About Clostridium difficile Infection

Clostridium difficile Infection

About

Clostridium difficile (C. diff.) infection is a life-threatening gastrointestinal disease that is typically acquired in the hospital or in an outpatient health care setting after treatment with an antibiotic.

There are about 700,000 C. diff. cases in the US each year with 29,0001 associated deaths. Elderly patients are most at risk, with 90% of deaths occurring in patients >65 years of age.2 C. diff. was associated with $4.8 billion in excess health care costs, according to 2008 data.3   In addition to the growing number of hospital-associated infections each year, the number of community acquired cases is rising and may account for up to one third of new cases.

The toxins created by C. diff. destroy the intestinal lining, leading to the characteristic symptoms of frequent watery diarrhea and abdominal pain with severe C. diff. infections becoming fatal. Severe cases of C. diff. are associated with and infection-related mortality of 5%, and all-cause mortality of 15 to 20%.4

These infection rates, limited therapeutic options, and global focus on antimicrobial resistance have prompted the US Centers for Disease Control and Prevention to identify C. diff. as an urgent public health threat.5

Risk Factors

Risk factors for C. diff. include:

  • Antibiotic use
  • Exposure to health care facilities
  • Advanced age (> 65 years)
  • Having a serious illness or medical procedure that reduces your immune response.

Antibiotic Resistance and C. diff.

Although C. diff. has been linked to prior use of antibiotics, the first-line treatment for the disease is antibiotic therapy to eliminate C. diff. at the risk of further depleting intestinal microbial diversity.  Following treatment and initial cure, approximately 30% of patients are expected to experience another C. diff. episode requiring additional care and increasing risk for C. diff. recurrence.6 Currently, there are no approved treatments for recurrent C. diff.

During antibiotic treatment, the C. diff. pathogen survives and multiplies while healthy, beneficial bacteria are destroyed.


 

how antibiotic resistance happens

Source: Antibiotic Resistance Threats in the US, 2013. US Department of Health and Human Services. Centers for Disease Control and Prevention.


 

References

  1. Lessa, FC, et al. Burden of Clostridium difficile infection in the United States. N Engl J Med. 2015; 372:2369-70.
  2. http://www.cdc.gov/VitalSigns/Hai/StoppingCdifficile/
  3. Dubberke ER, and MA Olsen. Burden of Clostridium difficile on the healthcare system. Clin Infect Dis. 2012;55 (Suppl 2) S88-92.
  4. Leffler DA, Lamont JT. Clostridium difficile infection. N Engl J Med. 2015. 372;16:1539-48.
  5. http://www.cdc.gov/media/releases/2013/p0916-untreatable.html
  6. Bagdasarian N, Rao K, Malani PN. Diagnosis and treatment of Clostridium difficile in adults. JAMA. 2015;313:398-404.