Nearly 500,000 Americans Had C. Difficile Infections in a Single Year
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One would be hard pressed to find a U.S. health care worker who was unaware of the devastation that Clostridium difficile can cause in the hospital setting, but it is also causing considerable damage in the community, too, according to Michael Bell, MD, who spoke during a telebriefing sponsored by the Centers for Disease Control and Prevention (CDC).
In 2011, C. difficile caused approximately 453,000 infections; 29,000 of those patients died within 30 days of the initial diagnosis of C. difficile (N Engl J Med 2015;372:825-834). Approximately two-thirds of the C. difficile infections (CDIs) were found to be associated with an inpatient stay in a health care facility, but only 24% of the cases occurred while patients were hospitalized. Almost as many cases occurred in nursing homes as in hospitals, and the remainder of the health care–associated (HCA) cases occurred among patients who were recently discharged from a health care facility. More than 80% of the deaths associated with C. difficile occurred among Americans aged 65 years or older.
“Infections have become increasingly common over the last few decades and are seen in patients in health care facilities, as well as people in the communities,” Dr. Bell explained. “In the past, patients infected with C. difficile have had diarrhea that was often perceived as a nuisance but was not a major problem.
“Unfortunately, the type of C. diff circulating in the U.S. today produces a powerful toxin that can cause a truly deadline diarrhea,” said Dr. Bell, who is deputy director, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, CDC.
Previous studies have indicated that C. difficile has become the most common microbial cause of HCA infections in U.S. hospitals and costs up to $4.8 billion each year in excess health care costs for acute care facilities alone. The new study found that one of every five patients with an HCA CDI experienced a recurrence of the infection, and one of every nine patients aged 65 or older with an HCA CDI died within 30 days of diagnosis.
“C. difficile infections cause immense suffering and death for thousands of Americans each year,” said CDC Director Tom Frieden, MD, MPH. “These infections can be prevented by improving antibiotic prescribing and by improving infection control in the health care system. The CDC hopes to ramp up prevention of this deadly infection by supporting state antibiotic resistance prevention programs in all 50 states.”
Patients at Highest Risk
Patients who take antibiotics are most at risk for developing CDIs. More than half of all hospitalized patients will get an antibiotic at some point during their hospital stay, but studies have shown that 30% to 50% of antibiotics prescribed in hospitals are unnecessary or incorrect, the CDC said. When an individual takes broad-spectrum antibiotics, beneficial bacteria that are normally present in the gut and protect against infection can be suppressed for several weeks to months. During this time, patients can develop C. difficile picked up from contaminated surfaces or spread person to person. Unnecessary antibiotic use and poor infection control may increase the spread of C. difficile within a facility and from facility to facility when infected patients transfer, such as from a hospital to a nursing home.
Older Americans are especially vulnerable to this deadly diarrheal infection. The new CDC found that one of every three CDIs occurs in patients 65 years or older and two of every three HCA CDIs occur in patients 65 years or older. More than 100,000 CDIs develop among residents of U.S. nursing homes each year. Women and whites are at increased risk for CDI.
Although more than 150,000 of the 500,000 infections in the new study were community-associated and had no documented inpatient health care exposure, a separate recent CDC study found that 82% of patients with community-associated CDIs reported exposure to outpatient health care settings such as doctors’ or dentists’ offices in the 12 weeks before their diagnosis; this finding underscores the need for improved antibiotic use and infection control in these settings as well. It is estimated that more than 50% of antibiotics are prescribed unnecessarily in outpatient settings for upper respiratory infections like cough and cold illness, most of which are caused by viruses.
Another recent CDC study showed that a 30% decrease in the use of antibiotics linked to CDIs in hospitals could reduce the deadly infections by more than 25% in hospitalized and recently discharged patients. A new retrospective study from a Canadian hospital found that a 10% decrease in overall antibiotic use across different wards was associated with a 34% decrease in CDIs. A third CDC study among patients without a recent hospitalization or nursing home stay (i.e., community-associated cases) found that a 10% reduction in the use of all antibiotics in outpatient settings could reduce CDIs by 16%. In England in recent years, the number of CDIs has been reduced by more than 60%, largely due to improvements in antibiotic prescribing.
To help hospitals develop antibiotic stewardship programs, the CDC has developed several tools, including a list of core elements of hospital antibiotic stewardship programs . The CDC is also working with states to improve outpatient prescribing and to implement stewardship across the continuum of care and has provided a variety of resources through the Get Smart: Know When Antibiotics Work and Get Smart for Healthcare campaigns.
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I am one that had c-diff along with my loved elderly aunt. Both of us recently hospitalized where it was contacted. I have even heard of patients not even put in private rooms anymore which could stop the spread. Treatment should be improved along with the disinfectant of all places including chairs etc.