Clostridium difficile is spawning infections in hospitals in the U.S. and abroad that can lead to severe diarrhea, ruptured colons, perforated bowels, kidney failure, blood poisoning and death. It is a common cause of antibiotic-associated diarrhea, accounting for 15-25% of all episodes. CDC estimates there are 500,000 cases of C. difficile infection annually in the U.S., contributing to between 15,000 and 30,000 deaths. Elderly hospitalized patients are at especially high risk and mortality in these patients may exceed 10%. The disease is very difficult to treat and recurs in at least 20% of cases, even when treated appropriately.
A key factor in Florida’s ability to detect, monitor, and control antimicrobial resistance is its public health laboratory capacity. There has been limited funding in the past for antibiotic resistance education programs and surveillance, and even this limited funding is declining. Approximately only half of state public health labs can provide some basic resistance testing. Like many states, Florida lacks the targeted technical ability to detect and characterize emerging resistance patterns promptly in a range of pathogens. Therefore, such resistant organisms continue to spread unrecognized and unimpeded throughout the state.
1 Dr. Fred Tenover, quoted in “The Bacteria Fight Back” Science, July 18, 2008. 2 R. Monina Klevens et al. “Invasive Methicillin-resistant Staphylococcus aureus Infections in the United States,” JAMA, October 17, 2007: 1763-1771.3 Elixhauser, A. and Steiner, C. Infections with Methicillin-Resistant Staphylococcus aureus (MRSA) in U.S. Hospitals, 1993–2005. HCUP Statistical Brief #35. July 2007. Agency for Healthcare Research and Quality.4 Roger Sanderson, regional epidemiologist, Florida Department of Health, “Surveillance of MRSA in the Outpatient Setting in Florida 2003-2005,” Florida’s Antimicrobial Resistance Report 2006.5 ibid6 CDC MMWR “Guidance for Control of Infections with Carbapenem-Resistant or Carbapenemase-Producing Enterobacteriaceae in Acute Care Facilities” March 20, 2009 / Vol. 58 / No. 107 K. F. Anderson, et al.; Evaluation of Methods To Identify the Klebsiella pneumoniae Carbapenemase in Enterobacteriaceae; Journal of Clinical Microbiology, August 2007, p. 2723-2725, Vol. 45, No. 88 John Gums, Professor of Pharmacy, University of Florida, “Variations in antimicrobial resistance within the State of Florida: Results of the Antimicrobial Resistance Management program,” Florida’s Antimicrobial Resistance Report 2006.9 CDC Wonder Death Certificate Data, cited in a July 28, 2008 communication to Senator Sherrod Brown 10 Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases (SID), Agency for Healthcare Research and Quality, http://www.hcupnet.ahrq.gov/, cited in a July 28, 2008 communication from CDC to Senator Sherrod Brown
STATE CONTACTActing State EpidemiologistRichard S. Hopkins, MD, MSPHrichard_hopkins@doh.state.fl.us
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