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C. diff Still Rising in Hospitals

Nov 11, 2008 | Parker Waichman Alonso LLP

We recently reported that a panel of experts said that this country’s epidemic of the potentially dangerous superbug Clostridium difficile, or C. diff, will probably worsen before any improvement is seen.  Cases of the C. diff diarrhea bug have been seen in all 50 states, says L. Clifford McDonald, MD, of the Center for Disease Control and Prevention’s (CDC) Division of Healthcare Quality and Promotion.  And "we haven't hit bottom yet," says Lance Peterson, MD, of the Evanston Northwestern Healthcare Research Institute in Illinois.

Now, a new survey has revealed that over one percent of U.S. hospital patients are infected with Clostridium difficile.  And, although making precise comparisons between prior and new data is challenging, a variety of current studies indicate that the prevalence of C. diff has risen dramatically in the past decade.  "They're all pointing to the same thing: This is a major public-health problem," said McDonald.

Meanwhile, the survey looked at 648 hospitals in 47 states over the course of one day and was was commissioned by the Association for Professionals in Infection Control and Epidemiology, a national professional society whose members include doctors, nurses, and epidemiologists.  The researchers found that 13 of every 1,000 hospitalized patients tested positive for C. diff, with 94 percent also exhibiting C. diff disease symptoms.  The study findings suggest that over 7,000 hospital patients nationwide are infected with C. diff on any given day, and that about 300 will die from C. diff.  The percentage of hospital patients with C. diff disease has more than doubled between 2000 and 2005, according to hospital data analyzed by federal researchers.

Typically, C. diff occurs in people taking antibiotics.  Spores enter the body through the mouth and travel to the gastrointestinal tract.  It is the overgrowth of the C. diff bacteria in the colon, or large intestine, that can lead to diarrhea, which is often severe and accompanied by colitis, or intestinal inflammation.  Because infection rates are often high in hospitals and nursing homes, where patients and health care workers are in close proximity, C. diff cannot be eradicated with standard cleaning agents.  Worse, the traditional antibiotic treatments no longer seem to be working, especially in cases where people are being treated for repeat bouts of C. diff.

Both the Infectious Diseases Society of America and the Society of Healthcare Epidemiology of America have published guidelines meant to minimize the spread of the C. diff superbug that include avoiding the overuse of antibiotics, using bleach to clean surfaces during outbreaks, wearing gowns and gloves when caring for patients, and following strict hand washing and other good hygiene practices.  C. diff thrives in patients treated with powerful broad-spectrum antibiotics, which clear away other intestinal bacteria that usually keep C. diff in check.  When possible, doctors are beginning to prescribe narrowly targeted antibiotics.  Also, using a bleach solution to clean the rooms of infected patients is important since C. diff forms hardy spores not killed by some cleaners.  Proper hand washing is also critical, because spores do not always die when alcohol-based disinfectant gels are used.