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BLOG: October 2009

 C. difficile warning

These days, anyone using medical services on a regular basis should be concerned about Clostridium difficile (C. difficile), tiny intestinal bug that can cause anything from severe diarrhea, colitis, hypotension and toxic megacolon, to sepsis and death. To a smaller extent, everyone else should be concerned as well: not only about the threat that this bug poses, but about the warning it delivers as well.

Mayo Clinic study presented at the annual meeting of the American College of Gastroenterology this October, on 385 cases in 1991-2005 period concluded that the incidence of C. difficile bacterial infection is on the rise in both hospital-like and community settings. The latter tend to be among younger individuals - median age 50 vs. 72 with hospital-acquired infection - and less severe.

 According to study's senior author, Darrell Pardi, the main cause for this rise in incidence of C. difficile infection is probably the steady uptrend in use of antibiotics, with the bacteria getting increasingly resistant to them. In addition, while antibiotics kill pathogens, they also

kill friendly intestinal bacteria,

allowing more resistant pathogens like C. difficile to grow out of control.

Toxins produced by the bacteria attack intestinal lining, causing variety of symptoms, including those potentially life-threatening.

Last fall, The Association of Professionals in Infection Control and Epidemiology, INC. (APIC) has concluded its large, nation-wide study on the status and trends of Clostridium difficile infection in the U.S. (National Prevalence Study of Clostridium difficile in U.S. Healthcare Facilities). It included all types and sizes of medical facilities in 47 states, with a total of over 110,000 patients during survey period. Among them were 1443 identified cases of C. difficile infection.

These are the main findings.

13 in every 1,000 inpatients (1.3%) were infected; that is 6.5 to 20 times higher rate than previous incidence estimates

85% of them were on medical services (i.e. treated for chronic diseases)

69% were over 60 years of age

72% were considered health-care associated infections

27% required ICU

79% had antibiotic exposure

average mortality was 4.2%

The study cites wider list of factors contributing to the spread of C. difficile infections: growing older population, widespread use of broad-spectrum antibiotics, inadequate health care facilities hygiene levels, inadequate infection control measures and emergence of a more virulent C. difficile strain, NAP1.

 This new strain (North American Pulse-field type 1), with unique genotype known as toxinotype III, has higher production of the two "standard" C. difficile toxins, produces an additional toxin and apparently is resistant to fluoroquinolones (large group of broad-spectrum antibiotics).

That is the warning that this nasty little bug, named Clostridium difficile - just one of many pathogens that surround, or inhabit us - delivers: "Watch out - or else!"

We may wake up tomorrow to face an army of superbugs that we created, and have no defense against.