Until recently, local infectious disease specialist Dr. Mark Anderson almost never saw patients die from a bacterial infection known as Clostridium difficile, or c. diff.
That’s changed.
“I’m actually seeing deaths now, and on a pretty regular basis in this area,” Dr. Anderson said.
He estimated that the three infection specialists in his practice are seeing one to two deaths per month, most of whom are elderly and frail patients. “Within the last five to six years, c. difficile has really changed and become a much more virulent organism.”
Across the country, c. diff. is sickening more people to more severe levels. Experts attribute the rise in serious cases of the previously manageable disease to more use of antibiotics, which has allowed the bug to build up resistance.
Though c. difficile infections are not tracked nationally or at the state level in Tennessee, Georgia or Alabama, a new study shows that the incidence is higher than expected.
“I think this is a wake-up call for a lot of patients and physicians to really look at how they (take and) prescribe antibiotics,” said Dr. Marion Kainer, medical epidemiologist with the Tennessee Department of Health.
A recent report by the Washington, D.C.-based Association for Professionals in Infection Control and Epidemiology found that 13 out of every 1,000 patients, or about 7,178 inpatients on any given day, were infected or colonized with C. difficile. The rate is 6.5 to 20 times higher than previous incidence estimates that were based on more limited data, said the study’s lead author, Dr. William Jarvis, a former epidemiologist with the U.S. Centers for Disease Control and Prevention.
Like methicillin-resistant Staphylococcus aureus, or MRSA, a drug-resistant staph infection, c. diff is associated with growing antibiotic use.
Almost 73 percent of the cases reported to the APIC study were acquired within a hospital, but doctors here and throughout the United States now are hearing reports that even people who have not been hospitalized recently or exposed to antibiotics are coming down with the sickness.
“Some of this is not understood as to why this is happening, but it’s just like MRSA,” said Gwen Davis, director of infection prevention at Memorial Hospital. “It used to be a hospital bug, and now it’s in the community.”
A fearfully high-powered strain of the bacterium has emerged in 39 states and the District of Columbia, including Tennessee and Georgia, as well as Canada and a number of European countries, said Dr. Carolyn Gould, medical epidemiologist with the CDC.
“It’s certainly a very high priority for us,” Dr. Gould said.
LOCAL and regional incidence
Hospitals here have been doing some tracking on their own to monitor c. diff. They say efforts to reduce and monitor antibiotic use, as well as emphasize hand-washing and thorough cleaning of hospital equipment and rooms, are paying off.
“Five, six years ago, we were seeing an onslaught of this particular problem, but now we’re seeing much less,” said Ms. Davis.
At Memorial and Parkridge hospitals, officials are seeing fewer than 10 cases of c. diff per month. Five years ago, Memorial was seeing closer to 50 to 75 cases per month, officials said.
In 2003, Erlanger hospital reported 62 laboratory-confirmed cases, but that grew to 155 cases in 2006, the last full year of available data. The incidence seems to have lessened in recent months, averaging about seven per month, said Coretha Weaver, infection control coordinator at Erlanger.
Hand-washing — with soap and water, not just an alcohol sanitizer — still is the best way to prevent the spread of c. difficile, in addition to thorough cleansing of the hospital environment with bleach, hospitals officials said.
Infection control specialists at Chattanooga hospitals, as well as Hutcheson Medical Center in Fort Oglethorpe and Hamilton Medical Center in Dalton, Ga., said they are focusing on “antibiotic stewardship.”
Inappropriate use of antibiotics “gives rise to more resistant and powerful c. diff” strains, said Dr. Gale Fellowes, chief medical officer at Memorial Hospital. “It’s absolutely critical that as health care providers we do a better job of controlling our use of antibiotics, so when they’re needed we use them, but we use them as carefully as possible.”
Georgia health officials recently have received a grant to track the infection in the eight-county Atlanta region and will make state projections about its incidence, said Dr. Katie Arnold, infectious disease epidemiologist with the Georgia Division of Public Health.
In Tennessee there are no immediate plans to make c. diff. a reportable disease, because that takes a significant investment of resources and does not necessarily help in prevention, Dr. Kainer said.
Health care reporter Emily Bregel has worked at the Chattanooga Times Free Press since July 2006. She previously covered banking and wrote for the Life section. Emily, a native of Baltimore, Md., earned a bachelor’s degree in American Studies from Columbia University. She received a first-place award for feature writing from the East Tennessee Society of Professional Journalists’ Golden Press Card Contest for a 2009 article about a boy with a congenital heart defect. She ...
