MS, CIC, FAPIC reviewed the list of top ten common areas for infection prevention improvement and the evidence-based best practices for addressing them. Participants were also introduced to resources, tools and best practices for successfully implementing quality improvement tactics to impact infection control. Access the presentation and recording on our Web site.