Health Care-Associated C Difficile Rates Similar in 2011 and 2015

Shelley S. Magill, MD, PhD

Health care-associated infection rates were lower in 2015 than 2011, though Clostridium difficile (C difficile) infections remained relatively stable, according to recent findings.

Investigators from the Centers for Disease Control and Prevention updated their original 2011 study in order to assess changes in the prevalence of these health care-associated infections. They noted there was national attention on these types of infections then and now. Back in 2011, their analysis showed that 4% of hospitalized patients had a health care-associated infection.

This time, the study authors recruited as many as 25 hospitals in Emerging Infections Program sites in 10 states. They prioritized locales that participated in the 2011 study. The hospitals chose 1 day that a selection of patients would be identified for their assessment and on that day, staff reviewed medical records using the 2011 definitions of infections.

There were 12,299 patients at 199 hospitals included in the 2015 investigation, compared to 11,282 patients from 183 hospitals in 2011.

Primarily, the investigators found that fewer patients had health care-associated infections in 2015 than 2011: 394 patients in 2015 compared to 452 in 2011.

“It was interesting to see that the reduction in the prevalence of health care associated infections between the 2011 and 2015 surveys appeared to have been due largely to reductions in urinary tract infections and surgical site infections, whereas we did not see significant changes in the prevalence of pneumonia or C difficile infections,” the study’s first author Shelley S. Magill, MD, PhD, told MD Magazine®.

The most common health care-associated infections the researchers observed were pneumonia and gastrointestinal infections; the majority of GI infections were due to C difficile, the study authors wrote.

C difficile accounted for 61 infections in 61 patients in the 2011 study, while it made up 66 infections in 66 patients in 2015, which the investigators reported and called “stable.” C difficile was also the top pathogen in 2015, the researchers learned. Some of the other health care associated pathogens included Staphylococcus aureus, Escherichia coli, Streptococcus species, which each represented 10% or more of all health care associated infections.

They did note, however, that they used the same definition for the infection in the 2011 and 2015 studies and did not take into account changes in testing and/or diagnosis.

“Regardless of whether changes in testing have inflated our estimate of the burden of C difficile infection in hospitals, there is room for improvement,” they wrote.

They also said that in order to make progress in prevention of pneumonia, C difficile, and any other health care-associated infections, strategies should be augmented.

“There was no significant reduction in the prevalence of pneumonia or C difficile infection, nor in the percentage of patients with health care-associated infection who died during their hospitalization, which suggests that more work is needed to prevent these infection types and reduce mortality among patients with health care associated infections,” the study authors wrote.

A patient’s risk for acquiring a health care-related infection dropped by 16% in 2015 compared to 2011, the analysis showed after being adjusted for age, presence of devices, days from admission to time of survey, and status of being in a large hospital setting.

“These findings are important for physicians because they suggest that prevention efforts for certain infection types in hospitals may be working, and they also suggest areas where more attention is needed,” Magill continued. “We are seeing improvements, but there is much work to be done. For example, physicians can help prevent C difficile infections in hospital patients through infection control measures to prevent transmission and also through antimicrobial stewardship.”

The paper, titled “Changes in Prevalence of Health Care—Associated Infections in U.S. Hospitals,” was published in The New England Journal of Medicine.