C Difficile Catching Up With MRSA

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Main Category: MRSA / Drug Resistance
Also Included In: Infectious Diseases / Bacteria / Viruses;  Seniors / Aging
Article Date: 12 Nov 2008 - 8:00 PDT

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Clostridium difficile, a life-threatening bacterium that causes diarrhea and more serious intestinal problems, is closing in on MRSA as the most prevalent and troublesome hospital-acquired superbug in the US; it is rapidly developing an antibiotic resistant form and a new survey suggests it is infecting between 6 and 20 times more patients than previously thought.

The Washington, DC-based Association for Professionals in Infection Control and Epidemiology (APIC) posted a summary of the results of a nationwide survey on Tuesday 11th November titled "The National Prevalence Study of Clostridium difficile in US Healthcare Facilities" on their website and announced that a study is scheduled to appear in a Spring 2009 issue of APIC's American Journal of Infection Control.

APIC estimated that in the US, 13 out of every 1,000 in-patients were either infected or colonized with C difficile and on any given day over 7,000 patients in America have C difficile and about 300 die from it. The cost to the American healthcare system is put at around 17.6 to 51.5 million dollars.

C difficile is second only to MRSA (methicillin-resistant Staphylococcus aureus) as the most common and troublesome bacterium that is usually acquired in hospitals and other treatment centres. It occurs mostly in older patients who have been treated with antibiotics, and others exposed to hospital, nursing home or other healthcare settings.

The infection route is via hand contact with feces-contaminated objects and once infected patients get diarrhea and they may also develop fatal conditions like colitis, toxic megacolon, and sepsis, said an APIC press statement. Like Staphylococcus aureus, a more virulent and antibiotic resistant form of C difficile has emerged in the last five years which leads to more serious and potentially fatal infections that resist treatment.

Kathy Warye, CEO of APIC told a press conference on Tuesday that the survey was the first to show the real scale of C difficile infections in America's hospitals.

For the survey, APIC took a one day snapshot of 648 hospitals and counted a total of 1,443 patients infected with C difficile.

The Association's 12,000 members collected data on all their C difficile patients on one day between May and August 2008. This represents about 12.5 per cent of all medical facilities in the US that care for all types of patients with every type of illness including those in acute care, children, cardiac patients, cancer patients and those undergoing rehabilitation.

Dr William Jarvis, president and co-founder of Jason and Jarvis Associates, a private consulting firm in healthcare epidemiology and principal investigator of the study said:

"This study shows that C difficile infection is an escalating issue in our nation's healthcare facilities."

Jarvis said preventing the growth and spread of C difficile "should be a top priority for every healthcare institution".

The survey showed that the majority of patients were admitted to hospital already infected. Hospitals need to look for patients with severe diarrhea and if they suspect C difficile they should invoke special precautions like gowns and gloves and keeping patients separate to stop the infection spreading, said APIC 2008 president Janet E Frain.

Jarvis said that C difficile is not just a surgical disease. Nearly 80 per cent of the patients had been treated with antibiotics before they became infected and in 17 per cent of those cases the antibiotics were given to prevent surgical infections.

Bleach is the only cleaner that kills the spore-forming type of C difficile and only 65 per cent of the hospitals they surveyed used it, said Jarvis.

Alcohol gels don't kill the spores either, and only vigorous washing with soap and water removes them, Jarvis told reporters in a briefing reported by the Center for Infectious Disease Research & Policy (CIDRAP) of the University of Minnesota.

Click here for Executive Summary of results (PDF).

Sources: APIC, CIDRAP.

Written by: Catharine Paddock, PhD
Copyright: Medical News Today
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