‘Get serious’ about antibiotics, APIC says

Healthcare facilities "need to get serious about antibiotic stewardship" if any headway is going to be made against Clostridium difficile infection, says the president of the Association for Professionals in Infection Control and Epidemiology (APIC). “It’s been estimated that up to half of antibiotic use in humans is unnecessary,” Jennie Mayfield, BSN, MPH, CIC, adds.

Three infection control measures also can reduce the spread of C. diff infections, says Kelly Reveles, PharmD, PhD:

• Use of contact precautions,
• Cleaning and disinfection of equipment and environment, and
• Hand hygiene.

Reveles is the lead author of a study of 2.2 million C. diff infection cases published in the October issue of the American Journal of Infection Control, APIC's official publication. The retrospective study from the University of Texas College of Pharmacy found that infections with the intestinal superbug nearly doubled from 2001 to 2010 in U.S. hospitals without noticeable improvement in patient mortality rates or hospital lengths of stay.

The researchers analyzed 10 years of data from the U.S. National Hospital Discharge Surveys and found that, from 2001 to 2010, rates of C. diff infection among hospitalized adults rose from 4.5 to 8.2 C. diff infection discharges per 1,000 total adult hospital discharges. And those discharges could be headed a long-term care facility near you.

“Several factors may have contributed to the rise in [C. diff infection] incidence in recent years,” Reveles says. “Antibiotic exposure remains the most important risk factor.” 

According to the Centers for Disease Control and Prevention (CDC), C. diff is the most common bacteria responsible for causing healthcare-associated infections in U.S. hospitals and is linked to 14,000 deaths each year. Reducing the use of high-risk, broad-spectrum antibiotics by 30 percent could lower C. diff infections by 26 percent, the agency estimates. The White House recently announced a new executive order and National Strategy for Combatting Antibiotic-resistant Bacteria that emphasized the need for antibiotic stewardship programs to help clinicians improve prescribing practices.

According to the University of Texas study, most people with C. diff infections were female (59 percent), white (86 percent) and aged more than 65 years (70 percent). Of the 2.2 million adult C. diff infection discharges, 33 percent had a principal diagnosis of C. diff infection, and 67 percent were classified as secondary C. diff infection, meaning that C. diff infection was not the primary reason they were hospitalized. Approximately 7.1 percent, or 154,184 patients, died during the study period.

“Our study found that peak [C. diff infection] incidence occurred in 2008, with a slight decline through 2010,” Reveles says. “The leveling off of [C. diff infection] incidence toward the end of our study period may be the result of increased antibiotic stewardship programs and improved infection control measures.”

According to a 2013 survey conducted by APIC, 60 percent of U.S. hospitals had implemented antibiotic stewardship programs by 2013, up from 52 percent in 2010.

“With bugs like C. diff, it takes everyone asking, 'Aare these antibiotics really necessary?’ to help curb inappropriate use and protect patients,” Mayfield said.

Antibiotic resistance and stewardship will be the theme of International Infection Prevention Week, led by APIC, Oct. 19 to 25. A free webinar and Twitter chat are being offered, along with an infographic poster for consumers on the “ABC’s of antibiotics.”