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C. difficile Prevention — SCE Infectious Diseases MCQ

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EasyHealthcare-Associated InfectionsC. difficile PreventionSCE Infectious Diseases

A hospital infection prevention team performs a root cause analysis after three patients on a surgical ward develop Clostridioides difficile infection within one week. All were on different antibiotics. What is the single most modifiable risk factor for hospital-acquired CDI?

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Correct answer: D — Antibiotic prescribing practices (particularly fluoroquinolone and cephalosporin use)

While multiple factors contribute to CDI risk (age, PPI use, hospital stay duration), antibiotic prescribing is the most modifiable and impactful risk factor. Fluoroquinolones (particularly associated with the hypervirulent ribotype 027) and broad-spectrum cephalosporins are the highest-risk antibiotic classes for CDI. Restricting these antibiotic classes through stewardship interventions has been shown to significantly reduce CDI rates. This is the cornerstone of CDI prevention alongside environmental cleaning and hand hygiene.

Reference: NICE NG199 2021 – C. difficile; UKHSA 2024 – C. difficile prevention; NICE NG15 – Antimicrobial stewardship