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.
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
diarrhea and more serious intestinal conditions such as colitis.
● Watery diarrhea (at least three bowel movements per day for two or
● Loss of appetite
● Abdominal pain or tenderness
People in good health usually dont 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.
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,
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
"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
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
For further information on the SHEA-IDSA Clinical
Practice Guidelines for Clostridium difficile Infection in Adults,
>> Links from the
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.