Objectives To reduce infections with Clostridioides difficile (CDI) in geriatric patients by interventions easily implementable in standard clinical care. Methods Prevalence and incidence of CDI between January 2015 and February 2020 were analysed (n = 25,311 patients). Pre-intervention status was assessed from April 2016 to March 2017 (n = 4,922). Between May 2017 and August 2019, a monocentric interventional crossover study (n = 4,655) was conducted including standard care and three interventions: (A) sporicidal cleaning of hospital wards, (B) probiotics and (C) improvement in personal hygiene for CDI patients. This was followed by a multicentric comparison of the interventional bundle (A + B + C) between September 2019 and February 2020 (n = 2,593) with the pre-intervention phase. In 98 CDI cases and matched controls individual risk factors for the development of CDI were compared. Results Time series analyses of CDI cases revealed a reduction in the prevalence of CDI in all three participating centres prior to the multicentric intervention phase. In the monocentric phase, no effect of individual interventions on CDI prevalence was identified. However, an aggregated analysis of CDI cases comparing the pre-intervention and the multicentric phase revealed a significant reduction in CDI prevalence. Risk factors for the development of CDI included use of antibiotics, anticoagulants, previous stay in long-term care facilities, prior hospital admissions, cardiac and renal failure, malnutrition and anaemia. Conclusions The observed reduction in CDI may be attributed to heightened awareness of the study objectives and specific staff training. Individual interventions did not appear to reduce CDI prevalence. A further randomised trial would be necessary to confirm whether the bundle of interventions is truly effective.

中文翻译：

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通过多种质量改进策略减少住院老年人的艰难梭菌感染

目的 通过在标准临床护理中易于实施的干预措施，减少老年患者的艰难梭菌 (CDI) 感染。方法 分析 2015 年 1 月至 2020 年 2 月期间 CDI 的患病率和发病率（n = 25,311 名患者）。在 2016 年 4 月至 2017 年 3 月期间评估了干预前状态（n = 4,922）。在 2017 年 5 月至 2019 年 8 月期间，进行了一项单中心介入交叉研究 (n = 4,655)，包括标准护理和三项干预措施：(A) 医院病房的杀孢子清洁，(B) 益生菌和 (C) 改善 CDI 患者的个人卫生. 随后，对 2019 年 9 月至 2020 年 2 月（n = 2,593）之间的介入包（A + B + C）与干预前阶段进行了多中心比较。在 98 例 CDI 病例和匹配对照中，比较了 CDI 发展的个体风险因素。结果 CDI 病例的时间序列分析显示，在多中心干预阶段之前，所有三个参与中心的 CDI 患病率均有所降低。在单中心阶段，未发现个体干预对 CDI 患病率的影响。然而，比较干预前和多中心阶段的 CDI 病例汇总分析显示 CDI 患病率显着降低。发生 CDI 的危险因素包括抗生素、抗凝剂的使用、以前在长期护理机构中的停留、以前住院、心脏和肾功能衰竭、营养不良和贫血。结论 观察到的 CDI 降低可能归因于对研究目标和特定员工培训的认识提高。个体干预似乎并未降低 CDI 患病率。需要进一步的随机试验来确认这一系列干预措施是否真正有效。