As Kingston General Hospital joins the list of hospitals reporting a C. difficile outbreak, Ontarians might be surprised to know that the rate of infection is actually less than it was just a few years ago.
There were 301 cases of C. difficile infections in Ontario in June, according to the latest available data from the Ministry of Health and Long-Term Care.
Looking back, the rate of infection in June was not unusually high, coming in at 0.36 cases per 1000 patient days.
Infections have generally been declining since 2008, said Dr. Michael Gardam, Medical Director of Infection Prevention and Control at the University Health Network, although the change is minimal.
C. difficile was at its lowest point in September 2010. The summer of 2009 was also low. The rate has been increasing in 2011, but June’s rate, while higher than average, is well below the historic high of 0.44 cases per 1000 patient days in September 2008.
Recent public attention to the issue is largely due to hospitals being required to report cases to their local health unit, said Gardam. “Two or three years ago, that never would have happened. You wouldn’t know who had an outbreak,” he said, adding that he thinks that the reporting requirement may have contributed to the decline in C. difficile cases.
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While infections may be rarer in recent years, they are potentially more serious. “C. difficile is a much worse disease now than it was 10 years ago. The strain that’s spreading to most hospitals is a far more serious strain than what we had ten years ago, which is causing more disease,” said Gardam.
Somewhere between five and 10 per cent of people who are infected with C. difficile die from it, he said, though it may be difficult to determine how much the infection had to do with a patient’s death. For example, he said, the 31 people since May in the Niagara Region whose deaths were related to C. difficile, may just be people who had C. difficile when they died – not necessarily people who died from the infection.
“When someone is sick in the hospital with often very complex medical problems and you get C. difficile, it’s often hard to figure out what exactly caused their death.
“In general, hospitals don’t know who died of C. difficile.”
Although the rates have declined, they are not low enough for Gardam. “C. difficile is a horrible disease,” he said.
“What I want to be able to see is that all hospitals are cleaning appropriately, they’re jumping on C. difficile cases very quickly, and they’re cleaning all the rooms appropriately, that they have anti-microbial stewardship programs in place so that we’re not overusing antibiotics and things like that,” he said.
“We’re not where we need to be with a number of those issues.”
Explore the graph of C. difficile infection rates in Ontario below. Data source: Ontario Ministry of Health and Long-Term Care
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