Magazine article Drug Topics

CDC Officer Says C. Difficile Still Increasing

Magazine article Drug Topics

CDC Officer Says C. Difficile Still Increasing

Article excerpt

The Clostridium difficile epidemic, expanding now for several years, has not yet peaked as far as anyone knows, a key expert from the Centers for Disease Control and Prevention (CDC) said.

C. difficile disease, often associated with use of antimicrobial medications, may now be causing 500,000 U.S. nursing-home and hospital-onset cases a year and contributing to more than 20,000 deaths, Clifford McDonald, MD, said in Bethesda, Md., at the annual conference on antimicrobial resistance, sponsored by the National Foundation for Infectious Diseases.

That is an extrapolation from reports from Ohio, McDonald said, where C. difficile in hospital or nursing-home patients was a reportable disease during 2006, due to public pressure arising after prominent outbreaks in the Cleveland area. Fred Tenover, PhD, head of CDCs Office of Antimicrobial Resistance, also cited the Ohio data in telling a June 24 Senate committee hearing that C. difficile is perhaps contributing to 15,000 to 30,000 deaths per year. Ohio recorded 14,100 cases in 2006, with 6,200 in hospitals and 7,900 in nursing homes. McDonald said the state also looked at its death certificates and found a marked increase in mortality related to the disease, with about 500 deaths in which the disease was reported as the primary underlying cause and a total of nearly 900 deaths for which the disease was included in any reported cause of death.

McDonald noted that a report last year in Emerging Infectious Diseases pointed out that C. difficile-related mortality on U.S. death certificates had exploded from 5.7 cases per million population in 1999 to 23.7 per million in 2004. He also cited a carefully case-controlled study published this year in Clinical Infectious Diseases that found a 5.7 percent attributable mortality rate in these patients within 180 days. Much of the increase in the disease and in its mortality may be due to a historically uncommon strain called BI/NAP1/027, the CDC officer noted, and "this change in behavior was coincident with the strain becoming more resistant to fluoroquinolones - categorical resistance to new fluoroquinolones but also just a general elevation of the MIC (minimum inhibitory concentration) for all the fluoroquinolones."

Displaying a U.S. map with most states in pink, McDonald told attendees that if their states were not pink, "it's probably just because no one has cultured for C. …

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