C. Diff Infections Are Falling, Thanks To Better Cleaning And Fewer Antibiotics
Thursday, June 29, 2017
The risk of getting a deadly, treatment-resistant infection in a hospital or nursing home is dropping for the first time in decades, thanks to new guidelines on antibiotic use and stricter cleaning standards in care facilities.
The rate of new Clostridium difficile or C. diff infections climbed year after year from 2000 to 2010, researchers found. But an early look at 2011-2014 data from the Centers for Disease Control and Prevention's Emerging Infections Program suggests infection rates are improving.
"Preliminary analyses suggest a 9 to 15 percent decrease in health care [C. diff] incidence nationally," says Dr. Alice Guh, a medical officer at the CDC. "It's very encouraging, but there's still a lot to do."
C. diff infections can cause severe diarrhea and are extremely painful, as Ruth Zimmer, an 87-year-old woman from Lexington, Ky., can attest. "It was a lot of diarrhea," she says. "It was a gripping stomach pain. It was very nasty and debilitating, but I survived."
People most commonly come into contact with the bacterium in health care settings, where many patients are carriers.
"In a nursing home, 20 to 50 percent of residents are colonized with it at any point," says Dr. John Haran, an assistant professor of emergency medicine at the University of Massachusetts Medical School. In hospitals, it's anywhere from 10 to 26 percent of patients, he says.
Most of them carry the bacterium without experiencing any disease, because other bacteria living in the gut can help keep C. diff in check, Haran says. But certain antibiotics can exterminate large swaths of the natural human microbiome, clearing the way for remnant C. diff bacteria to take over and cause a dangerous infection.
C. diff bacterium is hardy, too. It leaves the body in a spore form that can't be killed with conventional cleaning techniques. These can linger on equipment and surfaces until another person picks them up and ingests them.
"You can recover spores months later if you don't do a terminal clean with UV light or bleach or something," says Dr. Dimitri Drekonja, an infectious disease physician at the Minneapolis VA hospital and the University of Minnesota.
By 2011, C. diff had gained a lot of notoriety as a deadly and common hospital bug.
"It was estimated that C. diff infection was the most commonly reported infection [acquired in healthcare settings] nationally. That generated a lot of awareness," Guh says. Alarmed by the rapid rise in C. diff infections, she says more hospitals introduced antimicrobial stewardship programs aimed at tackling the problem.
The programs included guidelines to restrict unnecessary antibiotic prescriptions, as well as aggressive new cleaning and infection control protocols. She thinks those changes may now be driving down the infection rate.
One of the clearest examples of this is in the VA hospital system, which began an aggressive C. diff prevention program in 2012 that included restricting antibiotics closely associated with C. diff infections and meticulously disinfecting every spot in a room that held a patient with infectious diarrhea.
"It was things like making sure that patients identified with C. diff are identified with a sign and have appropriate precautions," Drekonja says. "We should always be washing our hands every time we see a patient, but a sign that says this person has infectious diarrhea helps."
In 2014, the VA issued a directive ordering all of its hospitals to implement antimicrobial stewardship programs, and last year, it reported that C. diff infections had dropped by about 15 percent from 2012 to 2015.
The vigilance spawned from C. diff and other dangerous infections may have had some other positive impacts, too. New data from the Institute for Health Metrics and Evaluation in June showed a decrease in all diarrheal disease deaths in the United States from 2010 to 2015.
"All the things you're doing with hand hygiene and cleaning very well and reducing unnecessary antibiotic use – that will help not just with C. diff but with others," including infections from MRSA and E. coli, Drekonja says.
That's given Drekonja some fragile optimism about the situation, but he says hospitals can never stop being vigilant against dangerous microbes. "In all honesty, we will never beat them back. We'll never eliminate antibiotic resistance. They have time and evolution on their side," he says.
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