Judicious Antibiotic Use in Long Term Care Facilities Program

Clostridium difficile: Epidemiology (part 1)

• There are an estimated 3 million annual cases of antibiotic-associated diarrhea in United States, of which 15-25% are caused by Clostridium difficile.

• Mortality rate from diarrheal illness caused by C. difficile is estimated to be between 1 to 2.5 percent. There are approximately 5000-6000 annual deaths in US from Clostridium difficile (1) .

Increasing Incidence of Clostridium difficile:

• From 1996 to 2003, the incidence of Clostridium difficile as a discharge diagnosis from acute care hospitals increased from 31 per 100,000 population to 61 per 100,000 population. This increase occurred primarily from 2000 to 2003. The increase was most pronounced in persons over the age of 65. In 2003, the rate of C. difficile as a discharge diagnosis was 228 per 100,000 in persons over the age of 65, compared to 40/100,000 in persons aged 45-64 (2).
  
  
• In Quebec study, incidence of Clostridium difficile associated disease increased by 4x from 1991 to 2003, with a 8x increase in individuals over the age of 65 (3).
  
  
• In 2003, 57,000 patients (1.87%) of transferred to long-term care faciliities from acute care hospitals had C. difficile associated diarrhea at the time of transfer (2).

References:

1. Redelings MD, Sorvillo F, Mascola L. Increase in Clostridium difficile-related mortality rates, United States, 1999-2004. Emerg Infect Dis 2007 Sep; [Epub ahead of print]

2. McDonald LC , Owings M, Jernigan DB. Clostridium difficile Infection in patients discharged from US short-stay hospitals, 1996-2003. Emerg Infect Dis. 2006 Mar.

3. Pépin J, Valiquette L, Alary ME, Villemure P, Pelletier A, Forget K, et al. Clostridium difficile-associated diarrhea in a region of Quebec from 1991 to 2003: a changing pattern of disease severity. CMAJ. 2004;171:466-72.