Clostridium difficile is a significant and increasing cause of death for an estimated 100,000 Americans every year. While estimates vary, the Association for Professionals in Infection Control and Epidemiology’s 2008 National Prevalence Study of Clostridium difficile in U.S. Healthcare Facilities, 301 Americans die every day from C. diff infections.

Moreover, deaths arising from C. diff infections have been increasing by 20-30% annually since 1999. According to the US Department of Health and Human Services, age-adjusted mortality rates for C. diff increased by an average of 30% from 1999 to 2006 (Figure).

In 2007, the Centers for Disease Control and Prevention reported that C. diff is “a cause of a substantial and increasing proportion of deaths in the United States and may be under recognized as a cause of death. Little attention has been paid to C. diff prevention; media and public health awareness efforts have focused largely on the prevention of disease from other intestinal pathogens such as Escherichia coli or Salmonella spp. However, the incidence of deaths from C. diff is greater than the extent of deaths from all other intestinal infectious diseases combined.”

More recent indicators of the increasing prevalence and virulence of C. diff include:

• In February 2009, Dr. Stuart Johnson, Associate Professor of Medicine at Loyola University, reported a “hardy” and “persistent” strain of C. diff and noted that “although most people haven't heard of C. diff, the disease sickens about 500,000 Americans a year, contributing to 15,000 to 30,000 deaths. The current epidemic strain has been found in 38 states.”

• While MRSA infections have been on the decline since 2005, C. diff has been on the rise since 2007. In a 2009 study of 28 US hospitals, 847 cases of inpatient acquired C. diff where found, compared to 680 cases of MRSA.

• While it used to be seen almost exclusively in hospitalized patients and those living in nursing homes, illness from C. diff is increasingly reported among people in the community. Between March and June of this year, 15 patients at a hospital in Manchester, England died from C. diff; nine are thought to have acquired the bacteria outside the hospital.