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CDC: Nearly 500,000 C. difficile infections in US in 2011
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Nearly half a million Clostridium difficile infections occurred in the United States in 2011, of which 83,000 recurred at least once and 29,000 were associated with death within 30 days of first diagnosis, according to new study data released by the CDC.
This study “gives us a better picture of where C. difficile infections are happening,” Michael Bell, MD, deputy director of CDC’s Division of Healthcare Quality Promotion, said during a media briefing. “In both nursing homes and hospitals, we’re seeing similar numbers of infections — about 100,000 infections each. Although people receiving care in hospitals made up two-thirds of all infections, two-thirds of those actually occurred after the patient went home. It’s essential that patients and their clinicians be aware that they need to take any diarrhea following antibiotic use very seriously.”
Michael Bell
To provide better estimates of the national burden of C. difficile infection, the CDC expanded its active population- and laboratory-based surveillance, started in 2009 as part of its Emerging Infections Program, from seven to 10 U.S. sites in 2011. The surveillance spans 34 geographically diverse counties with a total population of approximately 11.2 million. All positive C. difficile test results were identified from 88 inpatient and 33 outpatient laboratories throughout the calendar year. Cases were identified as either community-associated or health care-associated, and national incidence, total infections, first recurrences and 30-day mortality were estimated using regression models. Molecular typing also was performed using a sample population’s specimens.
The investigators identified 15,461 cases of C. difficile infection (occurring in 14,453 patients), 65.8% of which were health care-associated vs. 24.2% hospital-onset. The estimated overall incidence (adjusted for predictors of disease incidence) was 453,000 (95% CI, 397,100-508,500). Incidence estimates were higher in women (rate ratio = 1.26; 95% CI, 1.25-1.27), whites (rate ratio = 1.72; 95% CI, 1.56-2) and adults aged 65 years or older (rate ratio = 8.65; 95% CI, 8.16-9.31).
The national burden estimate for health care-associated cases was 293,300 (95% CI, 264,200-322,500), of which it was estimated that 107,600 (95% CI, 97,200-118,000) had hospital-onset, 104,400 (95% CI, 94,100-115,800) had nursing home-onset and 81,300 (95% CI, 72,900-89,000) had community-onset associated with a health care facility.
The estimate for overall number of first recurrences was 83,000 (95% CI, 57,000-108,900) and the estimate for overall number of deaths was 29,300 (95% CI, 16,500-42,100). Isolate characterization using samples from a subset of 1,364 patients showed that the North American pulsed-field gel electrophoresis type 1 (NAP1) strain was more prevalent in health care-associated vs. community-associated infections (30.7% vs. 18.8%; P < .001).
Tom Frieden
Bell said, “Overall, there are two main things that need to be improved:” making sure antibiotics are only used as necessary, and “ensuring rigorous infection control in all health care settings.”
“C. difficile infections cause immense suffering and death for thousands of Americans each year,” CDC Director Tom Frieden, MD, MPH, said in a press release. “These infections can be prevented by improving antibiotic prescribing and by improving infection control in the health care system. The CDC hopes to ramp up prevention of this deadly infection by supporting State Antibiotic Resistance Prevention Programs in all 50 states.” The CDC’s National Strategy to Combat Antibiotic Resistant Bacteria also will improve antibiotic stewardship, outbreak surveillance and antibiotic resistance prevention over the next 5 years, the release said. – by Adam Leitenberger
Disclosure: This study was funded by the CDC. Disclosure forms provided by the authors are available with the full text of this article at NEJM.org.
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