Antibiotic Overuse Still Biggest C. Diff Gap: Kaye, MD, MPH

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Clostridioides difficile (C. diff) is a germ that causes diarrhea and inflammation of the colon and can be life-threatening, according to the CDC. It often occurs in patients who are currently taking or have recently finished taking antibiotics, and it is estimated to cause almost half a million infections in the United States each year. Patients are up to 10 times more likely to develop C. diff infection while taking an antibiotic and during the month after finishing one.¹

Yet on an institutional level, there are numerous gaps allowing C. diff to persist, including unnecessary antibiotic usage and inconsistent compliance with hospital sanitary protocols, Keith Kaye, MD, MPH, chief of the Division of Allergy, Immunology, and Infectious Diseases and professor of medicine in the Department of Medicine at Rutgers Robert Wood Johnson Medical School, said in an interview with The American Journal of Managed Care^® (AJMC^®).

"You get into things like asymptomatic bacteriuria or patients who have positive respiratory cultures but no other respiratory symptoms," he explained. "And I think avoiding antibiotics as much as possible when they're not indicated still, I think, is one of the biggest challenges."

Additionally, he noted a trend toward local and national hand hygiene efforts favoring soap and water over alcohol-based hand rubs, since alcohol is not sporicidal and less effective at preventing the spread of C. diff.

He attributed lapses in compliance to sink availability and contact precaution fatigue among health care professionals.

"They are just in and out of those rooms so frequently. I think it's tough for them to remember to be, or are time-limited, that remembering to be 100% compliant can be a challenge," Kaye explained.

Kaye also pointed to gaps in dedicated equipment, noting that shared items like stethoscopes can move between patient rooms, which carries its own sanitary risk if handlers aren't careful.

"A lot of times I end up using my own stethoscope and then using an alcohol cloth or a disinfectant cloth to wipe down my stethoscope," he said.

References

1. About C. diff. CDC. May 13, 2026. Accessed September 14, 2026.