Dangerous infections now spreading outside hospitals

Liz Szabo | USA TODAY

Life-threatening infections caused by bacteria called Clostridium difficile now sicken nearly half a million Americans a year, health officials said Wednesday.

The number of these infections — which can cause "deadly diarrhea" and damage to the colon — doubled between 2000 and 2010, according to the Centers for Disease Control and Prevention.

In 2011, about 29,000 patients with the bacteria, also known as C. difficile or C. diff, died within a month of becoming sick, according to a CDC study published Wednesday in The New England Journal of Medicine. One out of three of these infections occurs in people 65 and older. People 65 and older also account for most deaths.

"C. difficile infections cause immense suffering and death for thousands of Americans each year," CDC Director Tom Frieden said in a statement.

Although the infections are often treatable with antibiotics, toxins released by the bacteria can severely damage the colon, forcing doctors to remove it, says the CDC's Michael Bell, who specializes in drug-resistant pathogens and hospital-acquired infections.

C. diff is the most common health care-associated infection in the USA, costing hospitals $4.8 billion a year, according to the CDC.

About two-thirds of C. diff infections developed in patients with a recent hospital stay, although symptoms often set in only after discharge, according to the CDC. About 100,000 C. diff. infections a year are diagnosed in nursing home residents.

More than 80% of patients who pick up C. diff outside of hospitals had visited outpatient doctor's or dentist's offices in the previous 12 weeks, according to the CDC. The bacteria are hardy and can live on bed linens, bathroom fixtures and medical equipment, according to the CDC.

Although soap and water can wash off the bacteria, hand sanitizers don't kill C. diff, Bell says. The CDC recommends that doctors treating C. diff patients wear disposable gowns and gloves.

"The numbers are pretty striking," says Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, who wasn't involved in the new study. "A substantial number of cases are occurring in people who have never been to a hospital."

Healthy people also can develop C. diff infections after taking antibiotics for illnesses as mild as urinary tract infections or bronchitis, says the CDC's Fernanda Lessa, the study's lead author.

Although antibiotics can save lives, they can also wipe out huge numbers of helpful bacteria that live in the digestive tract, says Amesh Adalja, senior associate at the Center for Health Security of the University of Pittsburgh Medical Center, who wasn't involved in the new study.

These bacteria normally keep the body healthy by competing with dangerous bacteria and keeping them in check, Adalja says. Antibiotics interfere with this delicate balance, killing off beneficial bacteria and allowing harmful ones to gain a foothold.

More than half of hospitalized patients are prescribed antibiotics. Yet studies show that 30% to 50% of these prescriptions are unnecessary or incorrect. Health care providers can help prevent C. diff infections by prescribing antibiotics only when they're really needed, Frieden said in his statement.

Christian Lillis says his mother died from C. diff in 2010 just a few days after taking an antibiotic related to a root canal surgery. She was 56.

"We struggled to understand how our mother could die from a disease we've never heard of," says Lillis, who founded the Peggy Lillis Memorial Foundation in her honor as a way to reduce the number of C. diff cases.

Hospitals have worked to combat C. diff infections for years, but authors of the new study say that the country needs to do more to prevent the infections in doctor's offices and clinics. England has reduced the number of C. diff infections by more than 60% by encouraging people to use antibiotics more carefully. A study from a Canadian hospital found that reducing antibiotic use 10% was associated with a 34% drop in C. diff cases.

People who are prescribed antibiotics should take the full dose exactly as prescribed, instead of stopping medications simply because they feel better, the CDC says. People who develop diarrhea after taking an antibiotic should contact a doctor, Bell says.

Some C. diff infections are hard to treat. Nearly one in five patients in the new study had a recurrence within 30 days of treatment.

In recent years, doctors have had success treating C. diff with fecal transplants, which help restore the gut's normal bacteria. A small 2013 study found that the transplants cured 94% of C. diff patients.

Although the transplants were once considered "last-ditch" efforts to save people who might otherwise have died, the procedures are now being done earlier in the course of treatment, Bell says. Several drug companies, including Sanofi and Pfizer, are working on C. diff vaccines.