Why is C. difficile such a concern?
Antibiotic Overuse and Resistance
Antibiotic overuse itself has been shown to be a risk factor for developing a C. difficile infection in all categories: severe, recurrent, and community-associated (30, 31). The fact that this is such a widespread risk factor means it is of concern for further and ongoing research.
Related to the overuse of antibiotics, antimicrobial resistance [when the bacteria can no longer be treated by a certain antibiotic] is becoming more widespread as community-associated infections continue to occur (32). The rate of resistance for C. difficile infections depends on the class of antibiotics, ranging from no resistance to 95% resistance (32). With this high level of resistance, researchers continue to be concerned about more strains of C. difficile developing that are more resistant to the current strains circulating right now (32). Resistant strains would render current antibiotic treatments useless, leaving us with no treatment options for patients with C. difficile infections.
Population Demographics
It is clear that C. difficile infection is a major concern for both patients and the healthcare system alike. As previously mentioned, advanced age (>65 years) is a factor that significantly increases risk for contracting a C. difficile infection (6, 16, 19). As populations who experienced a “baby boom” continue to age, the proportion of the population that is of advanced age will continue to increase (33, 34). This risk can be compounded with an increased risk of infection for seniors living in long term care homes and assisted living settings (31). Therefore, understanding how to best protect aging populations is of high importance, especially given the high mortality and morbidity risk in this population.
References
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30. Bernatz JT, Safdar N, Hetzel S, Anderson PA. Antibiotic Overuse is a Major Risk Factor for Clostridium difficile Infection in Surgical Patients. Infect Control Hosp Epidemiol. 2017;38(10):1254-7.
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32. Sholeh M, Krutova M, Forouzesh M, Mironov S, Sadeghifard N, Molaeipour L, et al. Antimicrobial resistance in Clostridioides (Clostridium) difficile derived from humans: a systematic review and meta-analysis. Antimicrobial Resistance & Infection Control. 2020;9(1):158.
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34. Chang AY, Skirbekk VF, Tyrovolas S, Kassebaum NJ, Dieleman JL. Measuring population ageing: an analysis of the Global Burden of Disease Study 2017. The Lancet Public Health. 2019;4(3):e159-e67.