The link to the CDC fact sheet on C.Diff states has some misinformation. To prevent the spread of C.Diff experts have said washing hands with soap and water is the only way to prevent the spread. But their FAQ states: "To prevent C. diff. infections, doctors, nurses, and other healthcare providers:Clean their hands with soap and water or an alcohol-based hand rub before and after caring for every patient." This fact sheet is out of date and should be changed.
My family is outraged.Our mom died from C-Difficile,From a so called well respected Hospital we thought.Our Mom is in Heaven But we are outraged how she got there.She died a torturess death.After surgery she was put in a room all rooms around her had signs on doors for gloves and gowns to enter them.As we watched nurses leave those rooms no gloves or gowns,and rolling a blood pressure machine from room to room without being cleanded.Mom had to go back to Sicu. a family of 10 asking questions,just hearing its natural to have surgery and your insides take longer to wake up.We heard this for weeks.A Heart specialists stopping 5 of us in the hall telling us to make them do another major surgery it would be better to die on the operating table as to lay there in pain being tortured he would rather be shot in the head as to suffer what she was..we had stomach dr's and atlanta cdc have a conferense with the family saying if they would have caught c-diff after her surgery mom would be home doing what she she loved doing.mom was little when she went in and had to have major surgery after laying there weeks in torturess pain ,her stomach swelled like a beach ball about to burst.We watched her suffer and die.I could write you a book on how this hospital treated her so bad seeing her tears begging in pain.This Hurt inside us,what we had to watch her suffer for weeks begging pleading with this hospital only to get put down.Many passed with c-diff,because of carelessness,This hospital needs to be held accountable for what they did how they let her suffer.i could write you a book of all the wrongs.Please if any of your family members died from this come forward no family should have to see what we did.I'm thankful she is in Heaven,But how she got their no one should ever have to go through.I close my eyes and see this nightmare sleeping in a computer chair 2 of us in sicu because she was terified of some nurses and the pain was torture.I wish everyone of the staff and Doctors see her face eveerytime they close their eyes and admit the mistakes they made.Money is no issue to me,But it was to them,They do not treat patents with love caring ,they are just people there a job is all to them.We are suffering now her 10 kids ,grandkids,greatgrandkids,her friends her family.We will not stop until they admit their wrong.I held my mother in my arms until she took her last breath my hand on her chest until her last heart beat.Please come forward so your family never has to go through this your loved one die this way,help us stop them please.I have plenty more i'll save for court my heart my nightmares will not stop i hurt so bad my childern do.Hand sanitizers used but the only way to kill this disease is hot water and soap.
Clostridium difficile is a bad infection. The above comments leave you to think this is only acquired in a hospital and is caused by the hospital staff activities. This is not always true. It can be acquired in the hospital. However, as hospital staff are tracking this organism more and more, they are seeing this coming into the hospital with the patient. This can be acquired in the ocmmunity as well as in a hospital. Many of us have this organism in our gut as we speak. This organism does no harm as long as it is in proportion to the other normal flora in the gut. When a person is challenged with high level antibiotics, the normal flora is killed out and the Clostridium difficile is allowed to over grow and product its damaging toxins. However, these patients would not survive their infections without these antibiotics. So it is sort of a catch 22 situation. Our hospitals strive to adhere to great disease transmission precautions such as isolation, hand hygiene, and building cleaning with approved products that will stop the spread of infections. We have seen a great decrease in this organism as hospitals have understood its transmission activities. All our hospitals are striving very had to limit this organism. Some things the patient can do to help the hospital limit the spread of this organism are reminding all staff to cleanse their hands (alcohol is better than nothing), wear gown and gloves to care for you if you have diarrhea after taking antibiotics, and having all visitor to cleanse their hand. Healthcare is striving to eliminate this organism. They are doing a good job. It is sad that some people do get this with not so good outcomes. It isn't intentional. We do live in a world of all sorts of bacteria. We can't live without them, even the C. diff. We do, however, need to be respectful of them. One way every citizen can help stop the spread of multiple drug resistant organisms is to stop pressing your physician for an antibiotic for a cold, flu, or other viral illness. Eventhough is appears to help, it really doesn't. You would be getting better from the virus anyway. The antibiotic did not cause the improvement.
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