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Stockton’s Dameron Hospital employs hi-tech C. difficile test

Laboratory Technician Assistant Mary Poier displays a sample to be tested for Clostridium Difficile at Dameron Hospital in Stockton. (...

Flaw-ridden testing for dangerous infections vexes health officials

Clostridium difficile is a dangerous, health care associated infection that can cause severe diarrhea, abdominal pain, even death. Here...

What is C. difficile, what to do about it

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Scientists make strides with new C.diff infection findings

CDC expert Dr. Cliff McDonald addresses overflow crowd about new research on infection Clostridium difficile, Thursday, Oct. 18, 2012, IDWeek12, San Diego Convention Center, San Diego, Calif. (Deborah Schoch / CHCF Center for Health Reporting)

SAN DIEGO—Organizers at a national conference on infectious diseases expected a healthy turnout for the session on Clostridium difficile earlier this month.

But no one here foresaw the crowd of more than 200 that flooded the informal poster session focused on the dangerous infection that can sicken patients in hospitals and nursing homes.

Only a lucky few nabbed seats. The rest formed a giant circle and strained to hear the opening remarks from Dr. Cliff McDonald, a top C. difficile expert at the U.S. Centers for Disease Control and Prevention.

Even McDonald was surprised.

“There’s a lot of interest in C.diff right now,” he said. One reason, he added, is that Medicare will require hospitals nationwide to report cases of the deadly infection to federal officials, starting in January, less than three months away. “People see it as a problem because it’s a problem in their facility.”

The “problem” is the potentially deadly infection known as C.difficile or C.diff for short that spreads in hospitals and other health care settings, causing extreme watery diarrhea, severe abdominal pain, damaged colons and worse. Officials estimate that it is now killing 14,000 to 30,000 people nationally each year.

The number of cases has not decreased like those for some other health care acquired infections. That is stirring alarm among scientists, regulators and health providers who sought new answers at this month’s IDWeek conference (ID stands for “infectious disease”).

As some learned at the poster session, scientists are tackling this virulent infection with unprecedented vigor. The results: plenty of innovative findings and possible fixes.

McDonald led the pack along a jam-packed aisle lined with posters. Each one was a snapshot of new research, much of it preliminary, and not yet published in peer-reviewed journals.

But they gave attendees an early look at the latest findings, proving that researchers from around the world are making unprecedented strides

The conference highlighted some surprising findings:

** Tests of cooked food from a university hospital in Texas turned up “significant C. difficile contamination,” reported researchers from Baylor College of Medicine and other Texas schools and hospitals. C.diff was found in 50 percent of the turkey, 43 percent of chicken and egg products, and 33 percent of seafood. Researchers plan further study.

** More and more children are being sickened, belying earlier perceptions that most victims are elderly, according to experts from The Children’s Hospital of Philadelphia and the University of Pennsylvania School of Medicine. They found that C. difficile “is associated with significantly longer (length of stays), higher costs and increased mortality among hospitalized children.”

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Clorox was a major sponsor of IDWeek12, and its display stood at the entrance to the exhibit hall in the San Diego Convention Center, San Diego, Calif., Oct. 20, 2012. Clorox is a leading maker of bleach, which many researchers say is an important cleanser to use in removing C. difficile bacteria. (Deborah Schoch / CHCF Center for Health Reporting)

**At least one potential cure is showing promise. Some scientists say that so-called “fecal transplants” could help cure infected patients. Euphemisms aside, a transplant means taking stool from a healthy donor, mixing it with warm water, filtering it and injecting it in the infected patient’s colon—providing a dose of healthy bacteria to combat the C. difficile. A study at a Michigan hospital released at IDWeek found that 46 out of 49 treated patients recovered within days. That’s a small sample size, but the National Institutes of Health is funding a more thorough trial of how these transplants work.

The conference was the first-ever joint meeting of four national associations focused on infections. It brought 3,800 attendees to San Diego for five days of seminars and speeches.

One session zoomed in on a testing problem reported earlier this month in “Spore Wars,” the Center for Health Reporting’s three-day series produced in partnership with the Stockton Record.

The series explored how more modern testing for C. difficile is finding many more cases than older, less expensive tests.

In the Stockton area, two hospitals using those modern tests scored badly in a recent state report on C.difficile cases. Dameron Hospital and Lodi Memorial Hospital both upgraded to so-called PCR testing – that stands for polymerase chain reaction – and discovered that the number of identified cases swiftly increased. Other area hospitals who didn’t switch reported fewer cases.

Now, it appears that hospitals could see cases shoot up 59 percent to 89 percent when they move to PCR-type testing, according to a new study led by CDC medical epidemiologist Dr. Carolyn Gould.

That would suggest a massive undercount of the number of patients sickened with C. difficile in this state and nationally – exactly what some hospital officials have suspected.

Some experts worry that the new tests’ higher sensitivity may make some facilities avoid adopting the new tests, fearing that they’ll score badly in state reporting.

“Obviously, if they detect less C. diff and report less C. diff, they think that makes them look good. This is not good and misleads patients and others,” said Dr. Jorge Parada, medical director of the infection prevention program at Loyola University Healthcare System in Chicago.

Parada participated in research reported on one of the IDWeek posters. He and his colleagues found that diagnosed C.diff cases doubled when hospitals switched to the new tests.

Hospitals using the old and new tests should not be lumped together in reports, he said in an email. “It is comparing apples and oranges.”

The California Department of Public Health is now preparing its 2011 C.difficile report for nearly 400 hospitals that use an array of tests.

Department spokesman Ralph Montano wrote in an email last week, “CDPH will list the methodology used (PCR or EIA) for each facility in the next report, At this time, it remains undetermined if the listings will be formatted together or separately.”

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Authors

Deborah Schoch

Senior writer Deborah Schoch reports on hospitals and health care delivery, nursing homes, environmental health and food. Her most recent articles have examined patient safety andhospital infections. She was a founding writer with the Center’s pilot project. Schoch spent 18 years as a staff writer at the Los Angeles Times, covering public health and the environment. She was a member of the Times newsroom teams that won Pulitzer Prizes for breaking news in 1992 and 1994. Schoch graduated from Cornell University and was a Nieman Fellow at Harvard University in 1999-2000, studying science, law and policy. Her work at the Center has won several honors, including first place in the 2010 Awards for Excellence in Health Care Journalism, from the Association of Health Care Journalists. She sits on the AHCJ board’s Right-to-Know Committee, which works to improve access to public health records.

© 2014 California Healthcare Foundation Center for Health Reporting

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