Optimising Antimicrobial Stewardship to Tackle Clostridioides difficile Infection and Improve Patient Outcomes

Clostridioides difficile, formerly known as Clostridium difficile, is a Gram-positive spore-forming and toxin-producing bacterium that causes diarrhoea in vulnerable patient groups. It is a common hospital-acquired infection but also occurs in the community. Typically, C. difficile colonises the gut in patients experiencing gut dysbiosis, for example, following antimicrobial treatment or chemotherapy. Cases of C. difficile are increasing worldwide, both in healthcare settings and in the community, and are an indicator of widespread antibiotic use. Antimicrobial stewardship (AMS) combines local, national, and international guidelines for good antimicrobial practice, effective monitoring of antimicrobial resistance, and control of antibiotic use. Such strategies are vital in the international drive to stem the rise in antimicrobial resistance and control hospital-acquired infections such as C. difficile. However, implementation of such strategies is often lacking. Resourcing issues and a lack of awareness of current best practices among physicians, prescribers, and the general public are significant barriers to implementation. EMJ spoke with two infectious disease experts: Benoît Guery, University Hospital of Lausanne, Switzerland, and Javier Cobo Reinoso, Hospital Universitario Ramón y Cajal, Madrid, Spain. They highlighted the challenges that face medical practitioners, infectious disease experts, hospital managers, and healthcare providers in developing and implementing effective antimicrobial strategies that support better patient outcomes. The two experts also discussed the changes required to ensure that good AMS can be implemented at local, national, and international levels.