Hsu et al from the University of Wisconsin reviewed the evidence on the prevention of the endemic healthcare-associated Clostridium difficle infection.
Clostridium difficile is the most common infectious cause of healthcare-associated diarrhea. Because of the increasing incidence and severity of endemic C. difficile infection (CDI), interventions to prevent healthcare-associated CDI are essential.
They found that few randomized controlled trials exist in the area of CDI prevention. The interventions with the greatest evidence for the prevention of CDI include antimicrobial stewardship, glove use, and disposable thermometers. Environmental decontamination also may decrease CDI rates, although the level of evidence is not as strong as for the other proven interventions. Treatment of asymptomatic carriage of C. difficile is not recommended. There is insufficient evidence to make a recommendation for or against the use of probiotics. In cases of known or suspected CDI, hand hygiene with soap and water is preferred over use of waterless alcohol hand rub. Many nonrandomized trials included in our analysis used multiple interventions concurrently, making the independent role of each preventive strategy difficult to determine.
Of interest is the more recent appreciation that proton pump inhibitor (PPI) use is associated with a higher risk for CDI. This finding does make sense as PPI therapy profoundly lowers stomach acid and this acid is the first line of defense against infection that may exist in the stomach contents. The PPI drugs that we thought were perfectly safe, clearly have some risks associated with them and like antibiotics should not be used so liberally. Of course, an appropriate treatment plan for GERD should be outlined by your doctor. The latest consensus says that we should be using the lowest effective dose for controlling reflux symptoms when using PPI therapy. This can be tailored with your gastroenterologist, and is usually based on one symptoms. It's important to keep in mind that at all patients present with the same symptoms when it comes to reflux. In fact, some patients with more severe forms of reflect, such as Barrett's esophagus, do not have many symptoms at all.
