CDI prevention in the ICU

Dr Mark Loeb is a professor in the Department of Pathology and Molecular Medicine, division director for Infectious Diseases, and Michael G. DeGroote Chair in Infectious Diseases at McMaster University.

How can we prevent Clostridium difficile infection (CDI) in the intensive care unit (ICU)?

Mark Loeb, MD, MSc: I think the first principle is to optimize the use of antibiotics. Almost any antibiotic is a risk for CDI, so it is really important to firstly optimize the use of antibiotics. There is emerging evidence that probiotics might be helpful. There needs to be a little bit more evidence, but probiotics might be a future risk mitigation strategy.

As well, screening for C difficile colonization: There are emerging studies that you can detect colonization and try to do something about it. That might reduce the risk.

I think at this point, however, just optimizing and reducing antibiotic use combined with very good infection control practices are the best ways to reduce the risk of C difficile in the ICU.