C. difficile, an intestinal superbug causing symptoms ranging from diarrhea to life-threatening inflammation of the colon, is the most common bacterial infection acquired in hospitals and as such, it is linked to 14,000 deaths in the United States each year. Now, a retrospective study from the University of Texas College of Pharmacy issues a wake-up call to health care providers nationwide. Infections with C. difficile nearly doubled in U.S. hospitals between the years 2001 and 2010, according to the researchers.

For the study, the team of scientists sifted through 10 years of data from the U.S. National Hospital Discharge Surveys (NHDS), including 2.2 million separate C. difficile infection (CDI) cases. After analyzing the data, the researchers found rates increased substantially between 2001 and 2010, from 4.5 CDI adult cases per 1,000 total hospital discharges to 8.2 cases per 1,000. Importantly, this spike occurred without any noticeable improvement in patient mortality rates or hospital lengths of stay.

In fact, nearly 7.1 percent, or 154,184 patients, died throughout the study period. “Our study found that peak CDI incidence occurred in 2008, with a slight decline through 2010,” said Dr. Kelly Reveles, lead author of the study. The data revealed that most CDI patients were female (59 percent), white (86 percent), and more than 65 years of age (70 percent). Of the total 2.2 million adult CDI discharges, 33 percent had a principal diagnosis of CDI while 67 percent were classified as secondary CDI, meaning the infection was not the primary reason for their hospitalization. “Several factors may have contributed to the rise in CDI incidence in recent years,” said Reveles. “Antibiotic exposure remains the most important risk factor for CDI.” 

Current estimates suggest up to half of all antibiotic use is unnecessary. Based on this estimate, the Centers for Disease Control and Prevention says a reduction in the use of broad-spectrum antibiotics by 30 percent could lower CDI by 26 percent. “To make headway against CDI, hospitals and health facilities need to get serious about antibiotic stewardship,” said Dr. Jennie Mayfield, president of the Association for Professionals in Infection Control and Epidemiology (APIC).

According to APIC’s 2013 survey, 60 percent of U.S. hospitals had implemented antibiotic stewardship programs up from 52 percent in 2010. Going forward, more effort should be expended in this area as just last week President Obama signed a new Executive Order to initiate a National Strategy for Combating Antibiotic-resistant Bacteria, which will develop and implement federal government policies to combat antibiotic-resistant bacteria.

Source: Reveles KR, Lee GC, Boyd NK, Frei CR. The rise in Clostridium difficile infection incidence among hospitalized adults in the United States: 2001-2010. American Journal of Infection Control. 2014.