The rate of Clostridium difficile infection in U.S. hospitals nearly doubled from 2001 to 2010, according to a study in the October issue of the American Journal of Infection Control. Researchers from the University of Texas College of Pharmacy analyzed data from the U.S. National Hospital Discharge Surveys and found that rates of CDI rose from 4.5 to 8.2 discharges per 1,000 total adult hospital discharges over that time period.
Several factors may have contributed to the rise in CDI incidence in recent years, Kelly Reveles, PharmD, PhD, the studys lead author, said in a news release. Antibiotic exposure remains the most important risk factor for CDI.
These data represent 2.2 million adult hospital discharges for CDI over the study period. The study also concluded that there is little evidence of improvement in patient mortality or hospital length of stay.
About 7.1% of patients died during the study period, representing 154,184 deaths among adults with CDI from 2001-2010. According to the study, overall patient mortality increased slightly, but significantly, during the study period, from 6.6% in 2001 to 7.2% during 2010. Patients with secondary CDI had significantly higher mortality (8.8%) compared with patients with principal CDI (3.6%). Patients with secondary CDI experienced an increase of 2.5% mortality during the study period. Conversely, patients with principal CDI experienced a decline in mortality, from 5.4% in 2001 to 2.8% in 2010.
Our study reveals the increasing burden of CDI among hospitalized adult patients in the U.S. in recent years, the study authors said in the release. Furthermore, little improvement was observed for clinically relevant outcomes, including patient mortality and hospital LOS.
Several factors may have contributed to the rise in CDI incidence in recent years, according to the study. Antibiotic stewardship programs play a critical role in improving prescribing practices and promoting more judicious antimicrobial agent use, the authors wrote. In fact, numerous reports have shown a reduction in CDI incidence following implementation of antimicrobial stewardship programs or specific antimicrobial restriction policies.
The study lists advanced patient age as another important risk factor for CDI, stating patients age 65 years or older are at significantly higher risk of developing CDI compared with younger patients. This is attributable to changes in immunity, exposure to antibiotics and other predisposing medications (e.g., gastric-acid suppressing medications), comorbid illness and frequent hospitalizations, according to the study.
The changing molecular epidemiology of C difficile may also influence CDI incidence in hospitals. Resource use and mortality remain a great concern for patients with CDI.
CDI incidence peaked during 2008 (8.6 CDI discharges per 1,000 total adult discharges) and slightly declined through 2010. The leveling off of CDI incidence toward the end of our study period may be the result of increased antibiotic stewardship programs and improved infection control, the authors said. According to a survey of infection preventionists, 52% of hospitals had implemented antibiotic stewardship programs by 2010. This proportion has since increased to 60% in 2013.
Furthermore, infection preventionists report increased efforts in infection control measures, such as use of contact precautions, cleaning and disinfection of equipment and environment, and hand hygiene.
Beginning in January 2013, the Centers for Medicare and Medicaid Services began to require public reporting of CDI rates via the National Healthcare Safety Network for those hospitals participating in the Inpatient Prospective Payment System. Mandatory public reporting programs in Canada and the United Kingdom have already resulted in a reduction in CDI during recent years. The results of our study underscore the importance of directing resources to the prevention of CDI, as well as developing public policy for reducing the incidence of these in infections in hospitals worldwide, the authors said. CDI treatment and prevention initiatives should remain a national priority.
In July, AHA and six national partners released a toolkit to help hospitals and health systems enhance their antimicrobial stewardship programs, according to a news release. A 2013 AHA Physician Leadership Forum white paper stated appropriate use of antibiotics is one of five areas where hospitals, in partnership with their clinical staff and patients, should look to reduce non-beneficial care through appropriate use of medical resources.
Read the study: http://www.ajicjournal.org/article/S0196-6553%2814%2900898-0/fulltext