C. Difficile Nearly Doubles in a Decade
Incidence of Clostridium difficile infection (CDI) in hospitalized patients nearly doubled between 2001 and 2010, according to new research, which suggested the overuse of antibiotics and lack of stewardship programs designed to improve prescribing practices are to blame for the jump in rates of deadly diarrhea.
The retrospective analysis of approximately 2.2 million hospital discharges collected by the Centers for Disease Control and Prevention (CDC) between 2001 and 2010 showed approximately 700,000 patients were admitted for CDI and nearly 1.5 million others acquired the infection while hospitalized for other reasons.
CDIs increased from 4.5 to 8.2 per 1,000 discharges across the study period. Overall, 7.1% of infected patients died, with mortality rates increasing significantly from 6.6% to 7.2% during the study period. Additionally, patients who acquired the infection while hospitalized were more than twice as likely to die than patients who were admitted for treatment of principal infection, a trend that increased during the study. Notably, average hospital length of stay remained consistent during the decade: 5 and 9 days in patients with principal and secondary CDI diagnoses, respectively.
Approximately half of the infected patients had secondary infections, with urinary tract infection the most common. Acute renal failure was the most commonly reported CDI-related adverse reaction, and less than 1% of the patients suffered serious events or required a colectomy.
Patients 65 years or older often have comorbid diseases, experience changes in immunity, and are exposed to antibiotics, putting them at the highest risk of CDI. With an aging patient population, greater diligence is needed to prevent infections in hospitalized patients, said the researchers. They called CDI an “increasing burden” and identified antimicrobial stewardship related to the prescribing of clindamycin, fluoroquinolones, and cephalosporins — the antibiotic classes most commonly associated with CDI — as one of the most important preventative strategies.
“We found little evidence of improvement in patient mortality or hospital length of stay,” said Dr. Kelly Reveles, an assistant professor at the University of Texas at Austin and lead author of the study. “CDI continues to be a major public health problem in the United States and further efforts in reducing inappropriate antibiotic use and improving infection control are needed.”
Antimicrobial stewardship programs play a critical role in improving prescribing practices and reducing the risk of CDI, said Dr. Reveles, who explained that numerous reports have shown that implementation of such programs or specific antimicrobial restriction policies reduced incidence of infection.
“The CDC estimates that reducing the use of broad-spectrum antibiotics by 30% could reduce CDI by 26%,” she continued. “As drug experts, health-system pharmacists can play a key role in limiting antibiotic use in hospitals.”
The study was published online in the American Journal of Infection Control.
—Dan Cook
Reference:
1. Reveles KR, Lee GC, Boyd NK, Frei CR. The rise in Clostridium difficile infection incidence among hospitalized adults in the United States: 2001-2010. Am J Infect Control. 2014;42(10):1028-1032.
