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Intractable C. Difficile Infection Linked to Multiple Care Settings

   February 26, 2015

Researchers find evidence of the deadly infection in care settings outside the hospital and in numbers greater than previously estimated.

Clostridium difficile infection sickened 453,000 people in the U.S. in 2011—80% more than previously reported—and was associated with 29,000 deaths that year, says a report from the Centers for Disease Control and Prevention.


Clifford McDonald, MD

"This is a tremendous burden of suffering and premature death, 80% of which occurs in people 65 and older who die within 30 days," says Clifford McDonald, MD, senior author of the study, which was published in the New England Journal of Medicine.

The study conducted lab-confirmed surveillance in 10 states—a population of 11.2 million people—and extrapolated the data nationally. It found a significantly larger number of cases than a 2013 CDC report which estimated 250,000 cases of C. difficile infections resulting in hospitalization which were associated with two types of care settings.

The new report looks more broadly across the healthcare continuum for infections and symptom onset and attributes acquired infections to four care settings:

  • Community-associated (a positive sample is collected in an outpatient setting or within three days after hospital admission indicating infection outside the hospital)
  • Community-onset associated with prior contact with a healthcare facility
  • Nursing home-onset
  • Hospital-onset

"This is our largest, most comprehensive snapshot, because we're looking at C. diff in the whole continuum of healthcare settings and the community," says McDonald, the CDC's senior adviser for science and integrity in the Division of Healthcare Quality Promotion. He emphasizes that the study should prompt more aggressive interventions by all healthcare facilities, especially with regard to more judicious and appropriate use of antibiotics, which predisposes patients to C. difficile illness.

Of the 453,000 cases identified, 293,000 were related to healthcare facilities. Of those infections:

  • 107,600 were hospital-onset
  • 104,400 were nursing home-onset
  • 81,300 were community-onset associated with a healthcare facility

Additionally, although people who were treated in hospitals made up about one-third of all C. difficile infections, two-thirds of those occurred after the patients were discharged.

Also of concern is that among those infected and whose infections were resolved, often after more than a week of illness and sometimes after surgery to remove the bowel, one in five patients experienced a recurrence. Cost is another concern. It is estimated that the cost to treat C. difficile is $4.8 billion a year in added U.S. healthcare costs.

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