C. diff. – New CDC Study – National Burden of Clostridium difficile (C. diff.) Infections

Nearly half a million Americans suffered from Clostridium difficile (C. diff.) infections in a single year according to a study released today, February 25, 2015, by the Centers for Disease Control and Prevention (CDC).

• More than 100,000 of these infections developed among residents of U.S. nursing homes.
Approximately 29,000 patients died within 30 days of the initial diagnosis of a C. diff. infection. Of these 29,000 – 15,000 deaths were estimated to be directly related to a
C. diff. infection. Therefore; C. diff. is an important cause of infectious disease death in the U.S.
Previous studies indicate that C. diff. has become the most common microbial cause of Healthcare-Associated Infections found in U.S. hospitals driving up costs to $4.8 billion each year in excess health care costs in acute care facilities alone. Approximately
two-thirds of C. diff. infections were found to be associated with an inpatient stay in a health care facility, only 24% of the total cases occurred in patients while they were hospitalized. The study also revealed that almost as many cases occurred in nursing homes as in hospitals and the remainder of individuals acquired the
Healthcare-Associated infection, C. diff., recently discharged from a health care facility.


This new study finds that 1 out of every 5 patients with the Healthcare-Associated Infection (HAI), C. diff., experience a recurrence of the infection and 1 out of every 9 patients over the age of 65 diagnosed with a HAI – C. diff. infection died within 30 days of being diagnosed. Older Americans are quite vulnerable to this life-threatening diarrhea infection. The CDC study also found that women and Caucasian individuals are at an increased risk of acquiring a C. diff. infection.


CDC Director, Dr. Tom Frieden, MD, MPH said, “C. difficile infections cause immense suffering and death for thousands of Americans each year.” “These infections can be prevented by improving antibiotic prescribing and by improving infection control in the health care system. CDC hopes to ramp up prevention of this deadly infection by supporting State Antibiotic Resistance Prevention Programs in all 50 states.”

The Agency for Healthcare Research and Quality (AHRQ) has developed a toolkit to help all hospitals begin antibiotic stewardship programs to reduce C. diff. infections.
Based on the National Plan to Prevent Healthcare – Associated Infections: Road Map to Elimination, new 2020 national reduction targets are being established for C. diff. and all hospitals participating in the Centers for Medicare & Medicaid Services (CMS) Hospital Inpatient Quality Reporting Program have been reporting C. diff. infection data to the CDC’s National Healthcare Safety Network since 2013. The baseline data allows for continued surveillance for C. diff. infections to monitor progress in prevention.

Improve the use of antibiotics in preventing C. diff. infections:
150,000 of the half a million C. diff. infections – the new study revealed that they were community-associated and had no documented health care exposure. A separate recent CDC study found that 82% of patients with community-associated C. diff. infections reported exposure to outpatient health care settings (e.g., physicians or dentist office) within twelve weeks before being diagnosed with a C. diff. infection. Through this finding confirms the need for infection control in these settings as well and the need for improved antibiotic use. Another recent CDC study showed a 30% decrease in the use of antibiotics lined to a C. diff. infection in hospitals could reduce newly diagnosed infections by more than 25% in hospitalized and recently discharged patients. A new retrospective study being conducted at a Canadian hospital found that a 10% decrease in overall antibiotic usage through different wards was related to a 34% decrease in newly diagnosed C. diff. infections. 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 newly diagnosed            C. diff. infections by 16%. In recent years England has seen a reduction of newly diagnosed          C. diff. cases by 60% largely due to improvements in antibiotic prescribing.

C. diff.; Different strains? The North American pulsed-field gel electrophoresis type 1 (NAP1) strain was more prevalent among healthcare-associated than community-associated infections. Changes in the epidemiology of C. difficile infections have occurred since the emergence of this strain in 2000, which has been responsible for widespread dispersed hospital-associated outbreaks. The NAP1 strain was first detected in Pittsburgh, PA and Montreal and is now global. It is causing the majority of infections in communities and healthcare settings. 30% detected in the study and increase seen in healthcare facilities as it is more easily transmitted. “All organisms producing toxins, all infections – must be looked upon with seriousness.”                          Dr. Michael Bell, MD and Dr. Clifford McDonald, MD both concurred.

