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Study Provides New Perspective on Current C. difficile Epidemic

Most infections occur outside hospital setting

According to a new study published in the Mayo Clinic Proceedings, more than 80% of hospitalized patients who tested positive for Clostridium difficile were tested outside the hospital or within the first 72 hours of hospitalization, suggesting that settings outside of the hospital may play a key role in the identification, onset, and possible transmission of the disease.

The study provides new insight into contagious and potentially deadly infections with C. difficile, a bacterium most often associated with hospitals and other in-patient health care settings. The report is also one of the first to identify a larger population of patients with C. difficile infection by examining them in outpatient settings as well as in the hospital.

Researchers examined the electronic health records of more than 268,000 Kaiser Permanente patients in Southern California who were admitted to 14 Kaiser Permanente hospitals between January 1, 2011 and December 31, 2012. Of these patients, 4,286 (1.6%) tested positive for C. difficile. The researchers also found that 49% of C. difficile cases were acquired in the community or from an indeterminate source, and that 31% of cases were associated with a previous hospitalization.

C. difficile infection is a major public health concern in the U.S., with infection rates tripling over the last decade,” said lead author Sara Y. Tartof, PhD. “This study’s comprehensive view gives a more complete picture of the extent of health care-associated infections.”

According to the Centers for Disease Control and Prevention (CDC), C. difficile most often affects sicker, older adults who take antibiotics and causes a range of symptoms, including diarrhea, fever, loss of appetite, and inflammation of the colon. People can become infected with C. difficile by touching items or surfaces that are contaminated with the bacteria or through physical contact with health care workers who have picked up the bacteria from surfaces or other patients.

The CDC reports that during the past several years, states have noted higher rates of C. difficile infection and an associated increased risk of death. Studies have also shown that C. difficile infections account for considerable increases in the length of hospital stays and more than $1.1 billion in health care costs each year in the U.S.

Source: Kaiser Permanente; July 23, 2014.

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