C'est difficile: Superbug kills 29,000 a year

Superbug kills

C. difficile (Clostridium difficile) has been linked to 29,000 annual deaths in a new study by the Centers for Disease Control and Prevention (CDC). The superbug, which resides in the gut, is directly credited with 15,000 of those deaths. More than 80% of the patients were 65 years old or older, of whom 1 in 9 died within a month of initial diagnosis. Additionally, the bacteria caused almost 500,000 infections in the U.S. in the same span of 12 months. “C. difficile infections cause immense suffering and death for thousands of Americans each year,” CDC director Tom Frieden said. “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.”

According to prior research, C. difficile is the most common microbial cause of healthcare-related infections in American hospitals, and one of the most expensive as well, costing up to $4.8 billion a year in excess healthcare costs for acute care facilities alone. The new study also highlights it as a major cause of infectious disease death in the U.S. Patients who are given antibiotics – 30% to 50% of which are prescribed unnecessarily or incorrectly – are most at risk for C. diff. That amounts to the more than half of all hospitalized patients who will be administered an antibiotic at some point during their stay. Elderly individuals are particularly susceptible to infection. The CDC study estimates that 1 in 3 C. difficile infections – and 2 in 3 healthcare-related C. difficile infections – occurs in patients aged 65 or older. Women and Caucasians are also at higher risk.

A person is most likely to pick up C. difficile from a surface or from person-to-person transmission when they take broad-spectrum antibiotics, which can suppress gut-dwelling beneficial bacteria that protect against infection for weeks and even months. Transmission of the bacteria inside a facility and from facility to facility – for instance when a patient is transferred from a hospital to a nursing home – may be increased by unnecessary use of antibiotics and inadequate infection control. Though about 2/3 of C. difficile infections were linked to inpatient stays in a medical facility, only 24% of all cases occurred among hospitalized patients. Approximately the same number of cases occurred in nursing homes as in hospitals, and the rest of the healthcare-related infections occurred among patients who had just been discharged from a medical facility.

Separate CDC studies found that 82% of people with community-associated C. difficile infections – which accounted for more than 150,000 of the half a million infections in the new study – reported exposure to outpatient healthcare environments like a doctor’s office or dentists office in the 3 months prior to their diagnosis, and that a 30% decrease in the use of antibiotics associated with C. difficile hospital infections could reduce cases by more than 25% in hospitalized and recently discharged patients. Putting 2 and 2 together (which does not equal 5, regardless of what O’Brien says), it is obvious that bettering antibiotic use is essential to prevent C. diff. infections. To that effect, the CDC has created the Core Elements of Hospital Antibiotic Stewardship Programs and an accompanying checklist, as well as the Get Smart: Know When Antibiotics Work and Get Smart for Healthcare campaigns. 

Additionally, the Agency for Healthcare Research and Quality (AHRQ) has created a toolkit to help hospitals enforce antibiotic stewardship programs, as part of AHRQ’s Healthcare-Associated Infections (HAI) Program. “AHRQ’s HAI Program funds projects that generate new scientific knowledge and, like the work on C. difficile, make this knowledge practical and approachable so clinicians on the front lines of care can prevent infections and make care safer for their patients,” AHRQ Director Richard Kronick said. New C. difficile 2020 national reduction targets have been established based on the National Action Plan to Prevent Health Care-Associated Infections: Road Map to Elimination. Plus, all hospitals participating in the Centers for Medicare and Medicaid Services’ (CMS) Hospital Inpatient Quality Reporting Program have been reporting C. difficile infection data to CDC’s National Healthcare Safety Network since 2013.

“CMS invests in structured learning and improvement opportunities for hospitals and communities through Quality Improvement Organizations,” CMS Acting Principal Deputy Director Patrick Conway said. Furthermore, the funding proposed in CDC’s FY 16 budget would support the State Antibiotic Resistance Prevention Programs, which would in turn work with healthcare facilities in all states of the Union to detect and prevent C. difficile infections and antibiotic-resistant organisms. This budget would also boost efforts to enhance antibiotic stewardship in inpatient and outpatient environments. Finally, the CDC will fight C. difficile infections and improve antibiotic stewardship, outbreak vigilance, and antibiotic resistance prevention over the next lustrum under the National Strategy to Combat Antibiotic Resistant Bacteria.

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