A recent survey of multiple large, national databases in the US has reported that Clostridium difficile (C.diff) colitis is now the 9th leading cause of gastrointestinal and liver related deaths. Way out of line with my own perception of GI-related mortality, this places C.diff colitis ahead of deaths due to GI hemorrhage, chronic hepatitis C, acute pancreatitis, diverticular disease, and cholecystitis. From 2002 to 2009 the number of deaths attributable to C.diff infection rose a whopping 230%!
The most widely recognized risk factor for the development of C.diff colitis is antibiotic use. Other factors include hospitalization, advanced age, and severe illness. Antibiotics not only disrupt the intestinal flora allowing for the overgrowth of C.diff. By contributing to the development of resistance to either clindamycin or fluoroquinolones, antibiotics can also make the organism more virulent.
C.diff is highly transmissible and spreads faster than a bad photo on Facebook. 20 to 50% of adults in hospitals and LTC facilities are carriers (versus 2-3% in the general healthy population). About 20% of patients entering a hospital negative come out with infection. It can be cultured from objects in patients’ rooms, hands, clothing, and… stethoscopes.
Needless to say, our friends in hospital infection control are all over this. On a personal level there are 10 factors to which we should pay attention and they are all at the ends of our two arms. Hand washing remains next to Godliness. In the convenience vs. effectiveness conundrum, the alcohol-based hand cleansers so readily available and easy-to-use do not eliminate the C.diff spores, and the CDC recommends good ol’ soap and water. By the way, the CDC also recommends disinfecting stethoscopes between patients.
Practice-wide stewardship and insuring appropriate antibiotic utilization is a professional obligation. We should not have a hand (hmmm) in the further rise of C.diff’s ranking.
Marshall Kubota, MD
Peery AF et al. Gastroenterology 2012 Nov 143:1179