Targeted Interventions Reduced CDI Rates in the ICU Setting

Under a low magnification of 4.8X, this photograph depicts three Clostridium difficile bacterial colonies, after undergoing a 48 hour incubation period, and cultivated on a blood agar plate. Courtesy of the CDC

October 14, 2025

Clostridium difficile infection (CDI) is a leading cause of hospital-acquired infections, particularly in high-risk environments like intensive care units (ICUs). Effective prevention requires comprehensive interventions, including antimicrobial stewardship, infection control measures, and healthcare worker training to mitigate infection rates, say Zhang, et al. (2025), who conducted a three-phase prospective intervention in two intensive care units of Xiangya Hospital over six months (January through June 2019, with every two months being a phase), involving 776 diarrhea patients and 72 cases of hospital-onset C. difficile infection (HO-CDI).

The primary outcome was the change in HO-CDI incidence, defined as the number of confirmed HO-CDI cases per 10,000 ICU days. Secondary outcomes included the proportion of patients with diarrhea who had HO-CDI, improvements in healthcare workers’ knowledge, attitudes, and practices (KAP) regarding CDI, as well as changes in antimicrobial use. The researchers  created a C. difficile infection prevention and control knowledge questionnaire and surveyed all healthcare workers before and after the training for the correctness of each question, and the pre- and post-intervention questionnaires assessed knowledge of CDI prevention. Antimicrobial usage was tracked across the three phases.

The proportion of patients with diarrhea who had HO-CDI in three phases (13.3%vs.8.79%vs.6.5%, P = 0.032) and the the incidence of HO-CDI per 10,000 ICU patient-days (117 vs. 99 vs. 72, P = 0.018) both showed a significant downward trend. After the training, the correctness of the healthcare workers’ questionnaire on knowledge, attitudes and practices (KAP) improved significantly (P = 0.002). Among all patients, there was a decline in the DDD (Define Daily Dosing) /1,000 patient-days of third-generation cephalosporin (212 vs. 185 vs. 172, P < 0.001).

The multi-faceted intervention effectively reduced Clostridium difficile infection (CDI) rates in the ICU setting. This highlights the importance of combining antimicrobial stewardship, healthcare worker training, and infection control measures.

Reference: Zhang S, et al. Impact of targeted interventions on healthcare-acquired infection prevention and control of Clostridium difficile infections. Antimicrobial Resistance & Infection Control. Vol. 14, article number 113 (2025)

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