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Health & Medicine for Senior Citizens

Deadly Antibiotic-Resistant Bacterium, Clostridium Difficile, Passes MRSA Infections

Infectious disease experts issue new guidelines to meet new threat of CDI

March 22, 2010 - Senior citizens, the most frequent users of hospital services and nursing home care, were just enjoying the news that MRSA infections seem to be slacking off, and now a new threat has emerged. A deadly antibiotic-resistant bacterium, Clostridium difficile, a new superbug is on the rise, according to research from the Duke Infection Control Outreach Network.

New data released today shows infections from Clostridium difficile are surpassing methicillin-resistant Staphylococcus aureus (MRSA) infections in community hospitals.


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“We found that MRSA infections have declined steadily since 2005, but C. difficile infections have increased since 2007,” said Becky Miller, MD, an infectious diseases fellow at Duke University Medical Center.

Also, today, a joint panel of experts from the Society for Healthcare Epidemiology (SHEA) and the Infectious Diseases Society of America (IDSA) released online new clinical practice guidelines for Clostridium difficile infection (CDI) in adults. The guidelines, to be published in the May issue of Infection Control and Hospital Epidemiology, update recommendations regarding the epidemiology, diagnosis, treatment and infection control and environmental management of this disease.

CDI is the most commonly recognized cause of infectious diarrhea in healthcare settings and accounts for 20 percent-30 percent of cases of antibiotic-associated diarrhea. The infection manifests itself in a range from symptomless cases to mild or moderate diarrhea to sudden and sometimes fatal colitis.

Clostridium Difficile Infections

Also called: C. diff. infections, Clostridium enterocolitis, pseudomembranous colitis

Clostridium difficile (C. difficile) is a bacterium that causes diarrhea and more serious intestinal conditions such as colitis.

Symptoms include:
  ●  Watery diarrhea (at least three bowel movements per day for two or more days)
  ●  Fever
  ●  Loss of appetite
  ●  Nausea
  ●  Abdominal pain or tenderness

People in good health usually don’t get C. difficile disease. You might get the disease if you have an illness that requires prolonged use of antibiotics. Increasingly, the disease can also be spread in the hospital. The elderly are also at risk. Treatment is with antibiotics.

Centers for Disease Control and Prevention

>> More at MedlinePlus

The infections are currently treated with one of two antibiotics. But relapses are common and occur in one-quarter of patients despite treatment, according to Miller.

“This is not a nuisance disease,” said Daniel Sexton, MD, director of the Duke Infection Control Outreach Network (DICON). “A small percentage of patients with C. difficile may die, despite treatment. Also, it is likely that the routine use of alcohol-containing hand cleansers to prevent infections from MRSA does not simultaneously prevent infections due to C. difficile.”

Miller and her team evaluated data from 28 hospitals in DICON, a collaboration between Duke and 39 community hospitals located in Georgia, North Carolina, South Carolina, and Virginia. The group tries to improve infection control programs by compiling data on infections occurring at member hospitals, identifying trends and areas for improvement, and providing ongoing education and leadership to community providers.

During a 24-month period, there were 847 cases of C. difficile infections in the 28 hospitals and the rate of C. difficile infection was 25 percent higher than the rate of infection due to MRSA.

Miller presented her findings at the Fifth Decennial International Conference on Healthcare-Associated Infections on March 20 in Atlanta, Georgia.

“C. difficile is very common and deserves more attention,” she said. “Most people continue to think of MRSA as the big, bad superbug. Based on our data, we can see that this thinking, along with prevention methods, will need to change.”

In the past, hospitals were focused on MRSA and developed their prevention methods on MRSA as the issue, Sexton said.

“I have always thought that we need to be looking more globally at all the problems and this new information about C. difficile provides more data to support that,” he said.

C. difficile has been a low priority for hospitals, but now it is a relatively important priority, Sexton said.

“The key is to develop prevention methods aimed at C. difficile while still maintaining the success we have had with MRSA,” Miller said.

New Guidelines to Meet New Threat of Infection

Since publication of guidelines on CDI in 1995, there has been an increase in overall incidence of the infection, a more virulent strain of the infection has been identified, and evidence regarding the decreased effectiveness of a common treatment of the disease has been reported.

"As healthcare professionals and infectious disease experts, we are committed to developing recommendations based on the best available evidence and practices," said Neil Fishman, MD, president of SHEA.

"Since our original guideline was published fifteen years ago, our understanding of the epidemiology of CDI has changed, and requires us to update the way we diagnose and treat this serious infection."

The guidelines provide recommendations on the minimum data that should be collected in cases of CDI and how that data should be reported; the best testing strategy to diagnose CDI; the most important infection control measures for a hospital to implement during an outbreak of CDI; and recommendations on the most appropriate drug treatment for patients with CDI.

"The entire infectious disease community is striving toward making our hospitals and healthcare institutions safer for both patients, families and the healthcare professionals who work in them every day," said Rich Whitley, MD, president of IDSA.

"The work of this joint panel of the brightest minds in the field demonstrates how closely and seriously we are studying this infection."

While mortality rates associated with CDI have historically been low, occurring in less than 2 percent of cases, the financial burden to the healthcare system has been significant.

From 2000 to 2002, annual excess hospital costs in the U.S. for the management of CDI were estimated at $3.2 billion per year.

For further information on the SHEA-IDSA Clinical Practice Guidelines for Clostridium difficile Infection in Adults, visit:

>> Links from the CDC

Clostridium difficile Infections

Clostridium difficile [klo-STRID-ee-um dif-uh-SEEL] is a bacterium that causes diarrhea and more serious intestinal conditions such as colitis.

Background/General Information

  ●  Have you heard? Some retail meats contain C. difficile.
C. difficile, a bacterium which causes diarrhea and is primarily associated with healthcare settings.

Fact Sheets

  ●  Information About A New Strain Of Clostridium difficile July 2005

  ●  Clostridium difficile - General Information August 2004

  ●  Clostridium difficile - Information for Healthcare Providers August 2004


  ●  Clostridium difficile-associated disease: New Challenges from an Established Pathogen PDF (11 pages/475KB) CCJM February 2006


  ●  Clostridium difficile: An Emerging Threat PPT (2 MB)

  ●  Clostridium difficile Symposium - Changing Diagnosis, Epidemiology, and Treatment* SHEA Conference 2008

>> About Clostridium difficile Colitis, JAMA reprint pdf

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