Half a million C. diff infections and 15,000 deaths in 1 year

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A new study led and funded by the Centers for Disease Control and Prevention finds that in 2011, Clostridium difficile was responsible for almost half a million infections and more than 15,000 deaths in the US.

Clostridium difficile
Around 453,000 individuals were infected with C. diff in 2011, and around 15,000 deaths were directly attributable to the infection.
Image credit: CDC

The Centers for Disease Control and Prevention (CDC) say the findings, which are published in The New England Journal of Medicine, emphasize how improvements in antibiotic use and infection control in health care settings are critical for tackling C. diff infection.

C. diff is a bacterium that causes colitis – inflammation of the colon. Infection can occur through touching surfaces or items that are contaminated with feces, in which C. diff is shed.

Symptoms of C. diff infection include fever, nausea, diarrhea, loss of appetite and abdominal pain.

People who are taking antibiotics for other illnesses are most prone to C. diff infection. Antibiotics can destroy some of the friendly bacteria in the gut, meaning it may be less protected against C. diff.

According to the CDC, more than half of patients who stay in hospital are treated with antibiotics, which is why health care settings have been identified as the primary source of transmission.

What is more, past research has shown around 30-50% of antibiotics prescribed in hospitals are not needed or incorrect, meaning many patients are being unnecessarily put at risk of C. diff infection and are putting others at risk by carrying the infection to other settings, such as nursing homes.

The aim of this latest study was to assess the burden of C. diff across the US.

Lead author Dr. Fernanda C. Lessa, a medical epidemiologist at the CDC, and his team set out to identify cases of C. diff infection over 10 geographic areas in the US in 2011.

Based on their findings, the team estimates that in 2011, around 453,000 people were infected with C. diff, and around 29,300 deaths occurred within 30 days of diagnosis. Of these deaths, around 15,000 were estimated to be directly attributable to C. diff.

The study found that individuals aged 65 and older are particularly vulnerable to C. diff infection. Around 1 in 3 cases occurred among patients in this age group, and they also accounted for 2 in 3 health care-associated C. diff infections. What is more, around 80% of C. diff-attributable deaths occurred in patients aged 65 or older.

The researchers also identified an increased risk of C. diff infection among women and Caucasian individuals.

Better infection control and antibiotic use needed across all health care settings

Around two thirds of C. diff cases were associated with stays in a health care facility, according to the research. Of these, almost a quarter occurred during hospitalization, and a similar number occurred in nursing homes. Patients who were recently discharged from a health care facility accounted for the remaining cases.

These results, the CDC say, emphasize the need for better infection control and antibiotic use in health care settings.

The organization points to a 2014 Vital Signs report that found that if hospitals reduced high-risk antibiotic use by 30%, the number of deadly diarrhea infections – such as C. diff – could be reduced by 26%. Another study found a 10% decrease in antibiotic use in different hospital wards was linked to a 34% reduction in C. diff infections.

The CDC note that more than 150,000 of the cases identified were community-associated, meaning the infection was not acquired in health care settings.

However, the organization points to a 2014 study published in JAMA Internal Medicine that found around 82% of patients with community-associated C. diff infection had reported visiting an outpatient health care facility – such as a doctor’s or dentist’s office – in the 12 weeks prior to diagnosis.

The CDC say these results indicate that improved antibiotic use and infection control needs to be put in place for outpatient health care, as well as inpatient facilities.

Dr. Michael Bell, deputy director of the Division of Healthcare Quality and Promotion at the CDC, says:

“Overall, there are two main things that need to be improved. Number one is how antibiotics are being used, making sure that we use them when they’re truly necessary and only for as long as necessary.

The second element is to ensure rigorous infection control in all health care settings. C. diff infections must be diagnosed quickly and correctly so that the infected patient can be cared for using the right infection control techniques.”

What are the CDC doing to tackle C. diff in health care settings?

The CDC say they are helping hospitals to develop programs – called “antibiotic stewardship” programs – aimed at improving antibiotic prescription for patients.

In addition, the organization has set up a number of resources to help all health care settings improve antibiotic prescription – such as the “Get Smart: Know When Antibiotics Work” campaign.

Since 2013, the CDC have required all hospitals that are taking part in the Centers for Medicare & Medicaid Services’ (CMS) Hospital Inpatient Quality Reporting Program to report all C. diff information to their National Healthcare Safety Network. “This now lets us track and report the nation’s progress in controlling this disease. So far we’ve seen at least a 10% reduction in infections since 2011,” notes Dr. Bell.

However, Dr. Bell admits that more needs to be done to control C. diff infection in the US. As such, he says that C. diff prevention is to be included in the value-based purchasing program of the CMS, known as “pay for performance.” This is a program that offers financial incentives to clinicians for improving health outcomes.

“In preparation for that, CDC are using a targeting strategy that identifies which hospitals are having infection issues so we and our partners in state and local health departments and agencies like CMS can deliver assistance where it’s needed most,” he adds.

“To reduce the majority of infections we’ll need to improve how antibiotics are being prescribed in hospitals and throughout health care. If we can improve antibiotic prescribing, we expect to see rates of C. diff infections improve dramatically.”

Medical News Today recently reported on a study by researchers from the University of Michigan in Ann Arbor, which claims to reveal how C. diff interferes with the gut.