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C. diff hospitalizations, deaths nearly double
Toxic strain, aging population likely factors
An aging population and the emergence of a hypervirulent strain are combining to make Clostridium difficile disease a killer. Hospitalizations and deaths from C. diff-associated disease (CDAD) are on the rise in the United States.
The incidence of adult CDAD hospitalizations doubled from 5.5 cases per 10,000 population in 2000 to 11.2 in 2005, and the CDAD-related age-adjusted case-fatality rate rose from 1.2% in 2000 to 2.2% in 2004, researchers found.1 In addition to a near doubling of deaths, their analysis detected a 23% annual increase in CDAD hospitalizations in the six-year period from 2000 through 2005. One factor is likely increased virulence of the organism, specifically the emergence of a highly virulent strain (NAP1) that is 20 times more toxic than typical C. diff. The study appears to reflect the consequences of NAP1 emergence in terms of hospitalizations and deaths, but another factor may be the aging of the population, the lead author tells Hospital Infection Control.
"There are other reports of this hypervirulent strain and that may be responsible for what we are seeing — at least partially," says Marya Zilberberg, MD, founder and president of EviMed Research Group LLC in Springfield, MA. "My own personal sense is that our population [also] is getting older and sicker; there is a lot more chronic disease then there used to be. That predisposes you to C. diff disease," she adds.
Whatever the reasons, increasing hospitalizations and mortality trends make preventing C. diff transmission all the more important. As a start, infection control professionals should establish surveillance systems for the pathogen and verify their local situation.
"All hospitals should really consider surveillance of some kind," Zilberberg says. "No. 2, obviously cleaning isolation of cases, barrier precautions, those are all things that can prevent the spread of C. diff from person to person. But it is very important to understand where you stand currently as an institution. If you don't quantify things, A: you don't recognize them as a problem; and B: you can't fix them. Every institution really needs to ask the question how much C. diff do we have?"
The researchers identified CDAD-related hospitalizations for 2000-2005 from the National Inpatient Sample data, available on the Healthcare Costs and Utilization Project Net web site, administered by the Agency for Healthcare Research and Quality. The National Inpatient Sample is a stratified 20% sample of U.S. community hospitals, and the data are weighted to provide national estimates. CDAD was identified by the presence of the International Classification of Diseases, 9th revision; Clinical Modification (ICD-9-CM); diagnosis code 8.45 (intestinal infection with Clostridium difficile), and the numbers of discharges per year were age-stratified.