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C. diff surpasses MRSA infections in Southeast
Duke reports trend in 30 community hospitals
The epidemic of Clostridium difficile (C. diff) has eclipsed the nosocomial threat of methicillin-resistant Staphylococcus aureus(MRSA) in a group of community hospitals in the Southeast.
"Despite the amount of attention given to MRSA, our study shows that CDI has emerged as the leading healthcare-associated infection in our network of hospitals," said Becky Miller, MD, lead author of the study and an epidemiologist at Duke University Medical Center in Durham, NC. In addition, our study likely underestimates the true scope of the problem since we did not include cases of community-onset healthcare-associated CDI."
Miller and colleagues conducted a cohort study of patients at 30 community hospitals in the Duke Infection Control Outreach Network from Jan 1, 2008 to June 30, 2009. Cases were defined according to Centers for Disease Control and Prevention criteria. They found that C. diff infections (CDI) occurred 21% more often than healthcare-associated infections due to MRSA.
This is the first large study to use patient level surveillance data (i.e. numerators and denominators) to compare the rates of healthcare-associated CDI and MRSA. Previous studies were based on estimates using hospital ICD-9-CM discharge diagnosis codes. Over the 18-month period, which included more than 2 million patient days, researchers compared 607 cases of CDI and 508 cases of infections due to MRSA. Essentially, the C. diff epidemic has surpassed declining MRSA, which has been the target of multiple infection prevention interventions.
"Rates of HAIs due to MRSA have steadily decreased, however rates of nosocomial CDI have increased since 2007," Miller said recently in Atlanta at the Fifth Decennial International Conference on Healthcare-Associated Infections. "The etiology for the increase in nosocomial C. diff in our network of community hospitals is likely multifactorial. At this time we can only hypothesize what factors led to this change. First we may be witnessing the spread of the hypervirulent strain of C. diff into community hospitals. Second, there may have been changes in antibiotic prescribing patterns that may have contributed to increased risk for developing C. diff infection. Third, increased physician and other health care worker awareness may [have increased] diagnostic test ordering and therefore enhanced detection."