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Incidents of Clostridium Difficile on the Rise

Infection with Clostridium difficile (C. diff) increased 173 percent in Pennsylvania hospitals between 1995 and 2005, according to a report released in May 2007 by the Pennsylvania Health Care Cost Containment Council (PHC4).

The report, which does not distinguish between community and hospital-acquired infections, found that incidences of C. diff in Pennsylvania hospitals rose from 7,026 in 1995 to 20,941 in 2005.

Patients with C. diff were hospitalized two and a half times longer, charged more than twice as much, and were four times as likely to die as patients without the infection.

The increase of C. diff has been linked to use of fluoroquinolones, third-generation cephalosporins, and clindamycin antibiotics, which alter the normal bacteria of the colon and cause over-production of toxins. This may cause diarrhea and colon inflammation, which, in severe cases, may lead to treatment in intensive care, surgical removal of the colon, and possible death.

For several years, the Pennsylvania Medical Society has been educating clinicians and the community about the importance of using antibiotics appropriately.

Physicians should ensure that C. diff cases are treated promptly. Discontinue use of the offending antibiotic and administer oral metronidazole. If treatment fails, consider using vancomycin.

Isolate patients in a room by themselves, use barrier precautions such as gowns, masks, and gloves, and use sporicidal agents to clean the environment.

Make sure anyone in contact with the patient is fastidious about hand washing because the infection can be spread by those who have contact with infected patients or touch surfaces contaminated with spores.

A study¹also linked proton pump inhibitors (PPIs) and H2-receptor antagonists (H2RAs) with an increased risk of C. diff. As with all medications, physicians should conduct a risk benefit assessment before prescribing PPIs and H2RAs for patients.

¹Dial S, Delaney JAC, Barkun AN, Suissa S. Use of Gastric Acid—Suppressive Agents and the Risk of Community-Acquired Clostridium difficile—Associated Disease. JAMA. December 21, 2005;294(23):2989-2995.