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C. Diff Cases Up by 10,000 Per Year

May 29, 2008 | Parker Waichman Alonso LLP

Last month, we reported that cases of potentially deadly diarrhea-related infections—known as CDAD or Clostridium difficile-associated disease—are seriously and dangerously on the rise, increasing in U.S. hospitals by over 200 percent between 2000 and 2005.   “It is the next major germ threat,” said Betsy McCaughey, the former lieutenant governor of New York state and current head of the Committee to Reduce Infection Deaths (RID), an agency focused on improving infection control in hospitals and health care settings.  This incredible spike has experts worried.  Now, a recent study reveals that the number of people hospitalized with a C. diff super bug is growing by over 10,000 cases annually.

C. diff is a spore-forming, toxin-producing bacterium that infectious disease experts say is growing in speed and virulence similar to methicillin-resistant Staphylococcus aureus—MRSA—and is moving from within hospitals to the community at large.  MRSA sickened over 94,000 and caused nearly 19,000 deaths in the U.S. in 2005.  Like MRSA, C. diff has become multi-drug-resistant.  C. diff is now crippling the healthy, has become antibiotic resistant, is a regular threat in healthcare facilities, and has been linked to nearly 300,000 hospitalizations in 2005, more than double the number in 2000.

C. diff is part of the natural flora, or bacteria, in the colon and is an ancient bacterium.  Many people can, and do, carry it naturally and it can live in us without causing disease; carrying C. diff does not mean we have an infection.  As a matter-of-fact, it is common in our bodies following birth.  The problem arises because what we don't have is the receptor for the toxin—the molecular key that unlocks C. diff's toxin-spewing capacity.  Newer, mutant C. diff is fully equipped with the receptor and is capable of boosting toxin amounts causing infections ranging from mild diarrhea to a deadly illness wherein a patient’s entire colon is removed and sometimes leading to death.  Because C-diff has grown resistant to some antibiotics that work against other colon bacteria, when patients take those antibiotics, competing bacteria die and C-diff rages and spreads in the body.


Virulent C-diff was rarely seen before 2000.

"The nature of this infection is changing.  It's more severe," said Dr. L. Clifford McDonald, a Centers for Disease Control and Prevention (CDC) expert not part of the study.  "There may be some overuse and inappropriate use of antibiotics," said Dr. Marya Zilberberg, a University of Massachusetts researcher and lead study author.  Worse, the new C. diff—The North American Phenotype 1/027—is thought to be about 20 times more toxic than previous strains and has been responsible for deadly outbreaks in Europe, Canada, and the U.S. in recent years; New York is one of 23 states the CDC has identified as having the highly toxic, mutant strain.

The Zilberberg study concluded that 2.3 percent—or 5,500—cases in 2004 were fatal, nearly double the 2000 figures; earlier research concluded C. diff is the underlying cause of thousands of deaths annually.  C. diff is an acute health concern in Canada, where it was blamed for 260 deaths at seven Ontario hospitals recently and 2,000 deaths in Quebec since 2002.