Infections from Clostridium difficile on the rise in community hospitals

While prevention methods appear to be helping to lower hospital infection rates from MRSA, a deadly antibiotic-resistant bacterium, a new superbug is on the rise, according to research from the Duke Infection Control Outreach Network.

New data shows infections from Clostridium difficile are surpassing methicillin-resistant Staphylococcus aureus (MRSA) infections in community hospitals.

"We found that MRSA infections have declined steadily since 2005, but C. difficile infections have increased since 2007," said Becky Miller, M.D., an infectious diseases fellow at Duke University Medical Center.

C. difficile is a multi-drug resistant bacterium that causes diarrhea and in some cases life-threatening inflammation of the colon. The infections are currently treated with one of two antibiotics. But relapses are common and occur in one-quarter of patients despite treatment, according to Miller.

"This is not a nuisance disease," said Daniel Sexton, M.D., director of the Duke Infection Control Outreach Network (DICON). "A small percentage of patients with C. difficile may die, despite treatment. Also, it is likely that the routine use of alcohol-containing hand cleansers to prevent infections from MRSA does not simultaneously prevent infections due to C difficile."

Miller and her team evaluated data from 28 hospitals in DICON, a collaboration between Duke and 39 community hospitals located in Georgia, North Carolina, South Carolina and Virginia. The group tries to improve infection control programs by compiling data on infections occurring at member hospitals, identifying trends and areas for improvement, and providing ongoing education and leadership to community providers.

During a 24-month period, there were 847 cases of C. difficile infections in the 28 hospitals and the rate of C. difficile infection was 25 percent higher than the rate of infection due to MRSA.

Miller presented her findings at the Fifth Decennial International Conference on Healthcare-Associated Infections on March 20 in Atlanta, GA.

"C. difficile is very common and deserves more attention," she said. "Most people continue to think of MRSA as the big, bad superbug. Based on our data, we can see that this thinking, along with prevention methods, will need to change."

In the past, hospitals were focused on MRSA and developed their prevention methods on MRSA as the issue, Sexton said.

"I have always thought that we need to be looking more globally at all the problems and this new information about C. difficile provides more data to support that," he said.

C. difficile has been a low priority for hospitals, but now it is relatively important priority, Sexton said.

"The key is to develop prevention methods aimed at C. difficile while still maintaining the success we have had with MRSA," Miller said.