Clostridium difficile (C. diff.) is spawning infections in hospitals in the U.S. and abroad that can lead to severe diarrhea, ruptured colons, perforated bowels, kidney failure, blood poisoning and death. It is a common cause of antibiotic-associated diarrhea, accounting for 15-25% of all episodes. CDC estimates there are 500,000 cases of C. diff. infection annually in the U.S., contributing to between 15,000 and 30,000 deaths. Elderly hospitalized patients are at especially high risk and mortality in these patients may exceed 10%. The disease is very difficult to treat and recurs in at least 20% of cases, even when treated appropriately.
Deaths from C. diff. have increased in Missouri over the past few years. There were 54 in 2001, 130 in 2002, 172 in 2003, 159 in 2004, and 216 in 2005.7
There were 10,558 hospital discharges in 2006 in Missouri that included C. diff. as a diagnosis, according to the Agency for Healthcare Research and Quality (AHRQ). The cost per C. diff. patient in a hospital is estimated by CDC to be at least $3,500, making the annual healthcare cost for C. diff. in Missouri more than $36.9 million.8
There were 65 cases of Drug-Resistant Streptococcus pneumoniae (DRSP) reported in Missouri in 2007. In 2006, there were 44 cases reported, while there were only 37 reported in 2005.9
A key factor in Missouri’s ability to detect, monitor and control antimicrobial resistance is its public health laboratory capacity. Across the nation, increasing cases of antimicrobial resistance are currently swamping the ability of each state's public health laboratory to keep pace. There has been limited funding in the past for antibiotic resistance education programs and surveillance, and even this limited funding is on the decrease. Approximately only half of state public health labs can provide some basic resistance testing. Like many states, Missouri lacks the targeted technical ability to detect and characterize emerging resistance patterns promptly in a range of pathogens. Therefore, such resistant organisms continue to spread unrecognized and unimpeded throughout the state.
1 Dr. Fred Tenover, quoted in “The Bacteria Fight Back” Science, July 18, 2008. 2 R. Monina Klevens et al. “Invasive Methicillin-resistant Staphylococcus aureus Infections in the United States,” JAMA, October 17, 2007: 1763-1771.3 Elixhauser, A. and Steiner, C. Infections with Methicillin-Resistant Staphylococcus Aureus (MRSA) in U.S. Hospitals, 1993–2005. HCUP Statistical Brief #35. July 2007. Agency for Healthcare Research and Quality.4 Communicable Disease Surveillance 2007 Annual Report; Missouri Department of Health and Senior Services5 CDC MMWR “Guidance for Control of Infections with Carbapenem-Resistant or Carbapenemase-Producing Enterobacteriaceae in Acute Care Facilities” March 20, 2009 / Vol. 58 / No. 106 K. F. Anderson, et al.; Evaluation of Methods To Identify the Klebsiella pneumoniae Carbapenemase in Enterobacteriaceae; Journal of Clinical Microbiology, August 2007, p. 2723-2725, Vol. 45, No. 87 CDC Wonder Death Certificate Data, cited in a July 28, 2008 communication to Senator Sherrod Brown8 Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases (SID), Agency for Healthcare Research and Quality, http://www.hcupnet.ahrq.gov/, cited in a July 28, 2008 communication from CDC to Senator Sherrod Brown9 Case Count of Selected Communicable Diseases – Missouri; Missouri Department of Health and Senior Services
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