CDC Plans Program to Combat Clostridium Difficile Infections

Amy Jacob

To help hospitals implement antibiotics prescribing improvement programs, the CDC has developed several tools and guidelines and has begun partnering with states to implement stewardship programs, awareness campaigns, and stringent checklists.

Clostridium difficile (C. difficile) is the underlying culprit in nearly half a million infections among patients in the US in a single year, according to a recent tele-briefing hosted by the Centers for Disease Control and Prevention (CDC).

Patients receiving antibiotics have been found to be at risk for not just mild diarrhea, but also for toxic mega colon as well, which can damage the bowels so severely as to warrant surgical removal of the colon.

C. difficile infections cause immense suffering and death for thousands of Americans each year,” said CDC Director Tom Frieden, MD, MPH. “These infections can be prevented by improving antibiotic prescribing and by improving infection control in the health care system. CDC hopes to ramp up prevention of this deadly infection by supporting State Antibiotic Resistance Prevention Programs in all 50 states.”

Prior studies indicated that C. difficile has become the most common microbial cause of health care-associated infections in US hospitals and costs up to $4.8 billion each year in excess health care costs for acute care facilities alone.

The CDC study found that 1 out of every 5 patients with a healthcare-associated C. difficile infection experienced a recurrence of the infection, and 1 out of every 9 patients aged 65 or older with a healthcare-associated C. difficile infection died within 30 days of diagnosis. More than 100,000 C. difficile infections develop in US nursing home residents annually. However, only 24 percent of the total cases occurred among patients while they were hospitalized.

According to the study, “Almost as many cases occurred in nursing homes as in hospitals, and the remainder of the healthcare-associated cases occurred among patients who were recently discharged from a health care facility.”

Another recent CDC study found that 82 percent of patients with community-associated C. difficile infections reported exposure to outpatient health care settings such as doctor’s or dentist’s offices in the 12 weeks prior to their diagnosis. This highlighted the necessity for improved antibiotic use and better infection control, as almost 50 percent of antibiotics are allegedly prescribed unnecessarily in outpatient settings for upper respiratory infections like cough and cold illness.

Furthermore, a retrospective study from a Canadian hospital indicated a 10 percent decrease in overall antibiotic use across different wards was associated with a 34 percent decrease in C. difficile infections.

To help hospitals implement antibiotics prescribing improvement programs, the CDC has developed several tools and guidelines and has begun partnering with states to implement stewardship programs, campaigns, and stringent checklists.

To establish national reduction targets for C. difficile, all hospitals participating in the Centers for Medicare & Medicaid Services’ (CMS) Hospital Inpatient Quality Reporting Program have been reporting C. difficile infection data to the CDC since 2013.

CMS Acting Principal Deputy Director Patrick Conway, MD, said, “CMS invests in structured learning and improvement opportunities for hospitals and communities through Quality Improvement Organizations. The Quality Innovation Networks systematically support clinicians in the sharing of best practices in antibiotic stewardship and prevention of C. difficile.”

The funding proposed in CDC’s FY 16 budget would work with health care facilities in all 50 states to detect and prevent both C. difficile infections and antibiotic-resistant organisms. Over the next 5 years, CDC’s will further work to battle C. difficile infections and antibiotic resistance and will enhance national capabilities for antibiotic stewardship, outbreak surveillance, and antibiotic resistance prevention. These efforts hold the potential to cut the incidence of C. difficile infections in half.