IMPACT–CDAD from Every Angle
An Acute Crisis•A Complete 180•The Right Angle•The 360˚ ApproachA Complete 180
An important aspect in the management of CDAD is recognizing patient risk factors for disease that allows an accurate and timely diagnosis. The leading risk factors for CDAD include prior antimicrobial use, exposure to a hospital or long-term care facility, prolonged hospitalization, and older age. CDAD should be suspected in all at-risk patients who develop diarrhea and should be differentiated from non-CDAD cases, such as patients who experience antibiotic-associated diarrhea. However, current diagnosis can be time-consuming or may rely on assays with poor sensitivity and specificity, such as those that detect C. difficile toxins in stool samples. An uncertain diagnosis of CDAD can contribute to the unnecessary use of antibiotics when the symptoms of diarrhea may be caused by a non-infectious nature. Newer assays, such as real-time PCR, may allow for a more accurate and rapid diagnosis of CDAD.
Despite the rapid increase in CDAD prevalence, clinicians now have the opportunity to learn from their experience and the experience of healthcare professionals at other institutions to prevent or minimize any potential outbreaks by modifying and adapting infection control strategies. More stringent infection control policies have been shown to be an important preventative measure. Strategies frequently employed include barrier precautions (such as gloves, hand hygiene, and patient isolation) and environmental cleaning (such as regular disinfection of rooms, single-use rectal thermometers, and endoscope disinfection). Surveillance will also be important to detect when a hypervirulent strain is present so that the necessary precautions can be initiated. Management guidelines from the Infectious Diseases Society of America (IDSA) have not been updated since 1995, although a new version is currently being developed and scheduled for release in 2008.