C-Diff Threatens More Hospital PatientsApr 24, 2008 | Parker Waichman LLP Cases of potentially deadly diarrhea-related infections—known as CDAD—are on the rise, increasing in U.S. hospitals by over 200 percent between 2000 and 2005. According to a new report by the federal Agency for Healthcare Research and Quality, 300,000 people contracted Clostridium difficile-associated disease (CDAD) and 8,600 died in 2005. Also, there was a 74 percent rise in CDAD cases recorded between 1993 and 2000 and over two million patients contracted CDAD between 1993 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 that focuses on improving infection control in hospitals and health care settings. This incredible spike has experts worried.
C. diff—or clostridium difficile—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. Only previously affecting the elderly, hospitalized patient, a bolder strain of C. diff is now crippling the healthy.
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, making C. diff lethal. C. diff can cause infections ranging from mild diarrhea to a deadly illness wherein a patient’s entire colon is removed.
C. diff produces hardy spores that can remain on surfaces—bedpans, toilet seats, floors—for weeks. “It’s on every surface,” McCaughey said. “They get the spores on their hands and their food arrives and they ingest the spores with their dinner rolls.” Alcohol does not work; only bleach can kill the spores.
Worse, there is a new, more virulent strain of C. diff thought to be about 20 times more toxic than previously known strains. The North American Phenotype 1/027 strain has been responsible for deadly outbreaks in Europe, Canada, and the U.S. in recent years and New York is one of 23 states the Centers for Disease Control and Prevention (CDC) has identified as having the highly toxic, mutant strain.
CDAD can be resistant to many traditional antibiotics, forcing use of the stronger vancomycin, but some infections are vancomycin-resistant, making them difficult or impossible to cure. The best treatment is prevention, McCaughey said. Hospitals must improve their hygiene practices and patients must be vigilant about not touching surfaces and keeping their hands out of their mouths. “This is a killer bacterium and we can’t be lazy about it,” she said.