The estimated 453,000 infections and 29,300 deaths caused by Clostridium difficile in the United States in 2011 underline the importance of appropriate use of antibiotics and rigorous infection control measures in health care settings, Dr. Michael Bell, an official at the Centers for Disease Control and Prevention, said during a CDC telebriefing.

“To reduce the majority of C. difficile infections, we will need to improve how antibiotics are being prescribed in hospitals and throughout health care,” said Dr. Bell , deputy director of the division of health care quality promotion, at the CDC’s National Center for Emerging and Zoonotic Infectious Diseases. Early diagnosis is also critical to prevent spread of C. difficile. Many infections are community acquired, and “it is essential that patients and their clinicians be aware that they need to take any diarrhea following antibiotic use very seriously,” he added.

The briefing was held to discuss the results and implications of the study published in the New England Journal of Medicine, which was supported by the CDC and the Emerging Infections Program (EIP) Cooperative Agreement between the 10 EIP sites and the CDC. In the study of 10 geographic regions in the United States in 2011, 15,461 cases were confirmed, with the estimated incidence of the infection being 453,000 (95% confidence interval, 397,100-508,500) after predictors of incidence were adjusted for, the investigators found. The estimated number of deaths from C. difficile was 29,300 (95% CI, 16,500-42,100).

Estimates for disease incidence were higher among women, whites, and patients 65 years of age or older, wrote Dr. Fernanda Lessa of the CDC, and her associates. Future efforts should focus on antibiotic use, the proper management of which may be effective in decreasing infection rates, the authors said in the report.

“Antibiotics clearly are driving this whole epidemic,” one of the study authors, Dr. Clifford McDonald of the CDC, said during the briefing. The epidemic strain in the United States, which emerged in 2000 in Pittsburgh and Montreal, is now spread globally, and accounted for about 30% of cases in this study, he added. It is transmitted more easily than other strains and causes more severe disease.

Dr. Bell said that to reduce the rate of these infections, antibiotics should be used only when needed and for as long as necessary, “and to ensure rigorous infection control in all health care settings.” The CDC’s National Strategy to Combat Antibiotic Resistant Bacteria has the potential to reduce C. difficile infections by 50%, he added.

“There’s no room for error” when infection control is considered, he added, pointing out that hand sanitizers do not kill C. difficile spores, which spread easily and are durable, “so that any breach in correct glove use, hand hygiene, or cleaning protocol can allow the spores to spread.”

The study also estimated that more than 150,000 infections were community acquired, with no documentation of inpatient exposure in the hospital. “Nonetheless, as we showed in another recent CDC study, 80% of patients with community-associated C. difficile infections did, in fact, have contact with a health care setting like a doctor’s office or a dental clinic,” generally during the 3-month period before being diagnosed, and most of the patients had also been treated with antibiotics, Dr. Bell said.

National efforts to address the increase in C. difficile infections include the requirement since 2013 that hospitals participating in the Centers for Medicare & Medicaid Services’ Hospital Inpatient Quality Reporting Program data on C. difficile infections to the CDC’s National Healthcare Safety Network, which has shown at least a 10% drop since 2013, Dr Bell said. Targets for reducing C. difficile infections in the United States by 2020 are being established in the National Action Plan to Prevent Health Care-Associated Infections: Road Map to Elimination.