C. diff virulance and mortality rising, study shows
Keys to prevention: Judicious use of antibiotics, contact precautions, disinfection
Diagnosed adult cases of Clostridium difficile-related illness more than doubled in five years: from 134,361 cases in 2000 to 291,303 cases in 2005, according to a study released in the June 2008 issue of Emerging Infectious Diseases. The mortality rate also rose to more than 2 percent.
The presence of C. diff in the intestinal tract is common and does not necessarily lead to illness. The primary risk factor for illness from C. diff is treatment with antibiotics for some other illness or condition. Antibiotics can interfere with the balance of beneficial bacteria in the intestine, leading to a proliferation of C. diff. However, a relatively small number of cases do not seem to be linked to antibiotic use.
Risk factors
Prevention in health care
Treatment
For more information…
Risk factors
According to the Centers for Disease Control and Prevention, risk for C. diff-related illness increases with:
- antibiotic exposure
- gastrointestinal surgery/manipulation
- long length of stay in health care settings
- a serious underlying illness
- immunocompromising conditions
- advanced age
Some evidence suggests that treatment with proton pump inhibitors or H2 blockers may increase risk, due to the reduction in gastric acid.
Infants younger than 6 months old are not thought to be affected by C. diff toxin, because they do not yet have receptors in the gut for the toxin.
Prevention in health care
C. difficile is shed in feces. Any surface, device or material that becomes contaminated with feces may serve as a reservoir. The spores are transferred to patients mainly via the hands of health care personnel who have touched a contaminated surface or item.
With these facts in mind, the CDC and other sources recommend that health care providers develop specific strategies and procedures for preventing C. diff-associated disease and its spread in hospitals, nursing homes and home health:
- Use antibiotics judiciously. Overuse of antibiotics is leading to increasing numbers of resistant organisms, including C. diff.
- Use contact precautions for patients with known or suspected C. diff-associated disease:
- Provide these patients with private rooms. If private rooms are not available, patients can be co-horted with other patients with C. diff-associated disease.
- Practice diligent hand hygiene. Use only soap and water for hand hygiene when caring for patients with C. diff-associated disease; alcohol-based hand rubs may not be as effective against spore-forming bacteria.
- Use gloves when entering patients’ rooms and during patient care.
- Use gowns if soiling of clothes is likely.
- Dedicate equipment whenever possible.
- Maintain precautions until symptoms cease.
- Increase diligence in cleaning and disinfection.
- Ensure adequate cleaning and disinfection of environmental surfaces and reusable devices, especially items likely to be contaminated with feces and surfaces that are touched frequently.
- Use an Environmental Protection Agency (EPA)-registered hypochlorite-based disinfectant after cleaning, in accordance with label instructions. Generic sources of hypochlorite (household chlorine bleach) also may be appropriately diluted and used. (Alcohol-based disinfectants are not effective against C. difficile and should not be used to disinfect environmental surfaces.)
- Follow the manufacturer’s instructions for disinfection of endoscopes and other devices.
Some evidence has suggested that probiotics may be beneficial in preventing C. diff-related illness in patient treated with antibiotics for other conditions. However, the CDC guidelines do not address probiotic use for this purpose.
Treatment
Some cases will resolve within two or three days of discontinuing the antibiotic to which the patient was previously exposed. However, most C. diff illnesses are treated with an appropriate course (about 10 days) of antibiotics, including metronidazole (intravenous or oral) or vancomycin (administered orally). New consensus hows that vancomycin is superior for severe disease. Patients may remain colonized after symptoms resolve; repeat testing is not currently recommended by the CDC.
Some evidence has suggested that probiotics or yogurt consumption may be beneficial in treating recurrent C. diff-associated disease. However, the evidence to date is largely considered inconclusive.
For more information…
AAFP: Clostridium difficile-Associated Diarrhea
CDC: Overview of Clostridium difficile Infections
C. diff FAQ for health care providers
Medscape CME/CE: Asymptomatic C difficile Carriers May Transmit Disease in Long-Term Care Facilities
WebMD: Gut bug gets deadlier