Intestinal Infection Widespread Throughout U.S. Hospitals

A serious and life-threatening bacterium known as Clostridium difficile has become far more common in U.S. hospitals than previously thought. Clostridium difficile Infection (CDI) causes diarrhea as well as more serious intestinal conditions and is now affecting as many as 13 out of every 1,000 hospital patients within the United States. This rate of infection is 6.5 to 20 times greater than previously estimated, according to the Association for Professionals in Infection Control and Epidemiology (APIC), alerting healthcare professionals to the urgent need for better hygiene and more cautious use of antibiotics.

Approximately 7,200 hospital patients suffer from CDI on any one given day. And, as the U.S. population continues to grow older and frailer, many more patients will be at risk of the sometimes fatal infection according to healthcare epidemiologist Dr. William Jarvis, who led the study. In a telephone interview, Jarvis said, “You can get disease that ranges all the way from simple diarrhea all the way to perforation of the bowel requiring surgery, shock and death.”

The 12,000 members of APIC collected data about all CDI patients on one single day between May and August 2008 at 648 American hospitals. The data gathered covered 12.5 percent of all U.S. medical facilities including patient of all types from acute care, cancer, cardiac, children’s, long-term care and rehabilitation hospitals.

Jarvis said that the comprehensive, one-day snapshot was representative of the entire nation as a whole and revealed that a surprising number of people were infected. He went on to note, “We are still trying to get a grip on it,” and pointed out that because the bacteria are hard to grow in culture, doctors commonly order a test that does not detect the infection in about 25 percent of cases. In addition, CDI is not a reportable disease. Therefore, few records are kept regarding it.

The study also showed that over half of the patients with CDI had been hospitalized for under 48 hours, suggesting that many patients may have acquire the infection prior to hospitalization.

Jarvis explained that since antibiotics kill natural bacteria in the gut, bacterium such as Clostridium difficile are allowed to invade and to flourish. Furthermore, CDI makes spores that are not killed by the use of non-bleach cleaners or alcohol-based hand rubs. He said, “Antibiotics don't kill it and most germicides used for environmental cleaning don't kill it. Only bleach does.” Therefore, by the time patients are diagnosed with CDI, their rooms and everyone who has had contact with them have already been contaminated.

According to U.S. federal government figures released in April of this year, there has been a 200 percent increase in the number of hospital patients with CDI from 2000 to 2005. Government health officials agreed that the rate cited by the new study is consistent with estimates that incidents of CDI have increased to approximately half a million people this year.

The results of the study are also consistent with an estimate by the Center For Disease Control (CDC) that as many as 500,000 people are diagnosed with CDI each year, according to Cliff McDonald, a CDC epidemiologist in the division of health care quality promotion. The CDC had estimated 134,000 hospital stays from CDI in 2000 and 291,000 in 2005.

Britain's Health Protection Agency also reported in July that CDI cases increased by 6 percent in the first quarter of 2008.

The survey was released at APIC’s conference Clostridium difficile: A Call To Action that took place in Orlando, Florida. The study will also be published in the American Journal of Infection Control.