The threat of bacterial spores

Hazards from bacterial spores

Twelve interesting facts

Bacterial spores are extremely resistant forms of bacterial survival [1].

Bacterial spores are resistant to alcohol and steam disinfection and can survive on surfaces for months [2, 3].

Clostridioides difficile (C. difficile) is a clinically relevant pathogen that is responsible for 15% - 25% of antibiotic-associated diarrheal diseases [4].

U. S. Centers for Disease Control and Prevention (CDC) classifies the pathogen C. difficile as an urgent threat alongside four other pathogens [5].

C. difficile infection (CDI) can be expected in around one in 100 patients treated with antibiotics [6].

In the animal model, 100 C. difficile spores were sufficient to trigger a CDI [7], while CDI patients typically excrete 1 million to 1 billion C. difficile pathogens per gram of stool [8].

The highest contamination rates were found on surfaces in the vicinity of patients, particularly around toilets and bedpans [3].

Approximately 750,000 cases of CDI occur each year in the USA, Europe and Japan [9, 10, 11].

Prolonged hospitalizations and increased hygiene requirements as a result of CDI lead to enormous economic damage in the healthcare system.

On average, the hospitalization time for a CDI case is extended by 11 days [12].

The cost of treating a CDI case in the USA is around USD 27,000 - 44,000 [13-15] and in Europe around EUR 13,000 - 25,500 [16-18].

Total economic damage caused by CDI in the USA alone: USD 1 billion - 4.8 billion per year [5, 19].

Literature:

[1] Wikipedia Endospore (https://de.wikipedia.org/wiki/Endospore)
[2] U.S. Centers for Disease Control and Prevention (CDC): Info page on C. difficile (https://www.cdc.gov/c-diff/about/index.html)

[3] Kampf G., Clostridium difficile - was ist für eine effektive Desinfektion zu beachten, Hyg Med, 2008; 33 (4)
[4] Bartlett J. G., Gerding D. N., Clinical Recognition and Diagnosis of Clostridium difficile Infection, Clinical Infectious Diseases, 2008, 46

[5] U.S. Centers for Disease Control and Prevention (CDC): Antibiotic Resistance Threats Report 2019

[6] Robert Koch Institute (RKI): Info page in C. difficile

[7] Sambol SP, Merrigan MM, Tang JK, Johnson S, Gerding DN, Colonization for the prevention of Clostridium difficile disease in hamsters, J Infect Dis. 2002; 186(12):1781–1789.

[8] Dionne L. et al. Correlation between Clostridium difficile Bacterial Load, Commercial Real-Time PCR Cycle Thresholds, and Results of Diagnostic Tests Based on Enzyme Immunoassay and Cell Culture Cytotoxicity Assay, J Clin Microbiol. 2013 Nov;51(11):3624-30

[9] Feuerstadt, P., Theriault, N. & Tillotson, G. The burden of CDI in the United States: a multifactorial challenge. BMC Infect Dis 23, 132 (2023)

[10] ECDC SURVEILLANCE REPORT Clostridioides (Clostridium ) difficile, Infections Annual Epidemiological Report for 2016–2017

[11] Tateda K. et al., Population-based incidence of hospitalized Clostridioides difficile infection among older adults in Ota-ku, Japan: A prospective surveillance study, Anaerobe 76 (2022): 102607

[12] P. N. Wiegand, D. Nathwani, M. H. Wilcox, J. Stephens, A. Shelbaya, and S. Haider, "Clinical and economic burden of Clostridium difficile infection in Europe: A systematic review of healthcare-facility-acquired infection," Journal of Hospital Infection, vol. 81, no. 1, pp. 1–14, 2012

[13] M. P. Shrestha, C. Bime, and S. Taleban, "Decreasing Clostridium difficile-Associated Fatality Rates Among Hospitalized Patients in the United States: 2004-2014," The American journal of medicine, vol. 131, no. 1, pp. 90– 96, 2018

[14] R. Luo and T. F. Barlam, "Ten-year review of Clostridium difficile infection in acute care hospitals in the USA, 2005-2014," The Journal of hospital infection, vol. 98, no. 1, pp. 40–43, 2018

[15] S. Mollard, L. Lurienne, S. M. Heimann, and P.-A. Bandinelli, "Burden of Clostridium (Clostridioides) difficile infection during inpatient stays in the USA between 2012 and 2016," The Journal of hospital infection, vol. 102, no. 2, pp. 135–140, 2019

[16] U. C. Braae, F. T. Møller, R. Ibsen, S. Ethelberg, J. Kjellberg, and K. Mølbak, "The Economic Burden of Clostridioides difficile in Denmark: A Retrospective Cohort Study," Frontiers in Public Health, vol. 8, 2020

[17] K. Kaier, M. Wolkewitz, P. Hehn, N. T. Mutters, and T. Heister, "The impact of hospital-acquired infections on the patient-level reimbursement-cost relationship in a DRG-based hospital payment system," International Journal of Health Economics and Management, vol. 20, no. 1, 2020

[18] S. M. Wingen-Heimann et al., "Clostridioides difficile infection (CDI): A pan-European multi-center cost and resource utilization study, results from the Combatting Bacterial Resistance in Europe CDI (COMBACTE-CDI)," Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases, vol. 29, no. 5, 651.e1-651.e8, 2023

[19] Dubberke, E. R., & Olsen, M. A. (2012). Burden of Clostridium difficile on the healthcare system. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 55 Suppl 2(Suppl 2), S88–S92

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