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CDC urges vigilance vs. rising tide of clostridial infections.(News)
ATLANTA -- Both health care-associated and community-acquired infections caused by the exotoxin-producing bacillus Clostridium difficile continue to increase, Dr. L. Clifford McDonald said during a meeting on emerging clostridial disease sponsored by the Centers for Disease Control and Prevention.
Better surveillance for C. difficile-associated disease (CDAD)--which can range in severity from mild diarrhea to fulminant colitis and death--has become a priority for the CDC.
The meeting, also sponsored by the Food and Drug Administration and the National Institute of Allergy and Infectious Diseases, was convened to develop a research agenda for studying both C. difficile and the related anaerobic bacterium Clostridium sordellii, which has been linked to complications following medical abortions (see related story, above).
The CDC plans to issue a formal statement saying that all health care facilities should conduct some type of surveillance for CDAD, a recommendation the agency has already made informally through its Web site and public presentations. The CDC is also using established networks, such as the Emerging Infections Programs' FoodNet project, and various pilot studies and state-based epidemiologic investigations to isolate CDAD cases that arise in the community, including human infections that have also appeared in food-producing animals and strains seen in pregnant women, said Dr. McDonald, a medical epidemiologist at the CDC's Division of Healthcare Quality Promotion.
Hospital discharges for which CDAD was listed as any diagnosis doubled between 2000 and 2003 (Emerg. Infect. Dis. 2006;12:409-15). And in the latest yearly update of an ongoing survey, CDAD rates rose by another 25% from 2003 to 2004, from 61 per 100,000 population (178,000 total discharges) to 75 per 100,000 (211,000 discharges). Rates have been highest among adults aged 65 years and older.
Although most CDAD cases are still thought to arise in health care facilities, recent reports of community-associated cases--including some without recent antimicrobial use--have prompted concern that the problem may be underrecognized. At present, C. difficile cases are not nationally reportable.
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