Rates of Clostridium difficile in Canadian hospitals dropped by about 36 per cent in recent years, according to a new study that suggests increased attention to infection-control measures such as handwashing and avoiding antibiotics is helping reduce the spread of hospital-acquired infections.
The study, published on Monday in the Canadian Medical Association Journal, examined trends at a large group of hospitals from 2009 to 2015 to determine if efforts to contain the pathogen were making headway.
The researchers found rates of C. difficile dropped significantly over the study period, a trend attributable to the increased vigilance at health-care institutions, said Kevin Katz, lead author and medical director of infection prevention and control at Toronto’s North York General Hospital.
“It actually is having an impact,” Dr. Katz said. “The job is not done, but it’s definitely moving very significantly in the right direction.”
C. difficile is a bacterial infection and the most common cause of infectious diarrhea in hospitals and long-term-care facilities in Canada. It can lead to serious illness and death. It affects older patients most frequently, and often takes hold when individuals are put on antibiotics, which kill off their healthy gut bacteria. The NAP1 strain of C. difficile, which is resistant to many antibiotics and known to cause more severe illness, is the most common form of the infection in Canada.
Health-care associated infections such as C. difficile and methicillin-resistant Staphylococcus aureus have emerged as a major threat in the past two decades. According to Canada’s chief public-health officer, more than 200,000 Canadians get infections while receiving health-care every year. Of those, about 8,000 die as a result. The vast majority of infections are spread by health-care workers, patients and visitors, which is why infection-control measures are so important.
Over the course of the study period, rates of the virulent NAP1 strain fell, but it remains the most common, Dr. Katz said. Hospitals that have the strain are more likely to see a greater number of severe cases, which is why it is important to stay focused on reducing the spread, he said.
The study was done by researchers involved in the Canadian Nosocomial Infection Surveillance Program, which tracks C. difficile and similar bacterial infections at health-care institutions in Canada.
Dina Kao, a gastroenterologist and associate professor of medicine at the University of Alberta, said the falling rates of hospital-based C. difficile are encouraging, but another challenge is the number of cases that go undetected in the community.
Dr. Kao, who is also director of Edmonton’s program for fecal transplants, which are used to treat C. difficile, said it is common for individuals to acquire infections at home after taking antibiotics. Tracking these cases is a logistical challenge, but Dr. Kao said they appear to be on the rise.
“It is a very big problem,” she said.
While hospitals have become very good at implementing measures in recent years to stop the spread of these infections, it is possible community doctors and patients have not got the same message, she said.
For instance, doctors should avoid giving unnecessary prescriptions for antibiotics, and patients should learn to not ask for those drugs. In many cases, antibiotics are still prescribed when they are unnecessary, such as for the treatment of viral infections that will go away on their own, because patients go to their doctor and insist on getting something to treat their symptoms, Dr. Kao said.
“This is everybody’s responsibility,” she said.
Carly Weeks