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CDC issues advisory on rise of deadly C. difficile infections

March 08, 2012

By Jean Williams, ADA News staff

While several other health care-associated infections rates are in decline, potentially fatal infections of Clostridium difficile, or C. difficile, not only persist but have climbed in the last decade, according to the Centers for Disease Control and Prevention, which recently issued a call to action on preventive measures.

The CDC is urging workers in health care settings to take stringent precautions to prevent these types of infections, which are linked to about 14,000 American deaths annually. The urging is based on a report in CDC Vital Signs, which offers recent data and calls to action for important public health issues.

According to the report, among C. difficile infections identified in Emerging Infections Program data in 2010, 94 percent were associated with receiving health care.

“It’s an important problem: 94 percent of all the C. difficile that’s happening in the country is related to health care in some way, and that includes dental care,” said Dr. L. Clifford McDonald, a medical epidemiologist with the CDC’s Division of Health Care Quality Promotion and lead author of the report.

Appropriate precautions, however, have proven effective in stanching the spread and saving lives. Among 71 hospitals participating in a C. difficile infections prevention program, there was a combined 20 percent decline in C. difficile infections, according to CDC’s Morbidity and Mortality Weekly Report on the topic.

C. difficile is a formidable opponent that is causing many Americans to suffer and die, even as we see rates of other health-care associated infections decline,” Dr. McDonald said. “People most at risk from this deadly diarrheal infection are those who take antibiotics and also receive medical care in any setting. This could include a nursing home, hospital, doctor’s office or outpatient surgery center.”

Dentists can help thwart the spread of C. difficile majorly, Dr. McDonald suggested.

“The main thing that dentists should be paying attention to here is the prescribing of antibiotics,” Dr. McDonald said, pointing out that the risk of patients getting C. difficile is increased seven- to tenfold while they’re taking antibiotics and over the month following discontinuation. Over the subsequent two months, the risk remains increased two- to threefold.

“One area where dentists need to think about their prescribing [antibiotics] is around prophylaxis for the prevention of infectious endocarditis,” Dr. McDonald said, citing the American Heart Association’s 2007 guidelines, which state: “Infective endocarditis prophylaxis for dental procedures is reasonable only for patients with underlying cardiac conditions associated with the highest risk of adverse outcome from infective endocarditis (Circulation. 2007;116:1736-1754).”

To obtain a copy of the Vital Signs report on C. difficile, visit www.cdc.gov/vitalsigns.