CDC Modeling Predicts Growth of Drug-resistant Infections and C. difficile

Publication/Release Date April 2015

The latest CDC Vital Signs includes mathematical modeling that predicts increases in drug-resistant infections and Clostridium difficile (C. difficile) without immediate, nationwide improvements in infection control and antibiotic prescribing. Antibiotic-resistant germs, those that no longer respond to the drugs designed to kill them, cause more than 2 million illnesses and at least 23,000 deaths each year in the US. C. difficile caused close to half a million illnesses in 2011, and an estimated 15,000 deaths a year are directly attributable to C. difficile infections.

The promising news is that CDC modeling projects that with a coordinated approach—that is, health care facilities and health departments in an area working together—up to 70 percent of life-threatening carbapenem-resistant Enterobacteriaceae (CRE) infections could be prevented over five years. Additional estimates show that national infection control and antibiotic stewardship efforts led by federal agencies, health care facilities, and public health departments could prevent 619,000 antibiotic-resistant and C. difficile infections and save 37,000 lives over five years.

The report recommends a coordinated, two-part approach to turn this data into action:

1. Public health departments track and alert health care facilities to drug-resistant outbreaks in their area and the threat of germs coming from other facilities, and
2. Health care facilities work together and with public health authorities to implement shared infection control actions to stop the spread of antibiotic-resistant germs and C. difficile between facilities.

The Vital Signs report shows that C. difficile and drug-resistant bacteria—like CRE, MRSA (methicillin-resistant Staphylococcus aureus), and Pseudomonas aeruginosa—spread inside of and between health care facilities when appropriate infection control actions are not in place and patients transfer from one health care facility to another for care. These infections can lead to serious health complications, including sepsis or death. Even facilities following recommended infection control and antibiotic use practices are at risk when they receive patients who carry these germs from other health care facilities.

The report also describes the importance of local public health departments taking the lead to:

• Identify health care facilities in the area and know how they are connected.
• Dedicate staff to improve connections and coordination with health care facilities in the area.
• Work with CDC to use data for action to prevent infections and improve antibiotic use in health care.
• Know the antibiotic resistance threats in the area and state.

Complementing the public health coordination, hospital owners and health care facility administrators would:

• Implement systems to alert receiving facilities when transferring patients who have drug-resistant germs.
• Review and perfect infection control actions in each facility.
• Get leadership commitment to join area health care-associated infection (HAI)/antibiotic resistance prevention activities.
• Connect with the public health departments to share data about antibiotic resistance and other HAIs.
• Provide clinical staff access to prompt and accurate laboratory testing for antibiotic-resistant germs.

The model shows how coordination could reduce CRE over the course of five years after the drug-resistant bacteria enters 10 facilities in an area sharing patients: with a coordinated approach, CRE would impact 400 patients. With the currently used common approach and independent efforts, CRE would affect 2,000 and 1,500 patients, respectively.