The diagnosing and detection of a C. difficile infection is at the transition point in how this infection is being diagnosed. There is a need to use better methods of testing and who gets tested and a combination of clinical symptoms and laboratory tests. The Enzyme assay may not be sensitive enough and the PCR is more readily used, is more sensitive, and was used in this study with 50% laboratory producing a C. diff. diagnosis.
The care involved treating a patient with a C. difficile infection begins as a short-term treatment and can develop into a long-term illness with many recurrences.

Dr. Michael Bell, MD shared a brief C. diff. infection possible scenario:
• The patient may have been on an antibiotic within 90 days and develops diarrhea, then the individual should see a medical physician and get tested for a C. diff. infection.
• If the test result is positive for a C. diff. infection then treatment begins with a prescribed oral antibiotic.
• It may take multiple rounds of a oral antibiotic to suppress a C. diff. infection.
• There is a challenge treating a C. diff. infection as the antibiotic continually disturbs the bacteria in the bowel.
• Toxic forming C. diff. can put one’s life at risk as leaks develop in the bowel allowing bacteria to enter the blood stream (bacteremia).
• The infection may progress and the physicians may have to perform a surgical procedure and remove part or the entire colon (colectomy).
• Or the progression of a C. diff. infection leads the patient diagnosed with a C. diff. infection into becoming a surgical patient which will change their life through a diversion of the bowel (colostomy).
Ways to prevent C. diff. infection recurrences:
Do not take antibiotics unless absolutely necessary and diagnosed with a infection that a antibiotic will be effective. The use of an antibiotic treating symptoms caused by a virus is not effective. (Antibiotic stewardship).
Make the clinician aware that a antibiotic has been taken to treat a infection.
Antibiotics are lifesaving medications and need to be prescribed correctly to avoid antibiotic-resistance.
Healthcare facilities must implement and maintain Hand-washing (hand-hygiene) programs – Infection control.
Probiotics – are found in foods (e.g., Kefir, Yogurt) and are sold as a nutritional supplement, (1) “The U.S. Food and Drug Administration (FDA) has no definition of probiotics and regulates them based on whether they fall into one of the existing regulated product categories,” says Hoffmann, who along with faculty members from the University of Maryland School of Medicine’s Institute for Genomics Sciences, the University of Maryland School of Pharmacy and the University of Maryland Carey School of Law, investigated how probiotics are being regulated
(1) See more at: http://www.thedailysheeple.com/fda-to-change-regulations-for-probiotics_102013#sthash.4IGLf8aE.dpuf


C. diff. spores and outpatient settings: There were C. diff. spores found in outpatient settings. A study done at outpatient clinics found that patients who had recently been treated for a C. diff. infection in a hospital, and discharged continued shedding C. diff. spores from weeks to months after recovering from the infection. Clostridium difficile (C. diff.) spores were found on the exam table and in the clinic exam areas. Based on this information it is beneficial to continue disinfecting hard non-porous surfaces utilizing EPA registered disinfecting products, with C. diff. kill claim, in home-care and within healthcare facilities to continue decreasing the spread of        C. diff. spores and maintain infection control. There are Infection programs ongoing with the CDC with continued monitoring/studies.


Preventing C. difficile is a National Priority

Based on the National Action Plan to Prevent Health Care-Associated Infections: Road Map to Elimination, new 2020 national reduction targets are being established for C. difficile, and all hospitals participating in the Centers for Medicare & Medicaid Services’ (CMS) Hospital Inpatient Quality Reporting Program have been reporting C. difficile infection data to CDC’s National Healthcare Safety Network since 2013. Those baseline data will allow continued surveillance for C. difficile infections to monitor progress in prevention.

The State Antibiotic Resistance Prevention Programs that would be supported by the funding proposed for CDC in the President’s FY16 budget would work with health care facilities in all 50 states to detect and prevent both C. difficile infections and antibiotic-resistant organisms. The FY 16 budget would also accelerate efforts to improve antibiotic stewardship in inpatient and outpatient settings. During the next five years, CDC’s efforts to combat C. difficile infections and antibiotic resistance under the National Strategy to Combat Antibiotic Resistant Bacteria will enhance national capabilities for antibiotic stewardship, outbreak surveillance, and antibiotic resistance prevention. These efforts hold the potential to cut the incidence of C. difficile infections in half.

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