Hospital Death Rate Triples From Just One Hospital-Acquired Infection

Doctors are notorious about refusing to do the obvious. They refuse to attend to adequate hygiene. They refuse to make adequate changes in how they prescribe antibiotics. It seems that they simply don't care. As long as patients keep going to them, then they see no need to change.

by Heidi Stevenson

7 November 2010

Most people are aware of the increase in bacterial infections in hospitals. What hasn't been clear is the resultant effect on mortality. A study to be published by the Journal of the American Medical Association (JAMA) provides stark evidence of how much harm is happening. Canadian research has shown that Clostridium difficile (C. diff) infections are tripling in-hospital deaths. That is only one of several hospital-acquired infections, and doesn't touch on drug-resistant infections.

The Study

The study was performed at the Ottawa Hospital in Ottawa, Ontario, Canada, and was funded by the Canadian Patient Safety Institute and the Ottawa Hospital. 136,877 patient admissions were examined. 1,393 cases of C. diff were identified, a little over 1% of those admitted to the hospital.

For every 10 patients who were diagnosed with C. diff, one died. Overall, the disease was blamed for trebling the number of in-hospital deaths.

The patients who entered the hospital in the worst health (the top decile) were 13 times more likely to acquire C. diff than those in the best health (the bottom decile).

However, patients who entered the hospital with a lower mortality risk were more likely to die if they contracted C. diff than those with higher anticipated mortality on entry. The increase was approximately 4% per decile. The authors suggest:

We speculate that this occurs because patients with a high baseline mortality risk already have many factors that predispose them to a poor outcome. Acquiring CDI [C. diff infection], in this context, will have a small relative impact on a patient's overall sickness. In contrast, a healthy patient who acquires CDI will experience a larger relative impact.

Clostridium difficile

C. diff came by its name honestly. It's a particularly severe bacterial infection. It is normally found in the human gut, rarely causing problems until antibiotics kill the probacteria that keep it in check. When that happens, C. diff has no competition and is able to multiply to dangerous levels.

Mild cases result in diarrhea. However, it can also cause bloody diarrhea by inflaming the colon, and in severe cases can cause megacolon requiring surgical removal of the colon, and death.

Medical treatment is by way of antibiotics, which is, of course, the usual cause of C. diff. Worse, though, is that C. diff has now developed new, virulent, drug resistant strains. A difficult bacterium to treat has become even worse.

Even non-drug resistant C. diff carries significant risk. The more it develops in hospitals, the more it's treated, and the more frequently we see drug resistant forms.

C. diff Prevention

The authors point out two areas in which physicians (and hospitals) need to improve: hand hygiene and "careful selection of antibiotic usage". However, as they note, these are:

...2 practices in which physicians are notoriously noncompliant with guidelines.

Frankly, one must wonder if any research has been done to determine the relative risks of contracting C. diff by comparing hand hygiene against antiobiotic use. Because C. diff is normally found in the human gut, the question arises: Is hand hygiene truly a significant issue in C. diff? Certainly, it's easy to see how a mutated version of it would spread because of poor hygiene. However, why would poor hygiene spread a bacterium that is already found in the gut?

It seems likely that antibiotics are the culprit in C. diff infections acquired in hospitals. Wouldn't it be appropriate to do studies examining whether limiting antibiotic use slows the rate of C. diff infections? Or to do studies on ways of limiting antibiotic use, which is well established as a cause of drug-resistant infections?

The Implications

C. diff is merely one serious infection that's becoming more common and is evolving into more severe, drug resistant diseases as a result of overuse and misuse of antibiotics. While there is certainly a place for antibiotics, that place is not in everyday use. It is not as a preventive measure. It is not for mild cases of bacterial infections—and probably shouldn't be used in most moderately severe infections.

In fact, antibiotics probably should not be used unless there is no other option. Modern medicine needs to step back and look at what it's doing. The fact is that misapplication and overapplication of antibiotics is destroying the good that they can do. People are entering hospitals and dying three times more often from C. diff—a single disease!—which has probably developed as a result of antibiotic overuse.

That should open eyes. Sadly, though, experience says that it won't. We'll hear a bit of lip-service...maybe. But very little is actually happening to prevent hospital-acquired and drug-resistant infections. The reason is simple: There's no profit in it. As this study notes, doctors are notorious about refusing to do the obvious. They refuse to attend to adequate hygiene. They refuse to make adequate changes in how they prescribe antibiotics. It seems that they simply don't care. As long as patients keep going to them, then they see no need to change.

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