Are cases of recurrent Clostridium difficile infection on the rise in the United States?

Researchers from the Perelman School of Medicine, at the University of Pennsylvania (PA, USA), have uncovered evidence to suggest multiple recurring Clostridium difficile infections (mrCDI) are on the rise in the United States. The results from this study, recently published in Annals of International Medicine, demonstrated the annual incidence of mrCDI increased by nearly 200% from 2001–2012.

C. difficile intestinal infection is the most frequent healthcare associated infection in the United States, infecting approximately half a million Americans each year. To study the annual incidence of mrCDI, one of the most difficult C. difficile cases, this group of researchers analyzed a large, commercial database with records on more than 40 million US patients enrolled in private health insurance plans

Results not only highlighted a rise in mrCDI cases from 2001–2012 but also demonstrated the prevalence of normal CDI only rose by 40%. In addition to this, patients with CDI were found to have multiple reoccurrences when they were treated with at least three courses of CDI antibiotics in a short time frame.

It was also demonstrated that patients with mrCDI were older, more likely to be female, and more likely to have been exposed to medications such as corticosteroids and antibiotics, compared with patients whose CDI cleared up after one or two courses of therapy. However, authors also thought that other factors may be involved in this rise. The study’s senior author James D. Lewis (University of Pennsylvania) explained: “An additional driver of this rise in incidence could be the recent emergence of new strains of C. difficile, such as NAP1, which has been shown to be a risk factor for recurrent CDI.”

The reasons behind this sharp rise of mrCDI are inconclusive but it was noted that this clearly effects the healthcare system with an increased demand for new treatments, one of which being fecal microbiota transplantation.

“The increasing incidence of C. difficile being treated with multiple courses of antibiotics signals rising demand for fecal microbiota transplantation in the United States,” commented Lewis. “While we know that fecal microbiota transplantation is generally safe and effective in the short term, we need to establish the long term safety of this procedure.”



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