Deadly C diff. infections higher than thought, report finds

Bacteria caused 453,000 infections in 2011 and was associated with 29,000 deaths according to a new Centers for Disease Control and Prevention study.

Dangerous and often deadly cases of healthcare-associated clostridium difficile bacteria infections were almost double estimates in 2011, a new report has found, adding new urgency for health systems to change practices to avoid an epidemic or steep financial penalties.

Clostridium difficile, or C. diff caused 453,000 infections in 2011 and was associated with 29,000 deaths, up from an estimated 14,000, according to a new Centers for Disease Control and Prevention study in the New England Journal of Medicine.

C. diff causes colon inflammation and severe diarrhea. It is increasingly antibiotic-resistant, and is being driven largely by overuse of antibiotics, the CDC said. Of the 29,000 deaths in patients diagnosed with C. diff, 15,000 were directly attributed to the bacteria infection, with more than 80 percent of those patients being senior citizens. Those who do survive have a significant chance of a recurrence -- about 20 percent.

“C. difficile infections cause immense suffering and death for thousands of Americans each year,” said CDC Director Tom Frieden, MD.  “These infections can be prevented by improving antibiotic prescribing and by improving infection control.”

Almost all of the C. diff infections identified in the study were contracted in hospitals or through contact with other healthcare facilities, the CDC found.

[Also: Medicare penalizes 721 hospitals over medical errors [full list]]

About 65 percent of the 453,000 infections came during an inpatient hospital stay -- although 75 percent of those patients didn’t develop symptoms until after they were discharged -- and 82 percent of the 150,000 cases of community-acquired C. diff. infections were in individuals who had visited outpatient health centers such as doctors offices.

For Frieden and other health officials, the new data makes urgent the need for providers to reconsider how and when they use antibiotics. More than than half of hospitalized patients will get an antibiotic at some point, but according to the CDC at least 30 percent and as many as half of all those treatments are unnecessary.

“When a person takes broad-spectrum antibiotics, beneficial bacteria that are normally present in the human gut and protect against infection can be suppressed for several weeks to months,” the CDC explained. “During this time, patients can get sick from C. difficile picked up from contaminated surfaces or spread person to person.” People who were infected with C. diff can continue to shed spores for weeks or even months afterwards, leaving a trail behind in outpatient health clinics that otherwise healthy people may be susceptible to if they’re taking antibiotics.

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The nearly half-a-million individuals impacted by C. diff each year also adds up financially, costing health systems more than $5 billion annually. But the condition also causes great suffering. The CDC in a conference call highlighted the case of Peggy Lillis, who died at the age of 56 in April 2010, 36-hours after contracting C. difficile most likely in a dentists office. Her son Christian now spearheads the Peggy Lillis foundation, promoting “robust antibiotic stewardship and sanitation and hygiene programs at every healthcare facility” and mandatory public reporting in every state.

C. difficile is one of the areas that hospitals are set to be penalized for by Medicare, along with methicillin-resistant Staphylococcus aureus. And according to other federal data, between 2010 and 2013 antibiotic-resistant C. diff increased 16 percent in hospitals, from 2.6 to 3.1 per 1,000 patients.

The one bright spot, according to the CDC, is that an emerging if unusual C. diff treatment has a high potential for success — microbiota transplants, which have success rates as high as 90 percent, a New England Journal of Medicine study found.

“One of the things that holds out some promise is fecal transplantation,” said senior press officer Benjamin Haynes, in a conference call. “What we know is that returning the bowel to its normal state in terms of the types and variety of bacteria that live there normally is one way that we can return a person to health. And the sooner that happens, the less likely they are to have recurrences of C-difficile infection. So, originally this was sort of a last-ditch desperation-type treatment. I think increasingly we're seeing it move earlier into the process.”

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While the Food and Drug Administration is still considering how to regulate these treatments, hospitals can secure permission to oversee fecal transplants -- because in the absence of availability some desperate patients are performing them on a DIY basis with the help of family or friends. Hospitals can also work with organizations like Open Biome, which is supplying tested transplant material to more than 150 hospitals in 36 states. 

Twitter: @AnthonyBrino