Recurrent C. Difficile Cases Rise


Sharp Spike Underscores Need for New Treatments

Recurrent clostridium difficile is on the rise, according to the results of a new study published in the Annals of Internal Medicine.

An analysis of a large, nationwide health insurance database showed a sharp spike in cases of the infection, which researchers said highlights an increased burden on the health care system.

The researchers, who are from the Perelman School of Medicine at the University of Pennsylvania, mapped the annual incidence of multiple recurring C. difficile infection (mrCDI).

Their results showed that the incidence of cases increased by nearly 200% between 2001 and 2012, whereas the incidence of ordinary CDI increased by only about 40%.

Cases of CDI were considered to have multiple recurrences when patients were treated with at least three closely spaced courses of antibiotics.

Patients with mrCDI tended to be older, were more likely to be female, and were more likely to have been exposed prior to infection to corticosteroids, proton-pump inhibitors and antibiotics. The researchers said that the spike in mrCDI could be a result of the increased use of medications, as well as the recent emergence of new, difficult-to-treat strains of C. difficile.

The findings point to a rising need for new C. difficile treatments, one of which—fecal microbiota transplantation (FMT)–the researchers noted as a potential new therapy. FMT infuses beneficial intestinal bacteria into patients to compete with the infection. The treatment is an alternative to antibiotics and aims to restore a normal gut bacteria population to discourage C. difficile growth. Although the therapy has shown promise in smaller studies, its long-term safety has not been thoroughly evaluated.


  • Ma GK, Brensinger CM, Wu Q, Lewis JD. Increasing incidence of multiply recurrent clostridium difficile infection in the United States: a cohort study. Annals of Internal Medicine. 2017. doi: 10.7326/M16-2733.

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