C. Diff Out of Control
March 8, 2007
More than 1,000 Ohioans every month last year came down with diarrhea-inducing -- and sometimes deadly -- infections during hospital or nursing home stays.
That was the finding in a report released Wednesday by the Ohio Department of Health on the first year of tracking Clostridium difficile (C. diff) infections in 210 hospitals and 966 nursing homes. There were about 14,300 cases statewide in 2006, the report said.
Long-term care hospitals -- where patients stay about 25 days, on average -- had the highest rates of infection. The Akron area's long-term care hospitals saw monthly C. diff rates as high as 45 and 53 cases per 10,000 patient days, compared with rates ranging from 1.1 to 15.1 cases per 10,000 patient days for other local hospitals.
Patient days are the number of patients a hospital sees in a given month divided by the number of days in that month.
Statewide, the report found that hospitals had seven to eight C. diff cases per 10,000 patient days, while nursing homes had two to three cases per 10,000 patient days.
C. diff infections have long been known as a byproduct of antibiotic use, especially among hospital patients and nursing home residents. However, the bacterium gained prominence in 2004 when a more toxic strain appeared across the United States and Canada. This strain caused severe diarrhea, colon damage (resulting in surgical removal of the colon) and more deaths.
In Ohio, C. diff-related deaths have increased by nearly 325 percent -- from 112 in 2000 to 473 deaths in 2005.
The report released Wednesday does not discuss C. diff-related deaths, however. The purpose of the report is to establish a baseline for C. diff cases, so that future outbreaks can be more easily identified, said state epidemiologist Dr. Forrest Smith.
The report also does not differentiate between different strains of C. diff. Though identifying strains may be important in an individual patient's care, Smith said, it's not as important when tracking cases at a statewide level.
'I'm sure we have a mixture here of all strains of C. diff,' he said.
The newest C. diff strain has 20 times the amount of toxin as other strains. In most cases, it is treated with two specific antibiotics: metronidazole (Flagyl) or vancomycin (Vancocin ). If treatment fails, the toxins can cause tissue to die, requiring surgery to remove the colon.
C. diff proliferates and causes sickness when 'good' bacteria in the intestinal tract is killed off by antibiotic use. Smith said it's important for people to understand that antibiotics do not come without risk. They should be taken as prescribed by the doctor.
The 2006 report is available on the state health department's Web site, though Smith said consumers should be careful in using the data to compare one hospital or nursing home to another.
Though the data are adjusted for patient volume, he said, they are not adjusted for the severity of illness. The yearlong reporting and surveillance behind the report cost state and local health departments, hospitals and nursing homes about $2.5 million.
In addition to tracking infections, Smith said, the state department of health is educating the medical industry about C. diff and how to prevent it. In 2006, the department presented 19 seminars to long-term care facilities.
Smith said finding out why long-term care hospitals have much higher rates is 'a question we're all grappling with.'
It's true that long-term care hospitals, which help patients make the move from hospital intensive-care units to nursing homes, have sicker patients, he said, but it's still important for these facilities to recognize and respond to outbreaks.
Excerpt from OHIO.COM
