Clostridium difficile infection in patients with end stage renal disease. Is it preventable?

Abstract

Clostridium difficile infection (CDI) is a leading cause of a healthcare-associated diarrhea worldwide. Recently, an increased number of new cases and growing mortality due to CDI have been observed. Patients suffering from end-stage renal disease (ESRD) are highly exposed to CDI. It has been proven that CDI in patients receiving renal replacement therapy (RRT) significantly increases mortality, prolongs hospitalization and increases the cost of treatment. Important risk factors of CDI in ERSD patients include hospitalization or stay in an intensive care unit in the last 90 days, HIV infection, bacteraemia, prolonged antibiotic therapy and hypoalbuminemia. Cirrhosis, age over 65 years, hypoalbuminaemia, longer hospitalization time and use of antibiotics are significant risk factors of death in these patients. Effective methods of preventing CDI include hand hygiene, isolation of infected patients, the use of masks, gloves, disinfection of the environment and systematic education and control of medical personnel, as well as rational antibiotic policy. In addition, it is important to avoid antibiotics with a proven risk of CDI, cautious use of proton pump inhibitors (PPI) and H2 receptor antagonists. It is also important in the prevention of CDI, in people with ERSD, to apply fast diagnostics right from the onset of the first symptoms. Use of probiotics and bile acids in the primary prevention of CDI requires further research. It seems that knowledge of these factors and methods of prevention will significantly reduce morbidity and mortality caused by the CDI.