Blog | Thursday, March 8, 2012

QD: News Every Day--C. diff prevention in hospitals has to start in the community

Most Clostridium difficile infections (CDIs) are related to nursing homes and similar settings where patients receive predisposing antibiotics and C. difficile transmission occurs, according to research by the Centers for Disease Control and Prevention.

Three programs were reviewed to come to the conclusion: the CDC's Emerging Infections Program, the National Healthcare Safety Network (NHSN) Multidrug-Resistant Organism and Clostridium difficile Infection module for laboratory-identified (LabID)-CDI events, and early results from three state-led programs in Illinois, Massachusetts and New York. Results appeared online March 6 at the Morbidity and Mortality Weekly Report.

The Emerging Infections Program included persons in the catchment areas of 111 acute-care hospitals and 310 nursing homes. More than 10,000 CDIs were identified; 44% of patients were aged less than 65 years. Overall, 94% of all CDIs were related to other health-care exposures. Of these, 75% had their onset outside of hospitals. Also, 20% of hospital-onset CDIs occurred in recent residents of a nursing home, and 67% of nursing home-onset CDI cases occurred in patients recently discharged from an acute-care hospital.

A total of 711 acute care hospitals in 28 states conducted facility-wide inpatient LabID-CDI event reporting to NHSN in 2010. More than 42,000 LabID-CDI events were reported. Overall, 52% of LabID-CDI events were already present on admission to hospitals. The pooled rate of hospital-onset CDI was 7.4 per 10,000 patient-days, with a median hospital rate of 5.4 per 10,000 and an interquartile range of 6.2.

The pooled hospital-onset CDI rate across the three states' prevention programs declined 20%, from 9.3 per 10,000 patient-days.

Report authors noted in MMWR that these findings emphasize how the risk for CDI from antibiotic exposure and transmission moves with patients across multiple health-care settings. Antibiotics received in one setting often predispose a patient to develop an infection in another.

Because the incubation period is a median of only 2 to 3 days, acquisition of C. difficile is overall more likely to have occurred in the setting where symptoms have their onset and CDI is diagnosed.

"Because nearly 75% of all CDIs related to U.S. health care have their onset outside of hospitals, more needs to be done to prevent CDIs across all health-care settings," the authors concluded.