C Diff: An Epidemic that’s here to stay!

Posted on May 4, 2012 in The Doctor Is In by eParisExtra

by Chris Prakash, MD

C. diff, short for clostridium difficile, is a bacteria that is a major cause of diarrhea, especially in the health care setting. Over the past few years infection with C diff has almost become an epidemic.

 

Why should we care about C diff?

C. diff kills about 14,000 Americans each year. Half of infections are in people younger than age 65. But 90% of deaths are in people 65 and older.

There’s an ongoing epidemic with an especially toxic C. diff strain. Cases have tripled over the last decade. The most plausible explanation for this is the increased and constant interplay between different kinds of health care facilities, that keeps C. diff in circulation. Patients are moving between acute care hospitals, rehab facilities, nursing homes, and long term facilities. An infection in one place can easily become a problem in another. Half of cases diagnosed in hospitals are in patients already infected when admitted to the hospital. This points to strict need for prevention across all facilities.

Who is at risk for C diff?

The number one risk factor for c diff infection is the use of antibiotics!

C. diff usually doesn’t infect healthy people (the normal bacteria living in the gut don’t let C. diff spores take root). But if you’ve recently taken antibiotics, the good bacteria that protect you from infection, are destroyed, leaving the door open for C. diff to take over. If people swallow C. diff spores during this time of vulnerability, they can become infected. Your risk of C. diff infection goes up seven to ten fold while you are taking antibiotics. And often this risk is unnecessary. Nearly 50% of antibiotics are inappropriately prescribed.

How does it spread?

Transmission of C. diff usually occurs by the orofecal route. As gross as it sounds, the bacteria are passed in feces and eventually find their way to our mouth. This usually happens when people who are infected don’t wash their hands thoroughly. In hospitals and nursing homes, C. diff spreads mainly on hands from person to person, but also on cart handles, bedrails, bedside tables, toilets, sinks, stethoscopes, thermometers, even telephones and remote controls.  The bacteria produce hardy spores that can persist in a room for weeks or months. If you touch a surface contaminated with C. diff, you may then unknowingly ingest the bacteria. Once established, C. diff can produce toxins that attack the lining of the intestine causing diarrhea.

Toxins produced by C. diff bacteria can usually be detected in a sample of your stool.

C diff infection (colitis) is treated with oral antibiotics (metronidazole).

What can we do to stop C diff?

Here’s the CDC’s advice on what patients can do to stop C. diff:

• Don’t beg your doctor for an antibiotic prescription if he or she doesn’t think you need one.
• Take antibiotics as prescribed.
• Tell your doctor if you have been on antibiotics and develop diarrhea.
• Wash your hands carefully after using the bathroom.
• If you have diarrhea, try to use a separate bathroom from the rest of the family.
• After bathroom is used by a person with diarrhea, clean it well with a bleach solution.
• Wear gloves while taking care of a patient with C diff.

This information is strictly an opinion of Dr Prakash, and is not intended to replace the advice of your doctor. Dr Chris Prakash is a contributing columnist, and author of eParisExtra’s “The Doctor is In” column. He is a medical oncologist at Texas Oncology Paris. He is board certified in Internal Medicine, Oncology and Hematology. He lives in Paris, TX with his wife and two children, and can be reached at 9037850031, or Sucharu.prakash@usoncology.com