“Deadly diarrhea” rates nearly doubled in 10 years: study



Washington, DC, September 29, 2014

Infections with the intestinal superbug C. difficile nearly doubled from 2001 to2010 in U.S. hospitals without noticeable improvement in patient mortalityrates or hospital lengths of stay, according to a study of 2.2 million C. difficile infection (CDI) casespublished in the October issue of the AmericanJournal of Infection Control, the official publication of theAssociation for Professionals in Infection Control and Epidemiology (APIC).

In this retrospective study from The University ofTexas College of Pharmacy, researchers analyzed 10 years of data from the U.S.National Hospital Discharge Surveys (NHDS). From 2001 to 2010, rates of CDIamong hospitalized adults rose from 4.5 to 8.2 CDI discharges per 1,000 total adulthospital discharges.

"Several factors may have contributed to the rise inCDI incidence in recent years," said Kelly Reveles, PharmD, PhD, lead author onthe study. "Antibiotic exposure remains the most important risk factor forCDI."

According to the Centers for Disease Control and Prevention(CDC), C. difficile is themost common bacteria responsible for causing healthcare-associated infectionsin U.S. hospitals and is linked to 14,000 deaths each year. Reducing the use ofhigh-risk, broad-spectrum antibiotics by 30 percent could lower CDI by 26percent, estimates the CDC. The WhiteHouse recently announced a new Executive Order and National Strategy for CombatingAntibiotic-resistant Bacteria, which emphasized the need for antibioticstewardship programs to help clinicians improve prescribing practices.

"It's been estimated that up to half of antibiotic usein humans is unnecessary," said APIC 2014 President Jennie Mayfield, BSN, MPH,CIC. "To make headway against CDI, hospitals and health facilities need to getserious about antibiotic stewardship."

According to The University of Texas College ofPharmacy study, most CDI patients were female (59 percent), white (86 percent),and more than 65 years of age (70 percent).

Of the 2.2 million adult CDI discharges, 33 percenthad a principal diagnosis of CDI; 67 percent were classified as secondary CDI,meaning that CDI was not the primary reason they were hospitalized. Approximately7.1 percent, or 154,184 patients, died during the study period.

"Our study found that peak CDI incidence occurred in2008, with a slight decline through 2010," said Dr. Reveles. "The leveling offof CDI incidence toward the end of our study period may be the result ofincreased antibiotic stewardship programs and improved infection controlmeasures, such as use of contact precautions, cleaning and disinfection ofequipment, and environment, and hand hygiene."

According to a 2013 survey conducted by APIC, 60 percent of US hospitalshad implemented antibiotic stewardship programs by 2013, up from 52 percent in2010.

"With bugs like C.diff, it takes everyone asking – 'are these antibiotics really necessary?'to help curb inappropriate use and protect patients," said Mayfield.

Antibiotic resistance and stewardship is the theme of International Infection Prevention Week led by APIC, October 19-25, 2014. A free webinar and Twitter chat are being offered, along with an infographic poster for consumers on the "ABC's of antibiotics."

Authors:

KellyR. Reveles, PharmD, PhD (Corresponding Author)

College of Pharmacy, The University of Texas, Austin,TX and the Pharmacotherapy Education and Research Center, TheUniversity of Texas Health Science Center, San Antonio, TX

Grace C.Lee, PharmD

College of Pharmacy, The University of Texas, Austin,TX and the Pharmacotherapy Education and Research Center, TheUniversity of Texas Health Science Center, San Antonio, TX

Natalie K.Boyd, PharmD, MS

College of Pharmacy, The University of Texas, Austin,TX and the Pharmacotherapy Education and Research Center, TheUniversity of Texas Health Science Center, San Antonio, TX

ChristopherR. Frei, PharmD, MSc

College of Pharmacy, The University of Texas, Austin,TX and the Pharmacotherapy Education and Research Center, TheUniversity of Texas Health Science Center, San Antonio, TX

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Notes for editors

"The rise in Clostridium difficile infection incidence among hospitalized adults in the UnitedStates: 2001 to 2010" appears in the American Journal of Infection Control, Volume 42, Issue 10 (October 2014).

About AJIC: American Journal of Infection Control

AJIC: American Journal of Infection Control covers key topics and issues in infection control and epidemiology. Infectionpreventionists, including physicians, nurses, and epidemiologists, rely on AJICfor peer-reviewed articles covering clinical topics as well as originalresearch. As the official publication of APIC, AJIC is the foremost resource on infection control, epidemiology, infectiousdiseases, quality management, occupational health, and disease prevention. AJICalso publishes infection control guidelines from APIC and the CDC. Published by Elsevier, AJIC is included in MEDLINE and CINAHL.

About APIC

APIC's mission is to create a safer world through prevention of infection. The association's more than 15,000 members direct infection prevention programs that save lives and improve the bottom line for hospitals and other healthcare facilities. APIC advances its mission through patient safety, implementation science, competencies and certification, advocacy, and data standardization. Visit APIC online at www.apic.org. Follow APIC on Twitter: http://twitter.com/apic and Facebook: www.facebook.com/APICInfectionPreventionandYou . For information on what patients and families can do, visit APIC's Infection Prevention and You website at www.apic.org/infectionpreventionandyou.