ATLANTA—While the war against COVID-19 continues, partial victory in another medical battle might have been overlooked.
A report in the New England Journal of Medicine described substantial progress in the fight to prevent Clostridioides difficile infection in hospitals.1
Furthermore, researchers from the Atlanta VAMC, Emory University and the national Centers for Disease Control and Prevention emphasized that the estimated burden of C. difficile infection in the United States declined from 2011 through 2017, despite the increasing use of the more sensitive nucleic acid amplification testing.
“When NAAT use was held constant over this period, we observed a significant decrease in the adjusted estimate of the national burden of C. difficile infection, which supports a true decline in C. difficile infection,” the authors wrote.
“Prevention of C. difficile infection has long been a national priority, as efforts to improve infection prevention and antibiotic stewardship continue to expand across the health care spectrum,” they added.
To determine if initiatives to curb C. Diff were working, the study team identified cases of C. difficile infection—using stool specimens positive for C. difficile in anyone older than a year old with no positive test in the previous eight weeks—at 10 sites in the United States.
Case and census sampling weights were used to estimate the national burden of C. difficile infection, first recurrences, hospitalizations and in-hospital deaths from 2011 through 2017.
For the study, health care-associated infections were defined as those with onset in a healthcare facility or associated with recent admission to a healthcare facility, with all others classified as community-associated infections.
Results indicated that the number of cases of C. difficile infection in the 10 U.S. sites was 15,461 in 2011—10,177 healthcare—associated and 5,284 community-associated cases—vs. 15,512 in 2017—7,973 healthcare-associated and 7,539 community-associated cases. At the same time, the estimated national burden of C. difficile infection was 476,400 cases (95% confidence interval [CI], 419,900 to 532,900) in 2011 and 462,100 cases (95% CI, 428,600 to 495,600) in 2017.
Researchers pointed out that “the adjusted estimate of the total burden of C. difficile infection decreased by 24% (95% CI, 6 to 36) from 2011 through 2017; the adjusted estimate of the national burden of healthcare-associated C. difficile infection decreased by 36% (95% CI, 24 to 54), whereas the adjusted estimate of the national burden of community-associated C. difficile infection was unchanged. The adjusted estimate of the burden of hospitalizations for C. difficile infection decreased by 24% (95% CI, 0 to 48), whereas the adjusted estimates of the burden of first recurrences and in-hospital deaths did not change significantly.”
The report concluded that the estimated national burden of C. difficile infection and associated hospitalizations decreased from 2011 through 2017, largely because of a decline in healthcare-associated infections.
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