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Dangerous C-diff infections more common in U.S. than previously thought, CDC study finds

Centers for Disease Control and Prevention
C-diff bacterium

The toll of Clostridium difficile, or C-diff — a bacterium that causes a dangerous form of diarrhea and is the most common cause of hospital-acquired infections in the United States — is much higher than previously believed, according to a study published Wednesday by the Centers for Disease Control and Prevention (CDC).

Using data collected from 10 regions of the country — including the central Minnesota counties of Stearns, Benton, Todd and Morrison — the study found that C-diff caused about 453,000 infections in the United States in 2011. Health officials had previously linked the bacterium to an estimated 240,000 to 333,000 infections each year.

The new study also estimated that 29,000 people died within 30 days of being diagnosed with C-diff in 2011. Of those deaths, about 15,000 were “directly attributable” to the infection.

More than 80 percent of all the deaths associated with C-diff in the study were among people aged 65 years or older.

These findings are troubling. C-diff can be very difficult to treat, mainly because strains of the bacterium have become resistant to standard antibiotics. To get rid of the infection, patients often have to have part of their colon removed. Even then, the disease frequently recurs — in 20 percent of patients, according to the new study.

Many C-diff infections could have been prevented with more appropriate use of antibiotics in both hospitals and other health-care settings, CDC officials note. Previous studies have suggested that 30 to 50 percent of antibiotics prescribed in U.S. hospitals are unnecessary or incorrect. The overuse and misuse of antibiotics contribute to C-diff illnesses by altering or killing off beneficial bacteria in the intestines that help protect against the C-diff bacterium. This suppression of beneficial bacteria can last for weeks or months, leaving people vulnerable to picking up the infection from contaminated surfaces long after they have stopped taking the antibiotics — and left the hospital.

Higher rates in Minnesota

C-diff infections have been increasingly diagnosed outside of hospitals, particularly in nursing homes but also in other “community” settings. This new CDC study found that more than 345,000 of the 2011 C-diff infections occurred in non-hospitals settings, including 100,000 in nursing homes. 

The Minnesota counties included in the study had a significantly higher rate of community-associated C-diff infections — 123 per 100,000 persons — than the other sites. Indeed, the combined rate for all 10 sites in the study was 48 per 100,000 persons.

In a released statement, Dr. Stacy Holzbauer, an epidemiologist at the Minnesota Department of Health (MDH) and a co-author of the study, said Minnesota’s higher rate was the result of a more sensitive method of testing for the disease and the fact that the four counties were more rural than the other sites in the study. Studies conducted elsewhere in the world, she pointed out, have also demonstrated higher rates of community-associated infections in rural areas.

Centers for Disease Control and Prevention

What patients can do

The CDC has made the prevention of C-diff infections a high priority, but getting health-care providers to prescribe and use antibiotics more appropriately has been a challenge. In addition, many health-care facilities do a less than stellar job of quickly identifying and isolating patients with C-diff infections and of notifying other facilities of such infections when patients are transferred.

The rest of us need to take some responsibility, however, and not demand antibiotics when our health-care providers say they are unnecessary.

In addition, CDC officials recommend the following preventive actions for patients:

  • Take antibiotics only as prescribed by your doctor and be sure to complete the entire prescribed course of treatment. (In other words, finish taking all the drugs even if you feel better.)
  • Tell your doctor if you develop diarrhea after taking antibiotics, even if it’s a few weeks later.
  • Always wash your hands before eating and after using a bathroom.
  • If you or someone in your family has diarrhea, try to use a separate bathroom, or be sure the bathroom is cleaned well each time someone with diarrhea has used it.

The CDC study was published in the New England Journal of Medicine.

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Comments (6)

  1. Submitted by Susan Lesch on 02/26/2015 - 09:39 am.

    Wash your hands

    Hi. Residents of nursing homes and hospitalized persons need to wash their hands constantly. Make that everybody everywhere. Even hospitals do not clean up the spores of these bacteria, otherwise we’d see an end to Cdiff infections. This mantra is so important I can’t stress it enough. Wash your hands.

  2. Submitted by Pavel Yankovic on 02/26/2015 - 10:36 am.

    Thanks….

    for a good article. You mention in passing the overuse and misuse of antibiotics which is a contributing factor. This is a consequence of consumer driven medicine. The patient is more satisfied if he or she leaves the office with a prescription rather than helpful advice. There is not a magic pill for everything.

  3. Submitted by Eric Paul Jacobsen on 02/26/2015 - 01:16 pm.

    What does “community-associated” mean?

