Medicolegal Issues

C. Diff Deaths at All-Time High


 

Both incidence and deaths related to the bacterial infection Clostridium difficile have reached an all-time high, according to the federal Centers for Disease Control and Prevention (CDC), which calls C. diff “a formidable opponent” and a widespread safety issue. A total of 14,000 deaths related to C. diff were reported during the period of 2006-2007, compared with 3,000 in 1999-2000. A quarter of infections now appear first in hospitalized patients, with the rest in nursing home residents or patients in doctors’ offices.

L. Clifford McDonald, MD, CDC epidemiologist and lead author of a recent CDC Vital Signs report on the subject, recommended several steps for reducing C. diff infections, starting with better antibiotic stewardship, early detection and isolation for those who test positive, use of gloves and gowns when treating them, and informing the receiving medical team when those patients are transferred.1 Dr. McDonald also noted that state-led hospital collaboratives in Illinois, Massachusetts, and New York have reduced infection rates by 20%.

Another recent example of successful antibiotic stewardship comes from the University of Maryland Medical Center (UMMC) and Health Day News, summarizing a study in the journal Infection Control and Hospital Epidemiology.2

A seven-year stewardship program using an anti-microbial monitoring team generated a $3 million reduction in the hospital’s annual budget for antibiotics by its third year, with no increase in death rates, hospital readmissions, or length of stay. After seven years, antibiotic spending per patient per day had been cut by nearly half. The antibiotic stewardship program was canceled in 2008 in favor of providing more infectious-disease consulting as an alternative mode of stewardship. Over the subsequent two years, antibiotic costs went back up 32%, reports lead author Harold Standiford, MD.

“Our results clearly show that an antimicrobial stewardship program like the one at UMMC is safe, effective, and makes good financial sense,” he says, adding physicians should eliminate wasteful healthcare spending.

References

  1. Centers for Disease Control and Prevention. Vital signs: preventing Clostridium difficile infections. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6109a3.htm. Accessed March 29, 2012.
  2. Standiford HC, Chan S, Tripoli M, Weekes E, Forrest GN. Antimicrobial stewardship at a large tertiary care academic medical center: cost analysis before, during, and after a 7-year program. Infect Control Hosp Epidemiol. 2012;33(4);338-345.

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