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Clostridium difficile Infection Incidence, Costs Reach Historic Highs
Community-onset Cases More Likely to Require Colectomy, Study Finds
By Lisa Curran
Still, the report found, many of these infections can be prevented, as demonstrated by a 20 percent reduction in hospital-onset CDIs among three state prevention programs conducted during a nearly two-year period.
- Clostridium difficile infections (CDIs) have emerged as a major problem in health care settings, the CDC reports, causing nearly 337,000 infections and 14,000 deaths each year.
- About 25 percent of CDI cases first show symptoms in hospital patients, while the other 75 percent show up first in nursing home patients or people recently cared for in doctors' offices and clinics.
- A recent study found that patients with community-onset CDI had colectomy rates four times higher than patients who developed symptoms while hospitalized.
The study findings come as no surprise to Doug Campos-Outcalt, M.D., M.P.A., of Phoenix.
"The community-onset cases that get to the hospital from the community are the severe ones, so it's expected that the colectomy rates would be higher," said Campos-Outcalt, who is chairman of the Department of Family, Community and Preventive Medicine at the University of Arizona College of Medicine, Phoenix, and the AAFP liaison to the U.S. Preventive Services Task Force. "The cases don't necessarily get counted unless they go to the hospital."
Community- versus Hospital-onset
Regardless of where they originate, however, much of the blame for the high prevalence of CDIs can be traced to a single factor, says the CDC: overuse of antibiotics.
It's a problem with which family physician Rupal Trivedi, M.D., of Clayton, Mo., is all too familiar.
"From what I've seen in my practice at St. Louis University, there is a large population of antibiotic-associated C. diff. -- mostly in older hospital and nursing home patients who were discharged and had to be readmitted because of C. diff.," she told AAFP News Now.
Key to thwarting the rise in CDIs, said Trivedi, is educating patients about antibiotic misuse and advocating preventive measures.
"It falls on the family physician to use antibiotics judiciously in the outpatient setting and educate patients on the possibility of this debilitating condition and means for early detection and treatment in the event it does occur," she said.
Infection Control Challenges
"We should have a high degree of suspicion with any diarrheal illness so that cases will be quickly identified, isolated and treated," said Juckett, who is a professor of family medicine at West Virginia University in Morgantown.
Juckett said it is sobering how easily C. difficile spores can spread. According to the CDC, C. difficile spores are transferred to patients mainly through the hands of health care personnel who have touched a contaminated surface or item because the spores are not necessarily killed by hand sanitizer or hand-washing. The agency recommends that health care professionals wear gloves and gowns when treating patients with CDI and that room surfaces be cleaned with bleach or another Environmental Protection Agency-approved sporicidal disinfectant after a patient with a CDI has been treated there.
"Our overuse of antibiotics is largely responsible, so, in effect, we are reaping what we have sown," Juckett noted.
Concern about overuse of antibiotics is hardly a new development. The CDC launched its Get Smart for Healthcare campaign in 1995 to combat inappropriate antibiotic use. And although progress has been made, the agency reports, still about 50 percent of antibiotics given are not needed, raising the risk for CDIs and, in the long term, boosting the likelihood that drug-resistant bacteria emerge.
The Academy also recently addressed antibiotic overuse -- specifically, for acute mild-to-moderate sinusitis -- as part of the national Choosing Wisely campaign.
AAFP News Now Online Editor Matt Brown contributed to this story.
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