    “In a released statement, Dr. Stacy Holzbauer, an epidemiologist at the Minnesota Department of Health (MDH) and a co-author of the study, said Minnesota’s higher rate was the result of a more sensitive method of testing for the disease and the fact that the four counties were more rural than the other sites in the study. Studies conducted elsewhere in the world, she pointed out, have also demonstrated higher rates of community-associated infections in rural areas.”

    What does “community-associated” mean?

    I want to know, because I am already alarmed by the possibility that we are breeding superbugs in Confined Animal Feeding Operations (CAFOs), where healthy animals are still routinely fed antibiotics, despite the solemn warning of the US Center for Disease Control and Prevention (CDC).

    http://articles.mercola.com/sites/articles/archive/2013/10/02/factory-farms-superbugs.aspx.

    The linked article does not connect Clostridium difficile directly with CAFOs, but it does mention that Methicillin-resistant Staphylococcus aureus (MRSA) seems to be linked with exposure to hog manure in CAFOs.

    Aren’t CAFOs more likely to be located in rural areas? Don’t we have a few of them in Minnesota?

  4. Submitted by Rachel Kahler on 02/26/2015 - 04:20 pm.

    Still underestimated

    I would guess that even the upwardly revised estimates are low. It may be possible that there are lots of people who have infections that result in either low-level symptoms, or symptoms that are ascribed to something else–like food sensitivity. I know of at least two people who became gluten sensitive/intolerant after an event that affected their digestive system. One was after a massive dose of antibiotic used as a preventative after a dental procedure. The other was after a diet change in order to lose weight prior to a vacation. It’s pretty likely that these events changed the biota of their intestines, which resulted in inflammation in response to gluten or other components of certain foods. Whether or not this is caused by a C. difficile infection remains to be seen. And whether or not it’s reversible is unknown.

    My guess is that there are lots of people out there suffering from antibiotic and cleanliness-induced digestive (and other) dysfunctions. Some may be the result of C. difficile, some may be the result of some other “bad” bug overload, some may be the result of a lack of “good” bugs, and some might just be that your immune system is so underworked it starts looking for trouble.

    In any case, we need to seriously reconsider our trivial use of antibiotics and our obsession over cleanliness. Sure, wash your hands, but do we really need to *sanitize* them? Really, it’s ok if your kid eats a little dirt or if the dog licks him in the face (yes, I know where that tongue has been).

    In fact, take your kid out to a farm–not one of those sterilized ones that look pristine and all the animals are housed indoors. Take them out to a farm with cows in a pasture. Touch the cows. Yes, it’s possible your kid might get sick with something the cow is carrying. That’s not necessarily a bad thing (so long as it isn’t something like BSE or anthrax). Your kids will probably thank you for the lack of allergies and the ability to eat bread later in life.

    In the meanwhile, for the poor souls who have wrecked their gut with a C. difficile infection, there might be an answer….a fecal transplant. It’s not as gross as it sounds. And if you get a transplant from someone with a weight problem, you might end up fighting obesity yourself. But, it’s a very possible solution.

    • Submitted by Joseph Finley on 02/26/2015 - 10:44 pm.

      Still underestimated

      Forget everything else, what is this about fecal transplant? Can you enlighten me on this please?

      • Submitted by Rachel Kahler on 02/27/2015 - 01:30 pm.

        It’s almost exactly what it sounds like

        No kidding. It starts out by collecting fecal material from a healthy donor, often a relative and sometimes the patient themselves prior to an anticipated antibiotic treatment. In the most basic procedure, the fecal material is diluted and then transferred to the patient via nasogastric tube or enema. In some instances, the fecal matter is further processed to produce a pill to be taken orally (they take out the offensive stuff first, obviously, in this process). The bacteria from the healthy fecal sample overwhelm the C. difficile in the patient and re-colonize the gut of the patient. Mayo claims a 90+% cure rate, even for people with long term infections (http://www.mayoclinic.org/medical-professionals/clinical-updates/digestive-diseases/quick-inexpensive-90-percent-cure-rate). Sometimes the cures are amazingly fast. And, because there isn’t a vacuum to fill as when antibiotics are used, the likelihood of recurrence is low.

        One recent “discovery” though, is that a fecal transplant from an overweight donor might contribute to weight gain in the patient. Though, if the doctors who performed this particular transplant were actually paying any attention, they might have anticipated this outcome. The exact same results happen in mice in experiments done a while back.

        What’s pretty amazing is that a fecal transplant (or fecal bacteriotherapy, as it is also called), might be beneficial for a LOT of other things, even things that seem completely unrelated, like Parkinson’s disease. Whether or not the early findings hold out depends on further research.

        Still, it points to the fact that we’ve ignored a very important part of our bodies for a long time–microbes. It turns out that, while sanitation is a very good thing, you can definitely overdo it.

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