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Recurrent C. difficile Incidence is Rapidly Increasing, Underscoring Need For New Therapies

JUL 10, 2017 | KRISTI ROSA
New research from the Perelman School of Medicine at the University of Pennsylvania (UPenn) presents startling new evidence on the most frequent healthcare-associated infection in the United States: Clostridium difficile.

The findings in question?

Incidence of “the most difficult of C. difficile cases,” multiple-recurring C. difficile infections (mrCDI), is rapidly increasing, thus, underscoring the need for new, effective therapies. This is according to the UPenn study, which was recently published in the journal Annals of Internal Medicine.

C. difficile is capable of being “relatively resistant to normal sterilizing procedures,” because it tends to encapsulate itself within “hardy spores.” Although there are antibiotics currently available to treat these infections—metronidazole, vancomycin, fidoxamicin—about one third of individuals who are infected experience recurrence of infection after initial treatment.

In their study, the UPenn researchers analyzed the records of “a large, nationwide health insurance database,” consisting of over 40 million US patients, to examine CDI trends. They found that, between 2001 and 2012, mrCDI incidence “per 1000 persons-years” increased by 188.8% (from 0.0107 to 0.0309 cases). The researchers considered C. difficile cases to be mrCDI if “doctors treated [the patients] with at least 3 closely-spaced courses of CDI antibiotics.” In that same time period, they found that C. difficile infections (CDI) also increased—but only by 42.7% (from 0.4408 to 0.6289 cases).

Furthermore, the researchers noted differences between mrCDI patients and regular CDI patients, “whose infections cleared up after just 1 or 2 courses of therapy,” according to the press release. Firstly, mrCDI patients were older, with a median age of 56 compared with their CDI counterparts whose median age was 49; a total of 63.8% of mrCDI patients were female, compared with 58.7% of CDI patients; and mrCDI patients had an increased likelihood of having been previously exposed to “medications such as corticosteroids (18.3% vs. 13.7%), proton-pump inhibitors (24.6% vs. 18.2%), and antibiotics (72.3% vs. 58.8%),” within 90 days of CDI diagnosis, the researchers wrote.

Although they admitted that the reason for the increasing number of mrCDI cases is currently unknown, study author James D. Lewis, MD, MSCE, professor of Gastroenterology and senior scholar in the Center for Clinical Epidemiology and Biostatistics surmises it, “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,” according to a quote by the professor in the press release.

Regardless of why the number of cases is growing, the fact remains that it’s a serious issue. Every year, half a million Americans suffer from CDI, and these infections result in tens of thousands of deaths. Not only that, but the financial burden on the nation’s healthcare system is estimated to be about $5 billion, according to the press release. The researches feel that this substantial burden underscores the need for new treatments against mrCDI. One such treatment that they feel may hold promise is fecal microbiota transplantation (FMT).

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