Deaths caused by or involving Clostridium difficile (C. difficile) went up every year from 1999 to 2006 in England and Wales (except for 2000 for which there is no data) said the UK’s Office for National Statistics (ONS). There are suggestions that this could be due to more accurate reporting of the disease.

In the two countries, the number of death certificates in 2006 that mentioned C. difficile was 6,480, an enormous 72 per cent higher than in 2005. However, in both years, the percentage of certificates that stated C. difficile as the underlying cause of death was largely similar at 55 per cent.

The death rates for both men and women went up over the period 1999 to 2006, with male deaths involving C. difficile rising from 37 per million in the population in 2005 to 65 per million in 2006. The 2005 to 2006 figures for women were similar, rising from 39 to 64 per milion of the population.

Most of the deaths were of older people. Among those aged 85 and over, the number of deaths in 2006 involving C. difficile was 2,795 per million of the population among men and and 2,785 among women in this age group. For the under 45s, the rates were much reduced, at 0.2 deaths per million population for men and 1.3 per million for women.

C. difficile is a highly contagious bacterium that lives in the gut of about 3 per cent of healthy adult humans. It can be spread via contaminated objects and surfaces. When the bacteria overgrows, it causes colitis, resulting in inflammation and bleeding of the large intestine in reaction to the powerful toxin that the bacteria produces. In some cases it results in perforation of the wall of the intestines, resulting in blood poisoning and even death.

Using broad spectrum antibiotics can increase the risk of succumbing to a C. difficile disease because of disruption to the balance of intestinal flora resulting in too much C. difficile.

The elderly, people with compromised immune systems, for instance chemotherapy patients, gastric surgery patients, anyone who spends long periods being cared for in hospital, and patients who are in hospital during an outbreak, are also at increased risk of developing C. difficile disease.

According to the BBC, there is a suggestion that the dramatic increase from 2005 to 2006 could be due to more complete reporting on death certificates.

They report chief microbiologist at the Department of Health, Professor Brian Duerden, saying there was a push for more accurate reporting of MRSA and C. difficile in death certificates in July 2005.

He told BBC News that the change from 2005 to 2006 shows the strategy worked and brought the figures more in line with other developed countries.

Over the last two years the UK has made considerable effort to fight infections, said Duerden, including:

“Stringent hand-washing guidance for the NHS, a bare below the elbows dress code, putting matrons back in charge of cleanliness on their wards and an ongoing deep clean of every ward.”

He said this was now starting to show in the falling infection rate in hospitals.

Click here for more information on deaths involving C. difficile from the Office for National Statistics.

Sources: Office for National Statistics, BBC News, MedlinePlus.

Written by: Catharine Paddock, PhD