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Assessing control bundles for Clostridium difficile: A review and mathematical model

Yakob, Laith; Riley, Thomas; Paterson, David; Marquess, J; Clements, Archie

Description

Clostridium difficile is the leading cause of infectious diarrhea in hospitalized patients. Integrating several infection control and prevention methods is a burgeoning strategy for reducing disease incidence in healthcare settings. We present an up-to-date review of the literature on 'control bundles' used to mitigate the transmission of this pathogen. All clinical studies of control bundles reported substantial reductions in disease rates, in the order of 33%-61%. Using a biologically...[Show more]

dc.contributor.authorYakob, Laith
dc.contributor.authorRiley, Thomas
dc.contributor.authorPaterson, David
dc.contributor.authorMarquess, J
dc.contributor.authorClements, Archie
dc.date.accessioned2015-12-13T22:16:40Z
dc.identifier.issn2222-1751
dc.identifier.urihttp://hdl.handle.net/1885/70965
dc.description.abstractClostridium difficile is the leading cause of infectious diarrhea in hospitalized patients. Integrating several infection control and prevention methods is a burgeoning strategy for reducing disease incidence in healthcare settings. We present an up-to-date review of the literature on 'control bundles' used to mitigate the transmission of this pathogen. All clinical studies of control bundles reported substantial reductions in disease rates, in the order of 33%-61%. Using a biologically realistic mathematical model we then simulated the efficacy of different combinations of the most prominent control methods: stricter antimicrobial stewardship; the administering of probiotics/intestinal microbiota transplantation; and improved hygiene and sanitation. We also assessed the health gains that can be expected from reducing the average length of stay of inpatients. In terms of reducing the rates of colonization, all combinations had the potential to give rise to marked improvements. For example, halving the number of inpatients on broad-spectrum antimicrobials combined with prescribing probiotics or intestinal microbiota transplantation could cut pathogen carriage by two-thirds. However, in terms of symptomatic disease incidence reduction, antimicrobials, probiotics and intestinal microbiota transplantation proved substantially less effective. Eliminating within-ward transmission by improving sanitation and reducing average length of stay (from six to three days) yielded the most potent symptomatic infection control combination, cutting rates down from three to less than one per 1000 hospital bed days. Both the empirical and theoretical exploration of C. difficile control combinations presented in the current study highlights the potential gains that can be achieved through strategically integrated infection control.
dc.publisherNature Publishing Group
dc.rightsAuthor/s retain copyright
dc.sourceEmerging Microbes and Infections
dc.titleAssessing control bundles for Clostridium difficile: A review and mathematical model
dc.typeJournal article
local.description.notesImported from ARIES
local.identifier.citationvolume3
dc.date.issued2014
local.identifier.absfor111706 - Epidemiology
local.identifier.ariespublicationU3488905xPUB2490
local.type.statusPublished Version
local.contributor.affiliationYakob, Laith, The University of Queensland
local.contributor.affiliationRiley, Thomas, University of Western Australia
local.contributor.affiliationPaterson, David, University of Queensland
local.contributor.affiliationMarquess, J, University of Queensland
local.contributor.affiliationClements, Archie, College of Medicine, Biology and Environment, ANU
local.bibliographicCitation.issue6
local.identifier.doi10.1038/emi.2014.43
dc.date.updated2015-12-11T07:28:07Z
local.identifier.scopusID2-s2.0-84901976695
local.identifier.thomsonID000339238500001
dcterms.accessRightsOpen Access
CollectionsANU Research Publications

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