Unnecessary antimicrobial use increases risk of recurrent infectious diarrhea
The impact of antibiotic misuse has far-reaching consequences in healthcare, including reduced efficacy of the drugs, increased prevalence of drug-resistant organisms, and increased risk of deadly infections. A new study featured in the February issue of Infection Control and Hospital Epidemiology, the journal of the Society for Healthcare Epidemiology of America, found that many patients with Clostridium difficile infection (C. difficile) are prescribed unnecessary antibiotics, increasing their risk of recurrence of the deadly infection. The retrospective report shows that unnecessary antibiotics use is alarmingly common in this vulnerable patient population.
C. difficile is a bacteria that usually affects people with recent antibiotic use or hospitalization. The symptoms of C. difficile range from mild diarrhea to severe illness and death, and it is now one of the most common healthcare-associated infections. Patients with C. difficile often experience recurrent episodes of the infection, especially if they receive antibiotics again in the future.
Researchers at the Minneapolis Veterans Affairs Medical Center reviewed patient cases with new-onset C. difficile infection. In total, 57 percent (141) of patients with new-onset C. difficile infection received additional antimicrobials during or within 30 days after their initial C. difficile treatment, raising their risk of recurrence substantially. From this group, 77 percent received at least one dose of unnecessary antibiotic, and 26 percent of patients received unnecessary antibiotics exclusively. Common reasons noted for unnecessary antibiotic use included urinary tract infections and pneumonia (despite little-to-no evidence of either being present), inappropriate surgical prophylaxis, and asymptomatic bacteriuria.
“Our findings serve as a reminder to both doctors and patients to use antibiotics only when absolutely necessary, particularly in patients with a history of C. difficile,” said lead researcher Megan K. Shaughnessy, MD. “Patients with C. difficile are at high-risk for recurrence, especially with additional antibiotic use. Because of this heightened risk, clinicians should be exercising increased caution with antimicrobial therapy.”
The researchers advise that providers contemplating antimicrobial therapy should be more aware of the risk of recurrent C. difficile with antimicrobial use, patients’ previous C. difficile history, and which clinical conditions require antimicrobial therapy.
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Megan K. Shaughnessy, William H. Amundson, Michael A. Kuskowski, Douglas D. DeCarolis, James R. Johnson, Dimitri M. Drekonja. “Unnecessary Antimicrobial Use in Patients with current or Recent Clostridium difficile Infection.” Infection Control and Hospital Epidemiology 34:2 (February 2013).
Published through a partnership between the Society for Healthcare Epidemiology of America and The University of Chicago Press, Infection Control and Hospital Epidemiology provides original, peer-reviewed scientific articles for anyone involved with an infection control or epidemiology program in a hospital or healthcare facility. ICHE is ranked 15 out of 140 journals in its discipline in the latest Journal Citation Reports from Thomson Reuters.
SHEA is a professional society representing more than 2,000 physicians and other healthcare professionals around the world with expertise in healthcare epidemiology and infection prevention and control. SHEA’s mission is to prevent and control healthcare-associated infections and advance the field of healthcare epidemiology. The society leads this field by promoting science and research and providing high-quality education and training in epidemiologic methods and prevention strategies. SHEA upholds the value and critical contributions of healthcare epidemiology to improving patient care and healthcare worker safety in all healthcare settings.
What is Clostridium difficile infection?
Clostridium difficile (C. difficile) is a bacterium (germ). It lives harmlessly in the gut of many people. About 3 in 100 healthy adults and as many as 7 in 10 healthy babies have a number of C. difficile bacteria living in their gut. The number of C. difficile bacteria that live in the gut of healthy people is kept in check by all the other harmless bacteria that also live in the gut. So, in other words, some of us normally have small numbers of C. difficile bacteria living in our guts, which do no harm.
C. difficile produces spores (like seeds) which are very hardy and resistant to high temperatures. Spores are passed out with the faeces (stools) of people who have C. difficile in their gut. Spores can persist in the environment (for example, on clothes, bedding, surfaces, etc) for several months or years. The spores can also be spread through the air (for example, when shaking bedclothes when making a bed). They may get on to food, and into the mouth and gut of some people. Spores that get into a human gut develop into mature bacteria. So, this is how some people end up with C. difficile living harmlessly in their gut.
However, if the number of C. difficile bacteria increases greatly in the gut, then it can cause problems. The most common reason why this occurs is due to taking antibiotics.
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Kate Enos
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Society for Healthcare Epidemiology of America